Healthcare in Mexico

From Wikipedia, the free encyclopedia
  (Redirected from Health care in Mexico)
Jump to navigation Jump to search
Secretary of Health, Mexico City, Mexico.

Healthcare in Mexico is provided by public institutions run by government departments, private hospitals and clinics, or private physicians. It is largely characterized by a special combination of coverage mainly based on the employment status of the people and secondarily, based on the capacity of affording external health insurance.[1]

Government has been devoted to protecting the Mexican population, according to the Mexican Federal Constitution, which gives main responsibility to the state in providing national health to the population. [2] Given this, public healthcare is accomplished by an elaborate segmented provisioning and delivery system put in place by the federal government of Mexico around 70 years ago. This segmentation in the system allowed private organization and private offices run by physicians to offer a variety of healthcare options to people who can afford it and are willing to pay for it.[3]

History[edit]

Hospital de Jesús Nazareno stairs and murals.

Hospitals were established in Mexico in the early 16th 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.[4][5][6]

Hospicio Cabañas in Guadalajara is a UNESCO World Heritage Site.

The Hospicio Cabañas in Guadalajara, Jalisco, Mexico, was founded in 1791. It is still functioning and 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, as we know it today, has its base on the creation of several health codes that ran during the first part of the 20th century.[7] It was in 1943 when the Mexican Secretariat of Health and Assistance was established to merge the Department of Public Sanitation and the Secretariat of Public Assistance. Also, in that same year, the Instituto Mexicano del Seguro Social and the Mexican Children's Hospital were founded, during the presidency of Manuel Avila Camacho.[8] After this, several and important changes came, aiming to provide better health for the population. In 1959, the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) was formed as a way of more effectively covering the health services of individuals employed in government institutions. Finally, the Seguro Popular, or Popular Health Insurance, was implemented countrywide in 2003 after the creation of the Social System for Health Protection (SPSS), during the presidency of Vicente Fox Quesada. This institution was charged with covering the country's most impoverished communities— those not covered under the IMSS or the ISSSTE.[9] During the next few years, some other changes in health policies have been made by different presidents as a way of reaching universal healthcare. [1][7]

Compared with 1940 or even 1970, 1990s Mexico had mortality patterns that more closely approximated those of developed societies.[10] 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 Centers for Disease Control and Prevention's flu director, Nancy Cox, added that Mexico's response "impressed the entire world."[11] Additionally, in 2008, a study found that the mortality rate in Mexico had fallen more than eighty percent in comparison to the figures in the first half of the twentieth century— to approximately 4.9 deaths per 1000 inhabitants.[9]

Private healthcare delivery[edit]

The services provided by private institutions and private physicians in their offices are afforded by a part of the population, either by contracting a private insurance or by paying directly for the services obtained. It is estimated that around 6.9% of the Mexican population has private insurance coverage, mainly paid as an out-of-pocket expenditure. Mexico has around 28.6 private facilities per 1 million inhabitants, which account for two thirds of all hospitals in Mexico, with 2,988 institutions.[12]

Public healthcare delivery[edit]

Central Offices of IMSS in Mexico city.

Public healthcare has an elaborate provisioning and delivery system instituted by the Mexican government. It is provided to all Mexican citizens, as guaranteed by Article 4 of the Constitution.

Public care is fully or partially subsidized by the federal government, depending upon the person's 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 Secretaría de Salubridad y Asistencia, or SSA) agency through the program called Seguro Popular, which offers coverage to Mexicans who do not have formal employment.[1] The program currently protects over 57 million inhabitants and covers around 260 common diseases and 18 high-cost interventions. [13] [14] This public insurance scheme, coupled with Social Security, represents 95% of the insured population in Mexico.[15] Funding for Seguro Popular is derived from the federal government, the Secretariat of Health, and the individuals who form a part of this system. However, approximately 20% of individuals in this system, representing the poorest covered sector, are exempt from this.[9]

Central offices of ISSSTE in Mexico City.

