OVERVIEW
- Population: 129 Million
- Housing: 83.4% Urban, 16.6% Rural
HISTORY
In 1917, after the Mexican Revolution, the state of Mexico adopted a constitution with a deep social orientation towards the policies of education, work, and health. Due to reasons rooted in Mexico’s history, an effective health system was not adopted. The system has always been characterized by fragmentation and disparities in financial resources and the populations it serves. In 1943, the President established three prominent institutions that still govern and manage health care today. The Ministry of Health, the Mexican Social Security Institute (IMSS), and the Mexican Children’s Hospital. The Ministry of Health covers the populations who do not qualify for health insurance through the IMSS, which covers private-sector employees. The Children’s Hospital was the first of the 13 National Health Institutes now in existence in Mexico, which typically offers highly specialized services, seeks to increase knowledge through research, and has a high impact both nationally and internationally. Coverage was then expanded to public sector employees with the creation of the Institute of Security and Social Services for State Workers (ISSSTE) in 1960.7
To address rural health disparities, a program was put in place in the late 1930s. The President at the time opted to demand that all medical students spend a set of amount of time working and living among the poorest indigenous Mexicans. Although the program posed some challenges such as language barriers, introducing western medicine to the existing culture of medicine, and inadequate living conditions for students, it was written into the Mexican Constitution. This brought awareness to rural health concerns and made physicians more well-rounded by exposing them to medicine not included in their urban training.7 Another initiative to close the gap with rural areas was the COPLAMAR or the Program for Social Protection of Marginal Groups. It took a community-based approach to health services by training local people such as midwives and traditional healers to provide primary care to local communities. One aspect that was crucial to the success of the program was the belief that each patient’s culture, language, and beliefs about health and healing would be respected.8
In 1983, the Mexican Political Constitution was reformed to recognize health as a universal right requiring the government to coordinate the health system to ensure access to health to all citizens. It wasn’t until 2003 that the General Law of Health was amended to rollout the Popular Health Insurance, or Seguro Popular. Its intentions were to cover a broad sector of the Mexican population including the poorest in the country, those without formal employment, and not protected by the IMSS or the ISSSTE.
7 The Popular Health Insurance was Mexico’s approach to universal health coverage, however, out of pocket spending still remained high. In the span of 10 years after the Popular health Insurance was implemented, Mexicans who experienced impoverishing health care costs fell from 3.3% to 0.8% and extended coverage to more than 50 million who were previously unprotected. Past reports have shown high satisfaction rates in the high 90s from health service users with the Popular Health Insurance.
9 This health insurance program was replaced in January of 2020 with the Institute of Health for Welfare as a decentralized body of the Ministry of Health.
HEALTH & HEALTH SYSTEM
Mexico has improved on many aspects of health in recent years but still falls short compared to other OECD countries. Mexico’s infant mortality rate has decreased by 11.5% since 2009 but remains the highest in the OECD. The OECD average for infant mortality rate is 3.8 and Mexico has a rate of 13 per 1,000 live births. Out-of-pocket costs in Mexico have decreased from 55% to 45% of health spending but it remains a burden for the population. High out-of-pocket spending has created significant financial barriers to health care access, particularly for low-income individuals. It emphasizes the need to develop a strong and affordable system for health coverage. The major health concern in Mexico is Obesity. In Mexico, 32.4% of the population is obese, making it the country with the 2nd highest prevalence of obesity, behind the US. The country also has the highest prevalence of diabetes in the OECD, with 15.9% of the population having diabetes.4 To address the obesity epidemic, Mexico has established policies such as taxing sugary drinks and high-calorie non-essential food, mandatory front-of-pack food labeling, and regulation of food advertising targeted at children. Despite these efforts, the prevalence of obesity continues to increase causing a health and economic burden throughout the country.13
Mexico has a fragmented healthcare system with three main types of service providers. These institutions provide health services to different segments of the population. The first provider is for the employed population. The Mexican Institute of Social Security (IMSS) provides coverage for private-sector employees and their families13. This health plan covers over 57 million people in Mexico, making it one of the largest health insurance providers in the western hemisphere.15 The insurance program is funded by the federal government as well as employer and employee fees. All employers must register with the IMSS which provides full government medical coverage, including outpatient care, inpatient care, maternity care, and disability and injury benefits.16 The Mexican State’s Employees’ Social Security and Social Services Institute (ISSSTE) provides health coverage for public-sector employees and their families.14 The program is financed by the federal government and employees and covers approximately 12 million beneficiaries.15 States within Mexico also have their own health and retirement benefits to offer their employees.
The second provider is the private sector with insurance companies and service providers that maintain their own clinics and hospitals. Private insurance is voluntary and individuals must pay premiums to the private insurer.14 Employers may offer private insurance to their employees where premiums and fees are split between the two. Premiums are determined by the individual’s risk profile and for a mutually agreed package of health services. The private health sector is better equipped to provides specialized procedures and overall higher quality care.16
Social programs through the government are the third major provider of health care and are reserved for citizens not covered by any other healthcare scheme. These programs are financed almost entirely by the federal government.
14 The prominent public health insurance scheme is the Institute of Health for Wellbeing (INSABI) which was established in January of 2020. Considering this is a new program, that replaced the prior public health insurance scheme, Seguro Popular”, there are still many components to finalize. Also, very little data exists to measure the effectiveness of the INSABI. The head of INSABI defends the program by affirming that the flaws and uncertainty are the products of the resistance faced by the ambitious project since it affects economic interests. He also mentions that the budget allocated to INSABI is much higher than the one allocated to Seguro Popular. The former Health Minister in charge of creating the now-extinct Seguro Popular, warns that a possible failure at the INSABI is because it puts the federal government in charge of medical attention, which was previously in the hands of local governments.
17 According to INSABI regulations, users will receive free medical care and medicines without restrictions since they will no longer need to enroll or pay fees. The annual fees associated with Seguro Popular have been eliminated as well as the requirement to be a Mexican citizen.
18 The requirements to receive care at the INSABI are currently very loose but legislation is subject to change due to the infancy of the program. Another program named IMSS-Opportunities is designed to cover specific vulnerable and marginalized populations and is funded completely by the federal government.
HEALTH INDICATORS & DEMOGRAPHICS
Health conditions also differ among social classes in urban areas with poor and indigenous Mexicans experiencing higher morbidity rates from unsafe water supplies, infections, respiratory diseases, and violence.10 Although Mexico does conduct a national census, it does not collect information about ethnicity.11 Racial identity remains a powerful social construct in Mexico.10
- Fertility Rate: 2.1 live births per woman
- Life Expectancy (Female, Male): 78, 73
- Infant Mortality Rate: 12.5 deaths per 1,000 live births
- Child Mortality Rate: 14.5 per 1,000 live births
- Maternal Mortality Rate: 33 deaths per 100,000 live births
- Prevalence of Obesity: 32.4%
- Mestizo: 62%
- Predominantly Amerindian: 21%
- Amerindian: 7%
- Other: 9%
- White European, Asian
- Afro-Mexican: 1%
- 0-14 years: 26.6%
- 15-24 years: 17.4%
- 25-54 years: 40.9%
- 55-64 years: 7.9%
- 65 years and over: 7.3%
