Healthcare in Mexico

Central offices of ISSSTE in Mexico City.

Healthcare in Mexico is provided via public institutions, private entities, or private physicians. Healthcare delivered through private organizations operates entirely on the free-market system, i.e., it is available to those who can afford it. This is also the case of healthcare obtained from private physicians at their private office or clinic. Public healthcare delivery, on the other hand, is accomplished via an elaborate provisioning and delivery system put in place by the Mexican Federal Government. In 2012, Mexico instituted universal healthcare.^[1] As of December 31, 2013, there were 4,466 hospitals in Mexico.^[2]

History

Hospicio Cabañas in Guadalajara is a UNESCO World Heritage Site.

Hospitals were established in Mexico in the early sixteenth century, including ones exclusively for Indians. Some were established by the crown, others by private endowment, but most by the Catholic Church. Bishop Vasco de Quiroga established hospital complexes in Michoacan in the sixteenth century. In Mexico City, conqueror Hernán Cortés established the Hospital de Jesús Nazareno for Indians, which still functions as a hospital.^[3][4][5] The Hospicio Cabañas in Guadalajara, Jalisco, Mexico, was founded in 1791. The institution, still functioning, is now a World Heritage Site. It is one of the oldest and largest hospital complexes in Latin America. The complex was founded by the Bishop of Guadalajara to combine the functions of a workhouse, hospital, orphanage, and almshouse.

The Mexican healthcare program IMSS was founded in 1943 during the presidency of Manuel Avila Camacho.^[6] In the early 1990s, Mexico showed clear signs of having entered a transitional stage in the health of its population. When compared with 1940 or even 1970, Mexico in the 1990s exhibited mortality patterns that more closely approximated those found in developed societies.^[7] By 2009, during the notorious swine flu pandemic, the World Health Organization director said that Mexico "gave the world a model of rapid and transparent reporting, aggressive control measures, and generous sharing of data and samples". The CDC's flu director Nancy Cox, added that Mexico's response "impressed the entire world".^[8]

Private healthcare delivery

While private hospitals account for 2/3 of all hospitals in Mexico with 2,988 institutions, less than 10% of the Mexican population has private insurance coverage, paying for care mainly "out of pocket".^[2]

Public healthcare delivery

The Instituto Nacional de Cancerología

Public Healthcare delivery is accomplished via an elaborate provisioning and delivery system instituted by the Mexican Federal Government. It is provided to all Mexican citizens as guaranteed via Article 4 of the Constitution. Public care is either fully or partially subsidized by the federal government, depending upon the person's (Spanish: derechohabiente) employment status. All Mexican citizens are eligible for subsidized healthcare regardless of their work status via a system of health care facilities operating under the federal Secretariat of Health (formerly the Secretariat de Salubridad y Asistencia, or SSA) agency.

The Secretariat of Health's Seguro Popular offers coverage to Mexicans who do not have formal employment. The program currently covers over 55 million people.^[9]

Employed citizens and their dependents, however, are further eligible to use the program administered and operated by the Instituto Mexicano del Seguro Social (IMSS) (English: Mexican Social Security Institute). The IMSS program is a tripartite system funded equally by the employee, the private employer, and the federal government. There are 58 million people covered through IMSS.

The IMSS does not provide service to public employees, who instead are serviced by the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (English: Institute for Social Security and Services for State Workers), which attends to the health and social care needs of government employees. This includes local, state, and federal government employees. There are nearly 13 million people covered through ISSSTE.^[9]

The government of the states in Mexico also provide health services independently of those services provided by the federal government programs. In most states, the state government has established free or subsidized healthcare to all their citizens.^[10]

The Secretariat of Health (Secretaria de Salud) is the largest public healthcare institution, operating 809 hospitals throughout the country. The Mexican Social Security Institute (Instituto Mexicano del Seguro Social - IMSS) grants hospital care and services to employed citizens and their dependents - there are 279 hospitals affiliated to IMSS. The Institute for Social Security and Services for State Workers (Instituto de Serguridad y Servicios Sociales de los Trabajadores del Estado - ISSSTE) grants hospital care and services to government employees - there are 115 hospitales affiliated to ISSSTE. The remaining 279 hospitals are affiliated with 9 government dependencies, including State Facilities, Secretariat of National Defense (Secretaria de Defensa Nacional), Mexican Navy (Secretaria de Marina), Petroleos Mexicanos (PEMEX), and the Red Cross (Cruz Roja).^[11]

The public hospital infrastructure required hospitals to be spread over a territory of 761,600 sq miles (1.973 million km²). As such, the public hospital infrastructure relies on a vast network of small hospitals. Over 50% of public hospitals have less than 50 beds.

Health statistics

The IMSS La Raza Medical Center, a typical public hospital in Mexico

Aggregate health statistics for Mexico have improved greatly since the 1970s. However, Mexico lags well behind other Organisation for Economic Co-operation and Development countries in health status and health care availability.^[12]

During 2005, 45.5 percent of health spending was paid from public sources—comparable to the share of public spending in the United States but significantly below the OECD average. Private financing in Mexico is almost entirely in the form of out-of-pocket payments, as only 3.1 percent of total expenditures on health are funded through private health insurance.^[12] Consistent with every other major industrialized country (except the U.S.), government healthcare in Mexico is universal, making private programs' health insurance unnecessary except for use in private hospitals.

Some authorities have noted that while Mexico has some 3000 private hospitals, some private “hospitals” could hardly be considered hospitals at all, since they have no laboratories, radiography equipment, or even nurses.^[15] The remaining 1000 or so public hospitals account for the majority of hospital beds and, in fact, the bulk of private hospitals are institutions with less than 20 beds.

The mortality rate for children younger than five years was 17 per 1,000 live births in 2005, and Mexico has shown a faster acceleration to lower mortality rates than the U.S., Cuba, and Canada in the last 10 years. Ninety-seven percent of the population had direct access to potable water and 80 percent to sanitation. Also in 2005 the incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) among persons aged 15 to 49 was 0.3 percent.^[12] At 11,000 deaths/year vs. 22,000/year in the U.S., this represents a 44% higher per capita death rate than the United States.^[16]

Affordability

Logo of the IMSS.

Residents of the United States, particularly those living near the Mexican border, now routinely cross the border into Mexico for medical care.^[17] Popular specialties include dentistry and plastic surgery. Mexican dentists often charge 20 to 25 percent of U.S. prices,^[18] while other procedures typically cost a third what they would cost in the US.^[17]

Universal health care

On December 1, 2006, the Mexican government created the Health Insurance for a New Generation (also called "Life Insurance for Babies").^[19][20][21] This was followed by a February 16, 2009, announcement by President Felipe Calderon where he stated that at the current rate of progress Mexico would receive Universal Health Coverage by 2011,^[22] and a May 28, 2009, announcement in which his administration made public Universal Care Coverage for Pregnant Women.^[23] In August 2012 Mexico installed a universal healthcare system.^[1]

Social determinants

Social determinants of health in Mexico are factors that influence the status of health among certain populations in Mexico. These factors consist of circumstances in which people grow, live, work, and age, as well as the systems put in place to deal with illnesses. In Mexico, the health inequality among the population is influenced by such social factors. In the past decade, Mexico has witnessed immense progress within their health care system that has allowed for greater access to health care and a decrease in mortality rate, yet there are still various health inequalities caused by social factors.

References