Mexico’s health care system was established in 1943 during the industrialization period who still face many challenges on a daily basis due to lack of education and access to supply and resources to healthcare facilities. However, the goal of its government now is to protect its community from public health risks and promote health and well-being. Mexico has developed national programs to improve healthy living in rural areas and areas of poverty through education and preventative care. Due to an increase in cost of medicine in developed countries, Mexico is fueling towards medical tourism for affordable treatment options. The purpose of this paper is to provide information on healthcare services coverage and financing, medical technology, long-term care, and cost, access and quality in Mexico.
Mexico does not have complete universal health coverage; their health system consists of a variety of public programs: Social Security Institute, Ministry of Health, and Seguro Popular as well as the private insurance plans. Social Security Institute provides services to non-government employees and their families. Whereas, Ministry of Health covers services for government employees and their families. Due to financial constraints and political pressures, the government employees, the states-owned oil company, and the military developed their own health care infrastructure to independently provide services (Rudman, 2015). The government created Seguro Popular in 2003 to help cover the uninsured population and poor families. Although, Mexico does have private insurance market which is mainly used by the wealthy residents and some middle class individuals. Based on which public sector or private insurance plan chosen, the care differentiates through medical facilities, providers, and the quality of care in those services being provided. For example, “patients with private insurance receive high-technology and highly-trained physician care, whereas the uninsured or Ministry of Health are provided with underequipped and understaffed care” (Rudman, 2015). Mexico’s social security insurance provides broad coverage for medical services such as pregnancy, childbirth, primary care, acute care, ambulatory and hospital care, and prescription medications. Seguro Popular provides access to a set of essential medical services and the needed medications for those conditions. Recently, Seguro Popular funds include free prenatal and delivery care, and has an ambulance service too. Figure 0.1 shows how the current healthcare system of Mexico is based on the needs of its citizens and community, instead it should also focus on system (OECD, 2016).
These three sectors are managed at the federal level to ensure adequate distribution of finances, however “there are still 50% of the 100 million inhabitants who still do not have health care coverage” (Barraza-Llorens, Bertozzi, Gonzalez-Pier & Gutierrez, 2002). According to Roberto Castro’s research, out of pocket payments by patients represent over half of financing for the Mexican health care system in order for them to receive care (Castro, 2015). The public sectors are financed through general taxes, and payment fro the employer and employee, determined by salary. Seguro Popular are also funded by taxes which is contributed by the federal and state government and payments by families based on income with small premiums. “About 20% of individuals” uninsured or those who do not have a source of income pay nothing at the time of delivery of the services to receive preventative services (Whyte, 2009). These insurance programs have lowered “catastrophic health costs by as much as nine percent among those who participated… including checkups for hypertension, (which is a) common problem” (Whyte, 2009). Figure 1.1 illustrates the structure of health service financing in Mexico (OECD Reviews of Health System: Mexico, 2005).
Nursing homes have been uncommon in Mexico since most elderly Mexicans live with their families until the end of their lives (Whyte, 2009). Due to financial constraints, the federal government focuses on providing financial support to individuals living in poverty. However, there has been a growing number of assisted living centers and nursing care facilities south of the border for retired foreigners to receive affordable care. Private insurance schemes have been developed for the population to access, however small number of Mexicans purchase it since its expensive; although, little is known about premiums and coverage.
The older population in Mexico have scarce services available. However, there are some private institutions that offer services such as day-care centers and institutions for those who cannot care for themselves and have no family to take care of them. National Institute for the Elderly was established to promote local seniors, above the age of 65 years, with health education and cultural activities. Whereas, the National System for the Integral Development of the family is a major public family welfare institution developed in 1999 that “covers on average 470 individuals” (OECD, 2011). Its primary focus is to provide care for the elderly and disability population in sheltered homes known as the “Day Residence Program.” These institutions were established for older adults and adults with disabilities to remain active participants in their care and community. Despite the continuing shifts towards long-term care in more developed countries, Mexico maintains a different structure.
