Article 4 of the Mexican Constitution of 1917 (revised in 2015) establishes that every person has the right to health. This article also highlights the state’s obligation to promote health and well-being for the population. The Mexican Social Security Institute was established in 1943, with the aim of providing health care for workers and their families. In 1985, the Secretariat of Health and Assistance evolved into the Secretariat of Health (equivalent to a ministry of health). The 1990s brought significant reforms, promoting privatization and increased health care competition.
A health system in transformation
Modern health systems reforms in Mexico aimed to increase coverage and quality of care and ensure equitable access to health services for the Mexican population. The Social Protection System in Health (Seguro Popular), established in 2004, sought to expand health coverage to the uninsured. However, after facing funding and quality of care issues, Seguro Popular was replaced by the Instituto de Salud para el Bienestar (Institute of Health for Well-being) (INSABI) in 2020. The implementation of Seguro Popular and INSABI aimed to reduce out-of-pocket (OOP) expenditures for essential services.
The Mexican health system comprises the public sector, social security and the private sector. Funding comes mainly from three sources: general taxes, social security contributions and direct household expenditure.[1]
High burden of out-of-pocket expenditures
Public health expenditure accounted for 3.3% of GDP in 2020, which is below the 6% recommended by the Pan American Health Organization, and represented 11% of total public expenditure in 2021.[1]
Catastrophic health spending was estimated at 4.4% in 2020.[2] Essential services coverage reached 74.5% in 2021.
Main challenges ahead
The Mexican government has embarked on a transformation of the health system. These reforms focus on systemic changes in the way health services are organized and funded to ensure sustainability, equity and universal access. Because the health care system faces multiple challenges, such as the increasing demand for services and budgetary constraints, changes are essential. The policy objectives stated in the Health Sector Program 2020–2024 are to achieve universal coverage through strengthening the efficiency of government health providers.
The high burden of OOP expenditures for households affects access to health services for vulnerable groups. The INSABI reform intends to remove user charges at time of service within the public health system. Another important issue is the unequal distribution of resources and funding among various institutions and sectors. Working towards a less fragmented and more equitable health care system would contribute to reaching the Mexican constitution’s goal to ensure the effective right to health care in the country.
References
[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)
[2] World Health Organization, Global Health Expenditure Database, Indicators and Data (choose country)
