Mexico's health system reforms working

Julio Frenk, Minister of Health of Mexico, outlines the results of the country's 6-year project of health system reform in a Public Health article in this week's issue of The Lancet.

Mexico is a middle-income country with a population of more than 100 million. Like most developing countries, Mexico is simultaneously facing the double burden of chronic and infectious disease. Over the past 6 years the country has been a ‘global laboratory' for health system reform, using the best available scientific evidence to address these complex challenges.

Special initiatives to address health threats such as malaria, HIV/AIDS, tuberculosis, and child mortality over the past 5 years are showing results: the number of cases of malaria have dropped by 60%, six times more people are receiving antiretroviral therapy, TB mortality has fallen by 30%, and Mexico is only one of seven countries on track to reduce child mortality by two-thirds by 2015—the fourth Millennium Development Goal (MDG4). The reforms have also led to a 17% reduction in the proportion of male teenagers who smoke, a 17% increase in the use of mammography, and a 32% increase in the number of pap smear tests over the past 5 years.

In the article, Frenk describes the main feature of the reform, a scheme called Popular Health Insurance (Seguro Popular) that came into effect in 2004. This initiative was introduced to improve universal access to health insurance, medicines, and heath care and reduce the numbers living in poverty. In 2000, analysis of national data revealed that many Mexican families suffered catastrophic expenditure or were forced below the poverty line by the cost of health care and medicines. This was directly related to health insurance being limited to salaried employees in private firms or in public-sector institutions. To address this problem the Seguro Popular scheme made it possible for 50 million, mainly poor Mexicans to access publicly subsidised health insurance. Seguro Popular and its associated Fund for Protection against Catastrophic Expenses includes a specific package of benefits enabling people to access more than 250 health promotion and disease prevention measures, including outpatient care and hospital care for the basic specialties, antiretroviral therapy, intensive care for newborns, cancer care, and haemodialysis. By the end of this year Seguro Popular will have enrolled the targeted 5·1 million families (about 22 million people) and is on track for achieving universal coverage by 2010.

Dr Frenk states: "A hallmark of the Mexican experience has been a substantial investment in research to design the reform, monitor progress towards its implementation, and assess its results. This is a clear example of the possibility of use of science to promote social change . . . By making our experience available to the international community, we hope to contribute to a process of shared learning among countries that will be essential to achieve our common health goals."

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