Health Reform in Mexico in 2004: the origin of the Health Social Protection System<br />Rafael Lozano MD MSc<br />Global H...
Outline<br />Background<br />Current Mexican´s  facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help i...
3<br />GDP PPP UDS per capita<br /><ul><li>Almost 2 mill Km2 (14th largest)
11,000 Km of littorals
 3,000 km border in the north and 1,000 south
Huge biodiversity
108 mill pop in 2009 (11th largest)
75% in Urban areas
56% in metropolitan areas
 Rural means marginality, exclusion
 12% indigenous disperse
Administrative division:
31 states and Federal District
2,455 municipalities
199 thousand localities</li></li></ul><li>4<br />100<br />90<br />1994 Gini = 0.511<br />2005  Gini = 0.489<br />80<br />7...
5<br />DEMOGRAPHIC INDICATORS<br />2009<br />100<br />90<br />80<br />Male<br />Female<br />70<br />Rates x 1000 pop<br />...
200.0<br />Tasa x 1000 ajs edad<br />Diarrheas<br />180.0<br /> Respiratory Infections<br />160.0<br />Diabetes Mellitus<b...
20.0<br />18.0<br />17.3<br />16.0<br />15.1<br />14.0<br />Diabetes<br />53%<br />Ischaemic<br />Heart Dis<br />21%<br />...
Leading causes of DALYs by sex, Mexico 2005<br />Women<br />Men<br />%<br />%<br />
Predicted Infant Mortality by Municipality and Level of Marginality, 2005<br />90.0<br />Very Low<br />Low<br />Medium<br ...
Mexican Health System (before reform)<br />30%<br />15%<br />55%<br />40%<br />30%<br />30%<br />45%<br />45%<br />10%<br ...
Outline<br />Background<br />Current Mexican´s  facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help i...
Reform<br />From Latin “reformare” … “form or shape again” (re-form)<br />“…make changes in (something) in order to improv...
Health reform typically attempts to<br />Broaden the population that receives health care coverage through either public s...
Three generations of Health Reform in Mexico<br />14<br />2004<br />1982<br />1943<br />Million of population<br />1943 Fo...
Health Reforms in Mexico: three generations<br />1943 Foundation of the Modern Health System<br />Ministry of Health<br />...
Outline<br />Background<br />Current Mexican´s  facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help i...
Priorities for research<br />and development<br />(the intelligence)<br />National Health<br />Accounts<br />(the means)<b...
Public Politics<br />Political<br />Ethical<br />Technical<br />Evidence andInformation<br />The Pillars of Public Politic...
The challenges of the Mexican Health System <br />Equity: change in the health pattern with more social and regional inequ...
Financial Protection<br />Motivation<br />Almost half the families have no health insurance, which leads to postpone care ...
Financial Unbalances<br />Level: investment: 5.8% of GDP <br />Source of funds: the predominance  out of pocket payments (...
Financial imbalances Underinvestment<br />Health expenditure as percentage of GDP<br />16<br />13.9<br />14<br />12<br />1...
Financial imbalances<br />Source of funds<br />Social Security <br />61%<br />States<br />7%<br />Federal<br />32%<br />Pr...
Financial imbalances<br />Unequal effort from the states<br />Federal<br />States<br />Percentage of federal and state exp...
Financial imbalances<br />Imbalance destination of the expenditure<br />Federal expenses by chapter<br />100%<br />80%<br ...
Financial imbalances<br />Impoverishment due to health spending<br />2 millions:<br />Catastrophic expenses (more<br />of ...
Universality<br />Social Inclusion<br />NationalPortability<br />Equal opportunities<br />Explicit Priorization<br />Fair ...
Democratizing the health System in Mexico<br />Empower people making them aware about their entitlements<br />Transparency...
More than a Legal process to get the change in the Law<br />Foundation of The National Institute of Public Health, January...
State Reform<br /><ul><li>Collaboration between congress and presidency
Two level of government were involved (state and national)
Transcendence of more than one administrative period (2004 to 2010)</li></li></ul><li>Outline<br />Background<br />Current...