Employed citizens and their dependents, however, can 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 more than 65 million people covered through IMSS and its programs.[14]Further, within IMSS there exists the IMSS-Oportunidades, a program established out of the Program to Combat Poverty, which is specifically targeted towards aiding the poorest individuals in the country in both the health and educational fields. This program is completely funded by the government.[9]

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: local, state, and federal government employees. There are nearly 9 million people covered by ISSSTE.[14]

Secretary of Health of Mexico Julio Frenk with former President Vicente Fox and Reyes Tamez, Secretary of Education, in Los Pinos during the initialing ceremony of the National Institute of Genomic Medicine.

The state governments of Mexico also provide health services independently of those that are provided by the federal government programs. In most states, the state government has established free or subsidized healthcare to all of its citizens.[16]

The Secretariat of Health is the largest public healthcare institution, operating 809 hospitals throughout the country. The IMSS grants hospital care and services to employed citizens and their dependents and had 279 hospitals affiliated to it. The ISSSTE grants hospital care and services to government employees and has 115 affiliated hospitals. The other 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).[17] The health systems associated with SEDENA, SEMAR, and PEMEX cover over one million individuals combined.[9]

In 2007, there were a total of 23,858 health units within the Mexican state. Approximately 27% of these were contained in the public sector.[9]

Health statistics[edit]

Fray Bernardino Alvarez Psychiatric Hospital located in the Tlalpan Borough, in Mexico City
The Instituto Nacional de Cancerología (The National Oncology Institute) located in Mexico City.
The IMSS La Raza Medical Center, a well known public hospital in Mexico City

Mexico has seen an overall improvement in almost every aspect of health trend.[18] However, Mexico lags well behind other Organisation for Economic Co-operation and Development countries in health status and availability.[19]


Healthcare statistics, reported by the PAHO [20]
2016
Life expectancy at birth (years) 77.5*
Life expectancy at birth, male (years) 75.1*
Life expectancy at birth, female (years) 79.9*
Maternal mortality ratio

(reported, per 100,000)

36.7
Mortality rate from [[communicable diseases (age-adjusted per 100,000) 52.1
Mortality rate from non-communicable diseases (age-adjusted per 100,000) 469.6
Mortality rate from external causes

(age-adjusted rates per 100,000)

56.6
Mortality from breast cancer, female

(age-adjusted rates per 100,000)

11.2
Mortality from lung cancer

(age-adjusted rates per 100,000)

6.4
Mortality from ischemic heart diseases

(age-adjusted rates per 100,000)

83.2
Mortality from cerebrovascular diseases

(age-adjusted rates per 100,000)

30.0
Mortality from homicide

(age-adjusted rates per 100,000)

35.5
Tobacco consumption among adults

(age adjusted, %)

14.2
Alcohol consumption among adults

(liters/per person/year)

6.5
Overweight and obesity, male

(age-adjusted, %)

63.6
Overweight and obesity, female

(age-adjusted, %)

66.0
Overweight and obesity in children aged < 5 years (%) 5.2**
Hospital births (%) 92.7
Antenatal care coverge by skilled birth attendants of 4+ visits (%) 89.5
Number of physicians

(per 10,000 population)

24.0
Number of nurses (per 10,000 population) 29
Number of dentists (per 10,000 population) 1.9
*Data from 2018

**Data from 2012

Source: Pan American Health Organization [20]

Top ten causes of death in Mexico in 2017, reported by IHME [21]
Cause Deaths
(per 100,000)
Percent
Cardiovascular diseases 127.82 22.74%
Diabetes and kidney diseases 102.15 18.18%
Neoplasms 76.86 13.68%
Digestive diseases 49.39 8.79%
Self-harm and interpersonal violence 40.19 7.15%
Neurological diseases 32.72 5.82%
Chronic respiratory diseases 27.11 4.82%
Respiratory infections and Tuberculosis 19.44 3.46%
Other non-communicable diseases 17.32 3.08%
Unintentional injuries 17.03 3.03%
Source: Institute for Health Metrics and Evaluation [21]
Health outpost operations in Izlapalapa, Mexico City

