Asa Cristina Laurell

Artículos en Inglés de Asa Cristina

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With the goal of fully guaranteeing the constitu- tional right to health protection, Mexico City’s left- ist administration (2000-2006) undertook a reform to provide health services to people without insur- ance. The reform had four components: free medi- cine and health services; the introduction of a new service model (MAS); the strengthening, expan- sion, and improvement of services, and legislation to ensure that the city government become guaran- tor of this constitutional right. The reform resulted in 95% of eligible families being enrolled in free care; expansion of health care infrastructure with the construction of five new health care centers and a 1/3 increase in the number of public hospital beds in impoverished and disadvantaged areas; increased access to and use of health services particularly by the poor and for expensive interventions; and the legal guarantee of the continuity of this policy. The implementation of this new policy was made possi- ble through an 80% budget increase, improvements in efficiency, and a successful fight against corrup- tion. The health impact of the reform was seen in decline of mortality rates in all age groups between 1997 and 2005 (22% for child mortality, 11% for economically active age groups, and 7.9% for retired age groups) and by a 16% decline in AIDS related mortality between 2000 and 2005. This reform contrasts with the health care reform pro- moted by the right wing Federal government in the rest of the country; the latter was based on volun- tary health insurance, cost-sharing by families, ac- cess to a limited package of services, and gradual enrollment of the population not covered by the Social Security System.

Universal health coverage (UHC) is today a dominant issue in the global health policy debate. The hegemonic proposal is UHC that recommends universal health insurance with an explicit service package and a payer- provider split with public and private managers. The Mexican Popular Health Insurance (PHI) is widely presented as a UHC success case to be followed. This article reviews critically its achievements after a decade of imple- mentation. It shows that universal coverage has not been reached and about 30 million Mexicans are uninsured. Access to needed services is quite limited for PHI affiliates given the restrictions of the service package, which excludes common high-cost diseases, and the lack of health facilities. Public health expenditure has increased 0.36 percent of Gross National Product, favoring the PHI at the expense of public social security. These funds are, however, lower than legal specifications and the service package under- priced. Private health expenditure as a percentage of total expenditure has not varied much and PHI affiliates’ out-of-pocket payment is larger than the whole PHI budget. There is no evidence of health impact. The Mexican health reform corresponds to neoclassic-neoliberal reorganization of society on the market principle. Although some of the PHI problems are particular to Mexico, it illustrates some of the overall flaws of the UHC model.