Seguro Popular, a public insurance scheme offering access to a comprehensive package of services, is the most important component of Mexico's Systems of Social Protection in Health.
A pilot study was conducted in 2001 to explore the feasibility of implementing a public health insurance for those not covered by social secutiry. In 2004, Mexico scaled-up this complementary tax-based public health insurance scheme, System of Social Protection in Health (SSPH), after a law was approved by Congress in 2003. This law was based on the Constitutional reform of every citizen’s right to health protection (est. in 1983). This national health insurance programme also called Seguro Popular, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from public, social insurance. While Mexico has made strong progress in coverage over the last decade, Mexico still experiences fragmentation and ineffective coverage as a result.
The major government-sponsored health insurance schemes include Seguro Popular and the Social Security scheme. In 2004, Mexico implemented a public health insurance scheme (Seguro Popular) to provide health protection to the population not covered by social security. Ten years after implementation, it has been able to affiliate most of its target population. However, access to effective high quality healthcare is currently a barrier to achieving effective UHC. Despite high levels of population coverage, 25% are not insured and the 75% who are covered do not have access to timely and high quality healthcare services. The Ministry of Health is currently implementing several reforms to address these challenges and achieve effective UHC.
The Mexican health system comprises three subsystems: Social Security, the Social Protection System in Health (SPSS), and the private system. The social security schemes offer different services, including health insurance and pensions, for salaried workers in the formal sector of the economy. There are several social security schemes in Mexico, the most important of which are the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social, IMSS), which insures about 42 million people; and the Institute of Social Security and Services for Government Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE), which provides a similar package of services to federal and some state government employees and which insures about 6 million people. This subsystem is funded by payroll contributions from the federal government, employers, employees, and a subsidy from the state. Each social security scheme has its own network of health care providers; beneficiaries can receive services only from their respective scheme’s providers. The publicly subsidized system, the SPSS, offers health insurance to all Mexicans not covered by any of the social security schemes. Services covered by the SPSS are mainly provided by the public health facility networks managed by the states. Finally, a small percentage of the population is covered by private health insurance schemes. However, the three health insurance subsystems, Social Security, SPSS, and the private sector, function in parallel with little coordination among them.
In terms of financing of the sector, about half of the health spending (which accounts for 6.5 percent of GDP) in Mexico is private, almost all out-of-pocket. Social Security represents 23 percent of the total expenditure and the publicly subsidized system about 22 percent. There is virtually a one-to-one relationship between financing agents and providers in the public health system in Mexico, since public schemes are vertically integrated: all social security institutions combine payment (as agents) and provision, while, the institutions of the publicly subsidized scheme, the agents and providers, behave as if they were vertically integrated (the payers for the SPSS, the National Commission for the Social Protection in Health [Comisión Nacional de Protección Social en Salud, CNPSS], and the Estate Regimes for Social Protection in Health [Regímenes Estatales para la Protección Social en Salud, REPSS] although the regulatory framework allows some freedom to payers in the purchase of health care.
by Nick Webster, the National
by Mark Wheeler, Medical Xpress