According to recent international statistics, Mexico has an estimated population of 130 millions of inhabitants, with a reported annual population growth rate of 1.2%. Since 1990 there was an increment of about 45 million people.[18]

Total health expenditure represented around 5% of GDP in 1995, which went up to around 6.2% in 2012; however, in 2015 it declined to 5.6%. Historically, out-of-pocket expenditure has been a big portion of health expenditure, going from around 56% in 1995 to below 50% since 2008, with the most recent data being 40.6% in 2015. [18] [20]

Demographic and epidemiological transitions have been notorious in the last 7 decades in Mexico. Life expectancy at birth (general) changed from being 45 years in 1950 to 71.5 years in 1990, and to actually reach 77.5 years, close to some high-income countries in America and the World. [20] [22] Child mortality rate, as one the major health trends, have improved most notoriously after 1950, when an average of 252 children under-five years were dead per 1000 live births, decreasing to 44.5 in 1990 and reaching 14.6, in 2018. [20] [22] Finally, after 1970, at least 20 years after the major changes in life expectancy and child mortality rate, there was a decrease in fertility rate. In 1950 it was estimated that for every woman, around 6.67 babies were born; in 1970, it increased to 6.8 and then, steadily decreased to 3.4 in 1990 to finally end in 2.1, which is below the world average.[20][22]

Affordability[edit]

Elena Arizmendi and volunteers of the Neutral White Cross, 1911.

In 1992, the New York Times reported that residents of the United States living near the Mexican border routinely crossed into Mexico for medical care.[23] Popular specialties included dentistry and plastic surgery. In 2007, the Washington Post reported that Mexican dentists charged 20-25% of US prices,[24] and other procedures typically cost a third of the US price.[23] Additionally, Pagán et al. found that in 2006, over 30 million Mexicans in lower socioeconomic classes resorted to self-medication due to the high medical costs and low proportions of coverage in the country.[25]

Universal health care[edit]

On December 1, 2006, the Mexican government created the Health Insurance for a New Generation (also called "Life Insurance for Babies").[26][27][28] It was followed by a February 16, 2009, announcement by President Felipe Calderon, who stated that at the current rate, Mexico would have universal health coverage by 2011,[29] and a May 28, 2009 announcement of universal coverage for pregnant women.[30] In August 2012 Mexico installed a universal healthcare system. [31]

Social determinants[edit]

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

See also[edit]

References[edit]

