Assessing the Effect of the 2001-2006 Mexican Health Reform: An Interim Report Card
Posted: 6 Jul 2007
Rationale: Since 2001, Mexico has been designing and implementing a comprehensive health reform, an essential component of which is called Seguro Popular (SP). This program aims to expand insurance coverage from 2003-2010 to all Mexicans without insurance as of 2003; about half the population (50 million people). The reform legislates a given government expenditure per family affiliated, which intends to raise public spending on health by roughly 1%, creates an explicit benefits package, allocates funds to state ministries of health based on the number of families affiliated (affiliation is voluntary), separates resources into personal and non-personal health services, and initiates a national fund to insure families against catastrophic illness.
Objectives: We evaluate the impact of Mexico's health reform using the WHO framework on health systems performance. The analysis measures whether SP reaches poor and rural families, in addition to changes in health expenditure, hospital utilization, coverage, and catastrophic spending. These metrics are evaluated using three separate perspectives: the system-wide level, the municipality level, and the individual level for SP enrollees themselves.
Methods: This study assesses the reform using multiple data sources, which include: ENSA 2000 to measure coverage and responsiveness before the reform, ENSANut 2005-2006 for coverage, responsiveness, catastrophic expenditure, hospital use, and functional health status, Mexico's Census 2000 and 2005 for SP affiliation analysis, SAEH 2000-2005 to investigate hospital use changes, Mexico's death certificate registry called SEED to explore age-standardized death-rate changes, and Mexico's Ministry of Health infrastructure and expenditure databases (SINERHAIS and SICUENTAS).
Results: By 2006, over 11 million Mexicans received health insurance from SP. The probability of affiliation to SP was highest for families in the lowest three wealth and community deprivation deciles. Total public expenditure on health in real, per capita terms increased by 20% from 2000-2005, while federal, non-social security health expenditure rose 38% in real per-capita terms. In addition, inequality of public expenditure per-capita across states fell. We found that SP enrollees have a higher probability of health-service use conditional on their perceived need than the uninsured. Moreover, the average increase in hospital use was estimated to be 71% for a municipality moving from no SP enrollees to full enrollment. Overall, coverage from 11 comparable indicators (like measles, ante-natal care, and hypertension, among others) increased from the 2000 to 2005-2006 surveys. In addition, the increases in coverage were largest in states with lowest coverage pre-SP, so that coverage inequality in Mexico decreased during the reform. Finally, we find that SP enrollees who utilized health services in the last year have a lower probability of incurring catastrophic expenditure.
Conclusions: Our analysis shows that SP is reaching poor families, although the program now faces the dual challenge of enrolling those in the most deprived communities, while maintaining quality as affiliation expands. To sustain the program, enrollment must also increase for families that do not qualify for free care. Nevertheless, the broad objectives of the reform have been mostly fulfilled. Our session will explore how these results were achieved and how they can be extended in the future.
Keywords: Mexico, health system reform, evaluation, Seguro Popular
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