According to research, “Mexico’s medical devices market is set to grow from $4.9 billion in 2015 to $6.5 billion by 2020 as the population increases, adopts more unhealthy lifestyles, and grows old” (Mexico’s medical device market to $6.5B by 2020, 2016). Even though Mexico is rising in import and export supply of medical devices, many rural areas and areas of poverty are not able to receive technologically sophisticated medical care. Since south of Mexico provides high medical technology care, it is becoming a facility for medical tourism: patients from Canada come to beat long wait times for services, and the U.S. is attracted to receive affordable care. For example, “a hip replacement in the U.S. can cost from $43,000 to $63,000 but in Mexico it’s a bargain at around $12,000” (Whyte, 2009). Another great example of med-tech is lumbar dynamic stabilization (LDS), which is still under the clinical trial stages in Canada and America (Shi & Singh, 2015, pp 46). However, Europe and Mexico have adopted to this low-invasive procedure to end back pain, and prevent debilitating chronic illnesses. While medical tourism is growing, tourist need to understand that medical malpractice is not enforced in Mexico. The other concern Mexicans have to increased medical tourism is public safety. However, there was little research found on what the government is doing to maintain safety.
Access to and quality of health care are parallel to one another because without access, resources go unused. Mexico has great disparity and availability to healthcare services for two main reasons. Some patients may not be able to reach health care facilities when they need them especially those residing in rural areas. The other concern is whether or not those with access to services can afford the care they need. For example, individuals living in the northern states are much better served than those living in the center and south of the country since they lack medical facilities and equipment; Figure 2.9 illustrates household health care spending (OECD Reviews of Health System: Mexico, 2005). Unfortunately, some states of Mexico still have limited number of medical facilities available to them including doctors due to areas of poverty. In other words, Mexico’s healthcare services are based on income and geographical characteristics when access should be based on needs.
Health status focuses on a range of factors to determine quality of care: income, education, diet, lifestyle, and environmental issues. Mexico has poor dietary habits since they lack knowledge on sedentary lifestyle. Multiple studies have shown that the leading cause of death in Mexico is diabetes followed by heart and liver disease (Whyte 2009). In order to decrease health risks and manage chronic illnesses, Seguro Popular developed national programs to focus on population education, preventative health and vaccinations which includes health screenings for cancers and HIV. For example, “Mexico has one of the world’s most successful vaccination programs…, dramatically reducing morbidity and mortality from childhood infectious diseases” (Barraza-Llorens, Bertozzi, Gonzalez-Pier & Gutierrez, 2002). Also, those residing in scarcity areas were educated on malnutrition, vaccination, and prenatal care to provide adequate health care services and decrease morbidity and mortality. Another task the government took upon them to decrease diabetes and obesity was by adopting new sales tax on sugared beverages and foods high in calories to improve health outcomes (Rudman, 2015). A recent study found that “special programs had helped reduce malaria rates by 60 per cent, TB mortality had fallen by 30 percent and that Mexico was on track to reduce child mortality by two thirds by 2015” (Whyte, 2009). All these initiatives enabled Mexicans to have healthy living, access to facilities, and making resources available to the community. However, Mexico still lacks healthcare equality since the middle-class and wealthy benefit more than individuals with public insurance plan or those who are uninsured.
The Mexican government has plans to provide a basic set of medical services for its population through public and private insurance plans. High medical technology care is available at low cost for medical tourists but unaffordable for majority of Mexico’s population. In the last two decades, Mexico has had many improvements through educating the population on basic health needs and utilizing preventative health care. For example, focusing on risk factors and communicable diseases has controlled environmental risk factors and improved their health status. Currently, there is a lack of formal long-term care services and benefits in Mexico since the culture is very different compared to other developed countries. However, the government may face many challenges if they are unable to meet the needs of all their citizens.