| Resumen: |
This case study assesses key features and achievements of Mexico s Social Protection System in Health (Sistema de Protección Social en Salud, SPSS). It analyzes the contribution of this policy to the establishment and implementation of universal health coverage in the country. Mexico is a large, upper-middle-income country that has benefited from sustained economic growth in the last decade, but where poverty and socioeconomic inequalities remain an important challenge. Indeed, in the early 2000s, a large percentage of the population did not have access to health insurance, which is mostly provided by social security schemes.
In this context, in 2003, the government revised the General Health Law to create the SPSS and its main pillar, Popular Health Insurance (PHI). The objectives of this reform were to (a) increase funds to the public health system and decrease the inequities in public expenditures across public insurance schemes and states; (b) improve health outcomes, reduce out-of-pocket payments for health services, and provide protection against catastrophic health expenditure; and (c) reform the organization and functioning of the state health systems.
The PHI is open to all residents with no access to social security. It transformed the transfer of public resources from the federation to the states from historical budgets to insurance premiums and secured funds for these premiums. The reform eliminated user fees, and in principle was supposed to collect family contributions among those with the ability to pay. although in practice almost nobody pays. It also created explicit entitlements to SPSS affiliates and fully funded them. The PHI benefits package, known as the Universal Health Services Catalogue (Catálogo Universal de Servicios de Salud, CAUSES), was designed to include the most cost-effective interventions to treat and control the main causes of morbidity and hospitalization in the country. This package has been revised following predetermined criteria to include new interventions. Today, it includes 284 primary- and secondary-level interventions and 522 related pharmaceutical products. In addition, through the Fund against Catastrophic Health Expenditure, an additional 57 high-complexity interventions are also offered to affiliates. |
