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

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