Structural reform of the health systemfinancing<br />Innovations<br />Universalization of social security on health<br />E...
Reorganization of the Mexican Health System<br />Source: Frenk J. et al 2003<br />
Stewardship<br />Key function, mother function<br />“…To do that others do what they must do…”<br />Tools and rules<br />C...
Stewardship<br />IV. How do we measured the advances<br />Accountability as part of the democratic process<br />-  Outcome...
New structure to provide universal financial protection<br />Contributors<br />Public Insurances<br /> Co-responsible<br /...
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Mexico Health Reform

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Rafael Lozano, MSc, MD
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  • Wise words from someone who knew what he was saying and because he said it. In Mexico we consider that Daniel Cosio Villegas is one of the greatest minds of the twentieth century and a wise man.
  • Mexico Health Reform

    1. 1. Health Reform in Mexico in 2004: the origin of the Health Social Protection System<br />Rafael Lozano MD MSc<br />Global Health Seminar, “Aid and Health”<br />November 13 2009<br />
    2. 2. Outline<br />Background<br />Current Mexican´s facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help in the design of the 2004 Health Reform in Mexico?<br />Empowerment and action<br /> Ethical component<br />Legal process to get approval<br />Democratizing the health System in Mexico : Innovations<br />Stewardship<br />Financing<br />Services delivery<br />Lessons Learned<br />
    3. 3. 3<br />GDP PPP UDS per capita<br /><ul><li>Almost 2 mill Km2 (14th largest)
    4. 4. 11,000 Km of littorals
    5. 5. 3,000 km border in the north and 1,000 south
    6. 6. Huge biodiversity
    7. 7. 108 mill pop in 2009 (11th largest)
    8. 8. 75% in Urban areas
    9. 9. 56% in metropolitan areas
    10. 10. Rural means marginality, exclusion
    11. 11. 12% indigenous disperse
    12. 12. Administrative division:
    13. 13. 31 states and Federal District
    14. 14. 2,455 municipalities
    15. 15. 199 thousand localities</li></li></ul><li>4<br />100<br />90<br />1994 Gini = 0.511<br />2005 Gini = 0.489<br />80<br />70<br />60<br />% Income<br />50<br />40<br />30<br />20<br />10<br />0<br />10<br />1<br />2<br />3<br />4<br />5<br />6<br />7<br />8<br />9<br />Income Distribution Mexico, 1994 and 2005<br />Distribution of population by marginality Level<br />Source: ENIGH, 1994, 2005<br />Percent of Population living in Poverty, Mexico 1992-2008<br />
    16. 16. 5<br />DEMOGRAPHIC INDICATORS<br />2009<br />100<br />90<br />80<br />Male<br />Female<br />70<br />Rates x 1000 pop<br />60<br />50<br />50<br />45<br />40<br />Births rate<br />30<br />40<br />20<br />10<br />35<br />0<br />Progress (years)<br />Life expectancy <br /> <br />30<br />1.2<br />1.0<br />0.8<br />0.6<br />0.4<br />0.2<br />0.0<br />0.2<br />0.4<br />0.6<br />0.8<br />1.0<br />1.2<br />Migrants to USA<br />Millions<br />Millions<br />-<br />35.9<br />1930<br />25<br /> 30.0<br />13<br />49.0<br />1950<br />18.2 millions<br />1st. - 3rd. generation<br />20<br /> 25.0<br />12<br />60.9<br />1970<br />10<br />71.2<br />1990<br />15<br /> 20.0<br />5<br />76.6<br />2010<br />10<br /> 15.0<br />Mortality<br />11.1 millions<br />Born in<br /> Mexico<br /> 10.0<br />5<br /> 5.0<br />0<br />0.8<br />4.5<br />1930<br />1940<br />1950<br />1960<br />1970<br />1980<br />1990<br />2000<br />2010<br />2020<br />2030<br />2040<br />2050<br />1900<br />1910<br />1920<br />1930<br />1940<br />1950<br />1960<br />1970<br />1980<br />1990<br />2006<br />Year<br /> Mexican Origin<br />Born in Mexico<br />Life expectancy at birth<br />Years<br />85<br />Female<br />80<br />75<br />Male<br />70<br />65<br />60<br />55<br />50<br />45<br />40<br />35<br />1930<br />40<br />50<br />60<br />70<br />80<br />90<br />2000<br />10<br />20<br />30<br />40<br />2050<br />Sources: INEGI, CONAPO, DGIS, <br />
