DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA
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DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA

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This presentation by Bogart MONTIEL REYNA was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at ...

This presentation by Bogart MONTIEL REYNA was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm

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DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA Presentation Transcript

  • 1. April 2014 CONTROLLING HEALTH CARE EXPENDITURE IN DECENTRALISED ENVIRONMENTS: A MEXICAN CASE STUDY BOGART MONTIEL WWW.SALUD.GOB.MX PARIS, FRANCE
  • 2. CONTENT Background • The main Health Maintenance Organizations (HMOs) in Mexico. • Decentralisation of health services in the Ministry of Health. Challenges • Redefine the calculation formula for financial transfers. • Analyse of strategies (decentralisation and universal healthcare) • Create of a single fund for all health care provision. • Create of a new national agreement on decentralisation. Achievements • Administrative. • Medical Services. Some statistics
  • 3. HEALTH SERVICES PROVISION IN MEXICO Main Health Maintenance Organizations (HMOs) in Mexico IMSS private-sector employees People with social security ISSSTE public-sector employees PEMEX oil-sector employees ISSSFAM national defense employees Ministry of Health People without social security
  • 4. Background 1983 Constitutional Reform (Article 4): shared obligation of health services provision between the central and local governments • First effort to decentralise some health services. • Less than half of the Mexican states signed agreements. • Spending decisions and the design of health policies and regulations remain in the hands of the central government. • Above all, an administrative decentralisation. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 5. Background 1996 National agreement for the decentralisation of health services • Local financial control was granted. • A National Health Council was created to maintain stewardship, improve quality, and set evaluation procedures. • The National Health Council is a permanent body coordinating healthcare between the central government and all states governments in Mexico. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 6. Background 1998 The Fiscal Coordination Act • Branches were set up by the Act, one of which (FASSA) deals with fund transfers from the central government to governments at the state and municipal levels. • A resource allocation formula was developed based solely on the following points: • health infrastructure inventory • employee lists from each state • the previous year’s operational and investment budgets • other resources to promote the equalisation of healthcare services. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 7. Challenges DECENTRALISATION OF HEALTH SERVICE IN MEXICO The Fiscal Coordination Act, however, did not take into account the following essential considerations:  What kind of diseases are there locally?  How much would treatment of these disease be?  How many hospitals or clinics are needed to attend to people?  What kind of special services should these hospitals or clinics have?  What staff is necessary to attend to local epidemiological needs?  What resource allocation is needed to meet the above demands? As a result, the Mexican government wants to redefine FASSA’s resource allocation formula to respond to present epidemiological profiles in order to eventually sign a new national agreement.  Analyse the strategies (decentralisation / universal healthcare)  Create an single fund for all healthcare provisions.  Standardise quality and coverage of healthcare services in all HMOs.
  • 8. Achievements Administrative • Design of local health acts and regulations • Design of local health programmes • Strengthening of the administrative structure • Closer links between central and local governements Medical Services • Adoption of the services model • General mortality reduction • Infant mortality reduction • Growth of the medical infraestructure 2003 Reform to the Ley General de Salud to establish Seguro Popular, universal healthcare coverage. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 9. Some statistics Ministry of Health Budget in 2014 • Branch 12 Health: 130,264.6 millions of pesos. 9,578 USD billions • Branch 33 FASSA: 72,045.2 millions of pesos. 5,297 USD billions 202,310 millions of pesos. 14,875 USD billions • 71% of the Branch 12 and 100% of the Brach 33 is transfer to local governments (164,274.7 millions of pesos. 12,578 USD billions) • So 81,2% of these branches is transfer by the central government. • Total amount of the public budget, including all HMOs 485,228 millions of pesos. 37,153.8 USD billions. DECENTRALISATION OF HEALTH SERVICE IN MEXICO