  1. ^ a b c Gómez, C. The Health System in Mexico. Mexico: Revista Conamed, Vol. 22 Núm 3; 2017.
  2. ^ Gutiérrez, N. Mexico: Availability and Cost of Health Care-Legal Aspects. The Law Library of Congress; 2014.
  3. ^ ManattJones Global Strategies. Mexican Healthcare System Challenges and Opportunities. Washington: ManattJones Global Strategies; 2015.
  4. ^ David Howard, The Royal Indian Hospital of Mexico City, Tempe: Arizona State University Center for Latin American Studies, Special Studies 20, 1979.
  5. ^ Carmen Venegas Ramírez, Régimen hospitalario para indios en la Nueva España. Mexico 1973.
  6. ^ Josefina Muriel, Hospitales de la Nueva España. 2 vols. Mexico 1956-60.
  7. ^ a b "Antología de la Atención a la Salud en México, 1902-2002". PAHO. Retrieved September 16, 2019.
  8. ^ Mexico's health care lures Americans. Chris Hawley. USA Today. 9/1/2009. Retrieved 24 August 2012.
  9. ^ a b c d e f Castro, Roberto (2014). "Health Care Delivery System: Mexico". The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. pp. 836–842. doi:10.1002/9781118410868.wbehibs101. ISBN 978-1-118-41086-8.
  10. ^ Health Care and Social Security. Tim L. Merrill and Ramón Miró, editors. Mexico: A Country Study. Washington: GPO for the Library of Congress, 1996. (Quoted as: "Source: U.S. Library of Congress.") Retrieved 24 August 2012.
  11. ^ Mexico Wins Praise for Swine Flu Response. Maria Cheng (London) and Vicente Panetta (Buenos Aires). Associated Press. Retrieved 4 July 2009.
  12. ^ Estudios de la OCDE sobre los Sistemas de Salud: México 2016. Organisation for Economic Co-operation and Development. 2016-12-21. ISBN 978-92-64-26552-3.[page needed]
  13. ^ Dantés, Octavio Gómez; Sesma, Sergio; Becerril, Victor M. (7 March 2011). "Sistema de salud de México". Salud Pública de México (in Spanish). 53.
  14. ^ a b c Secretaría de la Función Pública. Confronta al primer trimestre 2016 de los padrones del Sistema Nacional de Salud: Resumen Ejecutivo. Mexico: Secretaría de la Función Pública; 2016.
  15. ^ Urquieta-Salomón, José E; Villarreal, Héctor J (February 2016). "Evolution of health coverage in Mexico: evidence of progress and challenges in the Mexican health system". Health Policy and Planning. 31 (1): 28–36. doi:10.1093/heapol/czv015. PMID 25823751.
  16. ^ Quienes Somos. Archived 2009-07-21 at the Wayback Machine Secretaria de Salud. Federal Government of Mexico. Retrieved 4 July 2009.
  17. ^ National Health Information System, "SINAIS". Retrieved 1 June 2014.
  18. ^ a b c Pan American Health Organization. Health in the Americas+, 2017 Edition. Summary: Regional Outlook and Country Profiles. Washington, D.C.: PAHO; 2017.
  19. ^ Country profile: Mexico. Library of Congress Federal Research Division (July 2008).
  20. ^ a b c d e f Pan American Health Organization (2018). Health Situation in the Americas. Core Indicators 2018. Washington, DC: PAHO. hdl:123456789/49511.[page needed]
  21. ^ a b "GBD Compare". Institute for Health Metrics and Evaluation (IHME). Seattle, WA: University of Washington. 2019. Retrieved September 16, 2019.
  22. ^ a b c "Gapminder Data". Gapminder. Retrieved September 17, 2019.
  23. ^ a b Philip J. Hilts, Quality and Low Cost of Medical Care Lure Americans to Mexican Doctors, New York Times (November 23, 1992).
  24. ^ Manuel Roig-Franzia, Discount Dentistry, South of The Border, Washington Post (June 18, 2007).
  25. ^ Pagán, José A.; Ross, Sara; Yau, Jeffrey; Polsky, Daniel (January 2006). "Self-medication and health insurance coverage in Mexico". Health Policy. 75 (2): 170–177. doi:10.1016/j.healthpol.2005.03.007. PMID 16338480.
  26. ^ Message to the Nation from the President of Mexico, Felipe Calderón Hinojosa, on the occasion of his first State of the Union Address. Mexican Federal Government. Office of the Presidency. 2006. Retrieved 4 July 2009.
  27. ^ President Calderón during First National Week of Affiliation to Medical Insurance for a New Generation. Federal Government of Mexico. Office of the Presidency. 2006. Retrieved 4 July 2009.
  28. ^ President Calderón at Launching of Affiliation to Medical Insurance for a New Generation. Federal Government of Mexico. Office of the Presidency. 2006. Retrieved 4 July 2009.
  29. ^ Mexico to Achieve Universal Health Coverage by 2011. Federal Government of Mexico. Office of the Presidency. 2006. Retrieved 4 July 2009.
  30. ^ International Women's Day. Federal Government of Mexico. Office of the Presidency. 2006. Retrieved 4 July 2009.
  31. ^ "Mexico achieves universal health coverage, enrolls 52.6 million people in less than a decade". Harvard School of Public Health. 2012-08-15. Retrieved 2013-09-16.