    17. 17. 200.0<br />Tasa x 1000 ajs edad<br />Diarrheas<br />180.0<br /> Respiratory Infections<br />160.0<br />Diabetes Mellitus<br />140.0<br />Ischemic Heart Disease<br />120.0<br />Cirrhosis<br />100.0<br />80.0<br />60.0<br />40.0<br />20.0<br />0.0<br />1955<br />1960<br />1965<br />1970<br />1975<br />1980<br />1985<br />1990<br />1995<br />2000<br />2005<br />Fuentes: Lozano R, 2008. Basada en INEGI y CONAPO varios años<br />70 years of mortality transitions in Mexico: ages and causes<br />Deaths by age<br />Fuentes: Lozano R, 2008. Basada en INEGI y CONAPO variosaños<br />
    18. 18. 20.0<br />18.0<br />17.3<br />16.0<br />15.1<br />14.0<br />Diabetes<br />53%<br />Ischaemic<br />Heart Dis<br />21%<br />Hyperntensive<br />Heart Dis<br />13%<br />Cerebro vascular<br />Dis<br />8%<br />11.4<br />Diabetes<br />70%<br />Ischaemic<br />Heart Dis<br />22%<br />Cerebro vascular<br />Dis<br />8%<br />12.0<br />Ischaemic<br />Heart Dis<br />22%<br />Cerebro vascular<br />Dis<br />8%<br />Hyperntensive<br />Heart Dis<br />13%<br />10.0<br />8.0<br />5.3<br />6.0<br />5.0<br />4.5<br />4.3<br />4.1<br />COPD<br />Malnutrition<br />Diarrhea<br />HIV/AIDS<br />Diabetes<br />52%<br />I.H.D<br /> 10%<br />Stroke<br />10%<br />4.0<br />3.3<br />I.H.D<br /> 74%<br />Stroke<br />16%<br />COPD<br /> 43%<br />I.H.D.<br />14%<br />I.H.D<br /> 86%<br />Stroke<br />14%<br />I.H.D<br /> 56%<br />Cirrhosis<br />14%<br />2.0<br />0.0<br />High <br />Cholesterol<br />High Blood <br />Glucose<br />High Body <br />Mass Index<br />High Blood<br /> Pressure<br />Physical<br />Inactivity<br />Low Fruit & <br />Veget. Intake<br />Alcohol<br />Others<br />Tobacco<br />Main killers of women in Mexico, 2006<br />Source: MOH/DGIS, HIGH, 2006<br />
    19. 19. Leading causes of DALYs by sex, Mexico 2005<br />Women<br />Men<br />%<br />%<br />
    20. 20. Predicted Infant Mortality by Municipality and Level of Marginality, 2005<br />90.0<br />Very Low<br />Low<br />Medium<br />High<br />Very High<br />80.0<br />70.0<br />Infantl mortality per 1000 lb<br />60.0<br />4.5<br />50.0<br />4.0<br />Diarrheas<br />40.0<br />3.5<br />Low resp Infec<br />Under nutrition<br />30.0<br />3.0<br />20.0<br />2.5<br />8.0<br />2.0<br />10.0<br />Source: CONAPO, 2008<br />TM &lt; 5 años x 1000 nv<br />7.0<br />1.5<br />0.0<br />6.0<br />-3.0<br />-2.0<br />-1.0<br />0.0<br />1.0<br />2.0<br />3.0<br />Birth Asphyxia<br />Marginality<br />1.0<br />Congenital Anomalies<br />5.0<br />0.5<br />Prematurity<br />0.0<br />4.0<br />Very Low<br />Very High<br />Hugh<br />Median<br />low<br />TM &lt; 5 años x 1000 nv<br />3.0<br />2.0<br />1.0<br />0.0<br />Very High<br />High<br />Media<br />Low<br />Very low<br />Source: Lozano R,2008<br />
    21. 21. Mexican Health System (before reform)<br />30%<br />15%<br />55%<br />40%<br />30%<br />30%<br />45%<br />45%<br />10%<br />Source: Frenk J. et al 2003<br />
    22. 22. Outline<br />Background<br />Current Mexican´s facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help in the design of the 2004 Health Reform in Mexico?<br />Empowerment and action<br /> Ethical component<br />Legal process to get approval<br />Democratizing the health System in Mexico : Innovations<br />Stewardship<br />Financing<br />Services delivery<br />Lessons Learned<br />
    23. 23. Reform<br />From Latin “reformare” … “form or shape again” (re-form)<br />“…make changes in (something) in order to improve it…”<br />to remove abuse and injustices<br />reclaim, regenerate, rectify<br />Synonymous: better, improve, amend, ameliorate, meliorate, innovation, transform, modification, etc.<br />Can we put adjectives to the word “Reform”?<br />Radical, minimalist, moderate, progressive<br />For Public Policy, Public Health and Social Analysis Purposes <br />aim to improve the system<br />describe changes to public services<br />reform may be: <br />no more than fine tuning<br />Redressing serious wrongs without altering the fundamentals of the system<br />Reform seeks to improve the system as it stands, never to overthrow it wholesale<br />
