Health Policy

Francesca Colombo, Ian Forde, Ankit Kumar, Valerie Paris and Franco Sassi

Mexico has made significant progress in the health sector over the past few years. Through its innovative programme Seguro Popular, Mexico has virtually attained universal coverage for the population, bringing it in line with most other oEcD countries. However, despite dramatic improvements in life expectancy and infant mortality, it remains below the oecD average on basic indicators of health status. While health expenditure has grown fast in the past decade, it remains much below other oEcD countries. More importantly the level of public spending is particularly low and out-of-pocket payments are very high. the health system is also fragmented, leading to wasteful spending, and access to health care still varies considerably across states. Improving the country’s health services will require addressing the problems of the poorer states, targeting services where they can deliver the highest value for money, and improving the efficiency of health delivery. These changes will help Mexico deliver on the commitment contained in the 2012 Pact for Mexico to equalise quality and coverage across different health coverage schemes. This aspiration should guide further reforms to expand access to care services, with policy guided by the development of targets including the services covered and the actual utilization of services by different socio-economic groups and across regions.

^^exico has seen dramatic improvements in life expectancy and a steady reduction in infant mortality rates over the past decades. Life expectancy has increased by 19 years since 1960, reaching 75 years in 2010, while infant mortality has been reduced to a fifth of the 1970 rate thanks notably to Oportunidades (see Chapter 2). However, life expectancy remains the fifth lowest in the OECD and premature mortality is the highest in the OECD. Mexico has a comparatively low supply of inputs to the health care sector - beds and doctors - by OECD standards.

Mexico has already implemented an ambitious reform. Over a spectacularly short period of eight years, the Seguro Popular has succeeded in bringing universal coverage to half of the population which remained uninsured. Mexico’s path to achieving universal coverage of its population is remarkable in many respects including low fiscal costs and the financing mechanism that contributes to narrow inequality in the allocations of federal finance across the States.

Despite this success, several challenges remain. Mexico still spends considerably less on health than other OECD countries. While total per capita spending on health is near what might be expected given the level of income, the Mexican health sector is characterised by a relatively low level of public expenditure and significant out-of-pocket spending. This suggests that the system falls short of providing adequate insurance coverage. Improved efficiency in service delivery and better administrative capacity, particularly at state level, will be important to ensure the continued success of reforms over the longer term. In addition, emerging health threats such as obesity and the more generally the increasing burden associated with chronic diseases need to be addressed. The organisation of the system is characterised by different vertically integrated silos, each serving different segments of the population and with little interconnection between them. This has led to significant inequalities in the provision of health services across regions and fragmentation which has to be addressed.

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