Mexico HiT (2020)

Health status threatened by unhealthy lifestyles and violence

Health indicators for the Mexican population have improved in the past decade although life expectancy is still below the average of OECD countries and health inequalities are marked across regions of the country. Unhealthy lifestyles, increasing prevalence of chronic diseases – particularly diabetes and ischemic heart disease – and violence threaten to decrease healthy life expectancy in the near future.

The health system is segmented following the labour market

The Mexican population laboring in the formal sector – just under half of the total – are covered by social insurance institutions offering them generous benefits. Social insurance institutions are financed and governed by a state-corporativist structure imposing obligatory contributions by employers, employees and the government, who also share governance. Financing and provision are integrated within each institution, relying mostly on salaried personnel.  Turnover between the formal and informal labor markets as well as unemployment exposes a large proportion of employees to losing formal insurance coverage and hence continuity of care.
The uninsured population is covered by federal and state ministries of health through coordinated, health services offering a limited package of free services. As with social insurance, financing and provision are integrated and services are provided mostly through salaried personnel. Widespread dissatisfaction with public services has led to growth in the private health sector which now covers close to half of total outpatient care, mostly on a fee-for-service basis and without co-ordination with the rest of the health system.

Changing financial protection schemes

The right to health is enshrined in the Constitution committing the government to facilitate access to services. Since the 2000s and up until 2018 efforts were made to universalize public health insurance through Seguro Popular, a voluntary financial protection option covering a wide, yet limited, package of services managed by state governments through earmarked financial transfers from the federation. While catastrophic expenditures were reduced, out-of-pocket expenditure remained high, at over 40% of total health expenditure. Facing corruption and limited in terms of population coverage and the package of services, Seguro Popular was dismantled in 2019 and replaced with a new federally managed scheme to provide universal free access to health services to the uninsured.