    24. 24. Health reform typically attempts to<br />Broaden the population that receives health care coverage through either public sector insurance programs or private sector insurance companies <br />Expand the array of health care providers consumers <br />Improve the access to health care facilities Improve the quality of health care <br />Decrease the cost of health care <br />Increase the financial resources for health<br />etc., etc.,<br />
    25. 25. Three generations of Health Reform in Mexico<br />14<br />2004<br />1982<br />1943<br />Million of population<br />1943 Foundation of the Modern Health System<br />1982 Toward a National Health System<br />2004 Health Social Protection <br />Source: Frenk J. et al 2003<br />
    26. 26. Health Reforms in Mexico: three generations<br />1943 Foundation of the Modern Health System<br />Ministry of Health<br />Social Security for all workers<br />1982 Toward a National Health System<br />Change of the Mexican Constitution <br />Article 4: Health protection is a right of the population and an obligation of the government <br />General Health Law <br />Decentralization of the health system (state level)<br />Coordination and Integration of health providers<br />Administrative Modernization<br />2004 Health Social Protection <br />Separation of financing from the provision of services to stimulate competition and accountability; <br />Evaluation of health interventions with the goal of designing cost-effective benefit packages; <br />Programs for the continuous improvement of quality of care; and <br />Increased participation of citizens in their care.<br />Source: Frenk J. et al 2003<br />
    27. 27. Outline<br />Background<br />Current Mexican´s facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help in the design of the 2004 Health Reform in Mexico?<br />Empowerment and action<br /> Ethical component<br />Legal process to get approval<br />Democratizing the health System in Mexico : Innovations<br />Stewardship<br />Financing<br />Services delivery<br />Lessons Learned<br />
    28. 28. Priorities for research<br />and development<br />(the intelligence)<br />National Health<br />Accounts<br />(the means)<br />National Burden<br />of Disease<br />(the problem)<br />Universal package<br />of health services<br />(the solutions)<br />Proposals for<br />reform<br />(the vehicle)<br />Cost-<br />effectiveness<br />analysis<br />Financing<br />(the require-<br />ments)<br />Analysis of system<br />performance<br />(the capacity)<br />Building the evidence<br />Frenk J., Lozano R., González MA, et al 1994<br />
    29. 29. Public Politics<br />Political<br />Ethical<br />Technical<br />Evidence andInformation<br />The Pillars of Public Politics on Health<br />Source: Frenk, J. 2005<br />
    30. 30. The challenges of the Mexican Health System <br />Equity: change in the health pattern with more social and regional inequalities <br />Quality: heterogeneous performance by provider and lack of responsiveness <br />Financial Protection: the uncertainty risk to have catastrophic expenditures <br />
    31. 31. Financial Protection<br />Motivation<br />Almost half the families have no health insurance, which leads to postpone care and to be incurred in catastrophic expenditures, as well as generating a deep injustice<br />
    32. 32. Financial Unbalances<br />Level: investment: 5.8% of GDP <br />Source of funds: the predominance out of pocket payments (55%) <br />Distribution 3.1 Among populations: 1.5 times between insured and uninsured 3.2. Between states: 8 to 1 in the state with the highest per capita federal spending and the state with the lowest per capita federal spending<br />State effort on health expenses: 119 to 1 between higher and lower<br />Destination: increasing the payroll, with a fall in infrastructure investment<br />
