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Are the reforms of the health sector responding to Latin America's health challenges? The case of Mexico's Seguro Popular

Date: Poster sessions
Source: Forum 11
Authors: Hector Ochoa, Researcher, Health, Society, Culture and Health, El Colegio de Frontera Sur, Mexico
with Rosario GarcĂ­a

Abstract

Following the economic crisis of the eighties, and the `structural adjustment' advocated by the International Monetary Fund (IMF), public expenditure in health in most Latin American countries was reduced substantially. As a consequence, health-care systems weakened and inequities in both health status and health care increased. Multilateral organizations, such as the World Bank and the Inter-American Development Bank (IDB), responded to this situation by promoting neo-liberal reform of the health sector in the region based on privatization and decentralization. Among the principle Latin American examples of this are health reforms taking place in Chile, Costa Rica, Colombia and recently in Mexico.

By analysing the effectiveness of Mexico's Seguro Popular (popular health insurance) to improve equity, efficiency and quality of health services, this presentation is aimed at responding to the following question: What lessons for Latin America and elsewhere could be drawn from the Mexican experience?

The study uses secondary data from national household health, income and expenditure surveys, national health accounts data, health status, health services and resource statistics, statistics from the National Commission for Social Protection and data from the authors' own work in Chiapas in southeastern Mexico.

The achievements, drawbacks and problems of Seguro Popular have been analysed by reviewing various aspects such as: the involvement of the main stakeholders (e.g. legislators, health workers, patients and civil society) in the design; national and international evidence used; conceptual orientation (health objectives vs. economic rationality); type of decentralization of decision-making, planning, budgeting and management; content of the health-care services packages; orientation of health programmes (selective vertical vs. horizontal); costs and quality of health-care services; sufficiency of human and financial resources to meet the goals; impact on improving health status and reducing health-care inequities; and impact on health workers salaries and working conditions.

This study recommends the implementation of mechanisms for public monitoring of the performance of Seguro Popular, particularly on health status results and use of financial resources in a more transparent way. Conditions under which the agreements between the federal and state governments were signed should be fully disclosed to the public. The importance of analysis and evaluation of the programme by independent research teams is stressed. Recommendations focus on ways to emphasize the social dimension of health and health care by transforming the minimum health package for the poor to a comprehensive and high-quality health-care service centered on populations' needs and concerns.