Date Published: August 18, 2009
Publisher: Public Library of Science
Author(s): Núria Homedes, Antonio Ugalde
Abstract: Núria Homedes and Antonio Ugalde discuss 25 years of reform to the Mexican health care system and argue that although costs and accessibility have increased, health inequities, efficiency, productivity, and quality of care have not improved.
Partial Text: Mexico is a large country (population 109 million) with a per capita income of US$8,300 (purchasing power parity US$12,800) in 2007, and as can be seen in Table 1, a highly stratified society . In 2006, Mexico spent about 6.6% of its gross domestic product (GDP) on health care, of which 44% was public expenditure (see Table 1) .
In the early 1980s, the economy of Mexico suffered its worst recession since the Great Depression. The peso was greatly devalued , unemployment soared, and real income plummeted. In addition, an oil glut reduced demand for Mexican oil. Oil production is a nationalized industry in Mexico and the country’s first source of income. Consequently, the PRI-led government did not have sufficient cash reserves to repay its accumulating national debt. The WB and the IMF were ready to lend but, as a condition of their loan, they demanded, as they had done in other countries, that Mexico reduce its public social expenditure, including its expenditure on health and education .
The PRI government elected in 1994 understood that to win future elections it would need to modernize by increasing public participation and decreasing its traditional authoritarianism. It quickly launched a program known as The New Federalism. Decentralization was one of this program’s key components. The central government increased health funding to the states and transferred decision-making power (see Table 4). By 1999, all the states and the Federal District had signed the new decentralization agreements .
Throughout these years, the WB continued to promote the privatization of health services in response to a policy that promoted market competition as a way to increase productivity and quality. In 1985 the Mexican minister of health founded the private Health Foundation (Funsalud), which was funded by transnational corporations operating in Mexico including tobacco, pharmaceutical, and food corporations (http://www.funsalud.org.mx/).
In 2000, after almost 70 years in power, the PRI lost the national elections to the Partido de Acción Nacional (PAN), a conservative party, and Frenk was appointed minister of health. Aware that the labor unions would block the privatization of IMSS, a third health care reform was proposed called the System for Social Protection for Health (SSPH). This reform, which is commonly known as the People’s Health Insurance or Seguro Popular (SP), was approved by a Congress controlled by opposing parties.
Mexico’s attempts at health reform have been extremely convoluted. The first decentralization reform of its health care system was a response to requests from the WB and the IMF to free central funds to pay its external public debt during a world recession. After 6 y, only 14 states had agreed to be decentralized. The remaining states understood that decentralization was not accompanied with the additional funding needed to undertake the new responsibilities that decentralization was transferring. The decentralized states soon protested the minimal transfer of decision-making power as well as the demands made by the central government for additional state funds.