    33. 33. Financial imbalances Underinvestment<br />Health expenditure as percentage of GDP<br />16<br />13.9<br />14<br />12<br />10.9<br />Latin America average:<br />10<br />9.3<br />$ 36,948 mills. de USD<br />$ 356 USD per capita<br />Percent<br />8<br />7.2<br />6.9<br />5.8<br />6<br />5.3<br />4<br />2<br />0<br />Bolivia<br />Mexico<br />USA<br />Uruguay<br />Colombia<br />Costa Rica<br />
    34. 34. Financial imbalances<br />Source of funds<br />Social Security <br />61%<br />States<br />7%<br />Federal<br />32%<br />Private <br />Insurances<br />3%<br />Public <br />Expenses<br />42%<br />Out of<br /> Pocket<br />55%<br />
    35. 35. Financial imbalances<br />Unequal effort from the states<br />Federal<br />States<br />Percentage of federal and state expenses on health for uninsured population<br />100%<br />80%<br />60%<br />40%<br />20%<br />0%<br />AGS.<br />B.C.<br />B.C.S.<br />COL.<br />D.F.<br />HGO.<br />JAL.<br />MICH.<br />NAY.<br />PUE.<br />QRO.<br />S.L.P.<br />SON.<br />VER.<br />TLAX.<br />YUC.<br />ZAC.<br />CAM.<br />COAH.<br />CHIS.<br />CHIH.<br />DGO.<br />GTO.<br />GRO.<br />MEX.<br />MOR.<br />N.L.<br />OAX.<br />Q.ROO<br />SIN.<br />TAB.<br />TAMPS.<br />
    36. 36. Financial imbalances<br />Imbalance destination of the expenditure<br />Federal expenses by chapter<br />100%<br />80%<br />60%<br />40%<br />20%<br />0%<br />1995<br />1996<br />1997<br />1998<br />1999<br />2000<br />2001<br />2002<br />2003<br />Health care<br />Administrative<br />Investment on Infrastruc<br />
    37. 37. Financial imbalances<br />Impoverishment due to health spending<br />2 millions:<br />Catastrophic expenses (more<br />of 30% of <br />income available)<br />1.5 millions of families <br />.5 millions of families<br />1.8 millions of families<br />2.3 millions:<br />immiserizing spending ( &quot;Medical indigence&quot;)<br />Source: Encuesta Nacional de Ingresos y Gastos de los Hogares, 2000. <br /> Estimaciones CASESALUD<br />
    38. 38. Universality<br />Social Inclusion<br />NationalPortability<br />Equal opportunities<br />Explicit Priorization<br />Fair Finance<br />Free of Charge in the moment of use<br />Financial Solidarity<br />Co-respon-sability<br />Subsidiarity<br />Democratic Budgeting<br />Individual Autonomy<br />Accountability<br />Ethical foundations of the reform<br />Principles<br />Key Concept<br />Values<br />Democratization of Health <br />
    39. 39. Democratizing the health System in Mexico<br />Empower people making them aware about their entitlements<br />Transparency and accountability <br />Objectives of the Reform<br />Ordering the health financing and increasing public budget gradually, fiscally responsible and financially sustainable <br />To protect investments in prevention and health services to the community <br />To provide financial protection in health care to the population, especially the poorest<br />To transform the Incentives in order to achieve a democratic budgeting, which allows to increase the satisfaction of population&apos;s expectations<br />
    40. 40. More than a Legal process to get the change in the Law<br />Foundation of The National Institute of Public Health, January 1987<br />The Health and the Economy 1994, Frenk et al.<br />Beginning of the administrative period, Dec 2000<br />Release of the National Health Program 2000-2006, July 2001<br />Initiative sent to the congress, Nov 2002<br />Approval in the Congress, April 2003 (92% of votes in the senate house and 79% in the representatives house)<br />The Official Gazette published the decree that reforms and adds the General Health Law, May 2003 <br />Started the System of Social Protection in Health, January 2004<br />29<br />
    41. 41. State Reform<br /><ul><li>Collaboration between congress and presidency
