Mexico’s government insurance program covers all services for young children. Photo by Mexico Ministry of Health.
As the United States continues to debate the legality of President Obama’s healthcare law, south of the border Mexico is preparing to celebrate a healthcare milestone of its own: universal coverage.
Ten years ago, half of Mexico’s population had no health insurance. Then the congress passed a law guaranteeing access to care, and a government insurance program called Seguro Popular was born.
Mexico’s newly appointed health minister, Salomón Chertorivski, used to run the Seguro Popular program and spoke with the NewsHour in a phone interview about the progress and challenges ahead (edited for length):
Mexico has been working towards universal health care coverage for years, where does the program stand?
Health Minister Salomón Chertorivski: In 2000, half of the population in Mexico did have a financial mechanism for health, but that was because of their labor status. If you had a formal or salaried job you had access to social security and social security gave you access to medical attention, financing your medical attention.
But the other half of the population did not. In 2004, the Seguro Popular, which literally means popular insurance was created … today we already have more than 50 million people registered with Seguro Popular and together with those with social security, we are reaching in December universal coverage: that is all Mexicans are going to have a financial mechanism for their health.
As the new health minister what do you see as the biggest health challenge ahead?
I have a couple challenges in the 14 months to go in President Calderón’s administration — actually reaching the universal coverage, guaranteeing that every Mexican that wants coverage can have it. And with that universal coverage we still have two huge challenges.
The first one is how are we going to get to homogenizing the quality of the services that are received all around the country. Homogenizing quality is a major issue almost in every country, in Mexico it is as well. We have been investing a lot in infrastructure, in new hospitals — over the last five years we have constructed more than 1,000 new hospitals and clinics all around the country.
But still we have to work more precisely on the quality, so that it doesn’t matter where you go to get attention, you receive and have the same life expectancy, the same survival possibility. For that we are also working on electronic medical files, we are working on health guides and human resources … So that is a big issue.
The second challenge is how are we going to move faster than we are moving now from curative to preventive health? We have done a lot on preventive health but today because of the demographic change in Mexico and the epidemiological change we have to move even faster. Today only 9 percent of the population is older than 60 years of age, but in 2040, one out of every four Mexicans is going to be over 60 years of age. With that demographic sea change and the type of diseases and illnesses we are having today, the non-communicable diseases and the obesity epidemic, we are having we need to move faster to preventive health.
In this global financial climate will you have to reassess any health spending and can you keep up with the pace of growth in services?
President Calderon is really, really committed on the health agenda. So one of the priorities over the last year’s budget has been health and the executive already sent the budget to Congress and also for next year, our budget is what we need.
How the budget is calculated for the Seguro Popular is also established by law so in order for it to change they would have to change the law.
But talking about sustainability and the world financial crisis there are two things Mexicans have to continue doing. One is paying taxes because universal coverage is based basically on general taxation and the second one is moving faster from curative to preventative. Today we have an opportunity of around 30 years but we really have to move faster. If we do that the model shows that the financial mechanism is not just sustainable, but what we need. We think about health only as a cost but it’s important to think of health as an investment. If you invest in health you are investing also in economic growth, you are investing in development, you are investing in productivity.
What is the annual health budget for the country?
For health in Mexico the annual budget is around 40 billion (US) dollars.
What services are provided in the Seguro Popular plan and how much of the cost comes out of pocket?
Today 100 percent of first care needs are covered, that is any reason you have to go to a doctor for a consultation and the drugs or medicines associated. Ninty-five percent of all the secondary care, which is basically reasons you would have to spend at least a night in the hospital–but simple ones, frequently these cases are child birth or appendicitis. And in catastrophic diseases, we cover all cancers for people of 18 and under, we cover all breast, cervical and uteran cancers, testicular cancer, non-hogkins lymphoma, bone marrow transplantion also for adults. HIV and all the antiretrovirals and the laboratory testings. Everything is covered for child under five years of age, 100 percent of their needs are covered. If you need a prosthesis, if you need a transplant, everything for children under five years of age is covered.
The NewsHour visited the Oportunidades cash transfer program in Mexico in 2009. How do you see this program fitting into your health agenda?
Around 30 million Mexicans today are part of the Oportunidades program, which is probably one of the most well recognized cash transfer programs in the world. And as you know the Oportunidades program transfers you grants for a family and asks for the core responsibilities of sending your children to school and going to regular medical checkups.
The health sector is responsible for delivering the health services for the women and children in the Oportunidades programs so we do have around 45 million consultations a year for Opportunidades families and we have a lot of promotion and prevention programs around Opportunidades, part of preventative health.