    42. 42. Two level of government were involved (state and national)
    43. 43. Transcendence of more than one administrative period (2004 to 2010)</li></li></ul><li>Outline<br />Background<br />Current Mexican´s facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help in the design of the 2004 Health Reform in Mexico?<br />Empowerment and action<br /> Ethical component<br />Legal process to get approval<br />Democratizing the health System in Mexico: Innovations<br />Stewardship<br />Financing<br />Services delivery<br />Lessons Learned<br />
    44. 44. Structural reform of the health systemfinancing<br />Innovations<br />Universalization of social security on health<br />Establishment of the System on Social Protection in Health<br />Master Plan for Health infrastructure<br />Protection against catastrophic expenses<br />Budget priority for public health<br />New plan for democratic budgeting<br />Affiliation with explicit rights for all people<br />
    45. 45. Reorganization of the Mexican Health System<br />Source: Frenk J. et al 2003<br />
    46. 46. Stewardship<br />Key function, mother function<br />“…To do that others do what they must do…”<br />Tools and rules<br />Coordination, regulation, monitoring and evaluation<br />Create instruments with explicit rules for financial transfers<br />Priority setting to a package<br />Certification of health infrastructure<br />Orient financial flows Demand instead supply<br />Accountability <br />
    47. 47. Stewardship<br />IV. How do we measured the advances<br />Accountability as part of the democratic process<br />- Outcomes measurement and Health System performance assessment<br /><ul><li> Accountability</li></li></ul><li>Relation Between types of goods and financing funds in the System of Social Protection on Health<br />
    48. 48. New structure to provide universal financial protection<br />Contributors<br />Public Insurances<br /> Co-responsible<br />contributor<br />Federal Government<br />Beneficiary<br />IMSS salaried employees in the private sector<br />Private Employer<br />employee taxes<br />Social<br />contribution<br />Public Employer<br />Social<br />contribution<br />Employee <br />taxes<br />ISSSTE salaried employees in the public sector<br />Seguro Popular non-salaried workers,self-employees, families outside of the formal labour force<br />Family<br />Solidarity contribution<br />Social<br />contribution<br />State<br />Federal<br />Gov<br />
    49. 49. Service Delivery<br />Master plans<br />Investment in infrastructure<br />Medical equipment<br />Human resources<br />Universal Coverage<br />Essential package (249)<br />Catastrophic expenses (17)<br />Improving the Quality of care<br />Accreditation of health facilities<br />
    50. 50. Dimensions of <br />Universal Coverage<br />Type of coverage<br />Criteria<br />Reference<br />Gender and socioeconomic Equity<br />Target Population<br /><ul><li> Horizontal</li></ul>Type of Health Intervention<br /> Explicit for <br />Setting Priorities<br /><ul><li> Vertical</li></li></ul><li>Toward universal coverage<br />ACELERETED COVERAGE<br />GASTOS CATASTROFICOS<br />Package of Interventions<br />Benefits<br />Family<br />Insurance<br />PREVENTIVE ACTIONS FINANCED BY SEGURO POPULAR<br />COMUNITY HEALTH SERVICES<br />poor<br />I II III IV V VI VII VIII IX X<br />Rich<br />Income deciles<br />
    51. 51. Seguro Popular<br />Accelerated Vertical Coverage<br />New vaccines<br />Equal start of life<br />New vaccines<br />Children & adolescents Cancer<br />Cervix Cancer<br />Children Cancer<br />Cataracts<br />HIV/AIDS<br />&lt; 9 months<br />2 years<br />5 years<br />18 years<br />60 years<br />Life line<br />
    52. 52. Outline<br />Background<br />Current Mexican´s facts<br />Health reforms in Mexico 1943-2004<br />How evidence did help in the design of the 2004 Health Reform in Mexico?<br />Empowerment and action<br /> Ethical component<br />Legal process to get approval<br />Democratizing the health System in Mexico: Innovations<br />Stewardship<br />Financing<br />Services delivery<br />Lessons Learned<br />
    53. 53. Lessons Learned<br />The ABCDE of the successful reform<br />Agenda<br />Budget<br />Capacity<br />Deliverables<br />Evidence<br />Healthy Policies<br />National Commission for Risk Protection<br />Global Public Goods for local decision-making<br />
    54. 54. Report 2009 1stsem(NCSPH)<br />Affiliation<br />9.6 millions of families (28.5 millions of people)<br />Almost all Municipalities<br />Increase in the number of people of the first and second deciles (including indigenous population)<br />New generation program (2.2 million)<br />Healthy pregnancy (380 K)<br />90.9% of re-affiliation<br />Services Delivery<br />39 million of visits<br />Half a million of hospital discharges (245 K of deliveries)<br />Waiting time 58 min (?)<br />78% of patients have received all drugs from doctor prescription (?)<br />Financial imbalances follow up<br />Source: Frenk J., et.al. 2006<br />
    55. 55. Critical aspects<br />Summary of findings<br /><ul><li>Increasing health funding in Mexico is important, but independent evaluations suggest that SP is not the most successful model to achieve equity, efficiency, and quality care.
    56. 56. Promote privatization of health services
    57. 57. Federal government funding below promised levels
    58. 58. Bureaucratic rigidity and slow implementation of contracts
    59. 59. Limited progress in signing SP portability agreements among states
    60. 60. The use of funds for purposes other than those for which they were intended</li></ul>The poor are affiliating to Seguro Popular<br />More resources are available for the uninsured and the distribution of resources across states is more equal<br />Mixed results for utilization of health services among SP affiliates<br />Composite coverage has increased for the country and for the uninsured <br />Inequalities in coverage have decreased across states and across wealth deciles<br />Catastrophic spending is lower among SP affiliates than the uninsured, especially within subgroup that use health services<br />
    61. 61. 46<br />National Health System (2007)<br />Physicians<br />%<br />Beds<br />%<br />Population Affiliated<br />%<br />Health Expenses per capita<br />USD<br />Hospitals<br />%<br />87.9<br />34.5<br />33.3<br />42.4<br />No Medical Insurance<br />26.8<br />325.6<br />36.0<br />36.5<br />27.9<br /> Medical Insurance<br />73.2<br />324.8<br />25.0<br />27.6<br />16.3<br /> IMSS<br />35.8<br />231.9<br />7.7<br />5.9<br />6.4<br /> ISSSTE<br />7.5<br />216.8<br />Seguro Popular (Health Reform)<br />25.5<br />910.0<br />3.2<br />3.2<br />5.0<br />Others<br />1.5<br />1,000.0<br />29.5<br />30.2<br />29.7***<br />Private<br />2.9<br />534.2<br />218**<br />115**<br />1,664<br />Total (absolute)<br />106*<br />* Millions ** thousands *** Includes Hospitals over 15 beds. Private Sector has more than 2.5 thousand small hospitals <br />
    62. 62. Lesson Learned<br />Money matters. More money better result, but just at the beginning, after, strong management is needed<br />Health reform is more complicate that a change of the law. Besides the need of lobby is necessary to build good stakeholders<br />How do get ownership of the reform?<br />More that the inner circle <br />Institutionalization of the change<br />How do get the achieved the goals offered?<br />Affiliation<br />Increase the budget<br />Change the predominance of private money<br />Increase the quality of care<br />Decrease inequalities<br />
    63. 63. Daniel Cosio Villegas<br />Those that are inside of the government know what is going on, but they don&apos;t have time to write anything; however who is out the government write many things, but they don&apos;t have any idea of what is going on<br />48<br />

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