Mexico's Universal Healthcare Progress Highlighted in The Lancet

An article in the 16 August edition of The Lancet highlights the upward trajectory of success Mexico is having in building a universal healthcare system, while simultaneously taking stock of the challenges that lay ahead for the country. The authors posit that out of the three stages necessary to successfully implement universal health coverage—universal enrolment, followed by regular access for all to health services with financial protection, and the final stage being high quality services which require limited out-of-pocket (OOP) expenditure—Mexico has had success with the first two, but still has a long road ahead to complete the last stage.

Although universal health coverage has been long in the making, with the first murmurings of action dating back to the 1970s, Mexico's 2003 health reform solidified and galvanised the drive. These reforms legislated the Systems of Social Protection in Health (SSPH), which saw the establishment of the public health insurance scheme Seguro Popular, which aimed to give all Mexicans access to adequate health services regardless of income. Precipitated by, among other things, the exclusion of the poor from financial protection and health insurance and high OOP payments for most citizens, the health SSPH in general and Seguro Popular in particular sought to correct imbalances and to provide healthcare coverage to the previously excluded over 50 million Mexicans. This was to be achieved by structural and competencies changes and by using public resources to increase funding for healthcare by one percentage point of GDP. Hospital reform, drug supply improvements, and technology assessments complemented these efforts.

Less than 10 years after the SSPH came into being, it can already be considered a success argue the journal authors, as evidenced by the 52.6 million Mexicans who have been integrated into the programme and the budget allocation for universal coverage is complete. Rising health indicators over the last nine years also speak of its success. Maternal and child mortality is on the decline; cancer screening and prevention services have prevented deaths and in turn rates are dropping.

Although Mexico should be heralded as a beacon in the quest for universal healthcare, the authors are quick to point out that much work still needs to be done. The authors highlight that gaps and disparities in quality between and among regions still persist and OOP expenditure has only dropped marginally. The goal of providing all citizens with similar quality and financial protection still remains an elusive goal and necessitates the implementation of additional reforms, specifically ones which, as the authors note, "translate financial resources into more effective, equitable and responsive health services".

Outlook and Implications

Implementing universal health coverage is a goal of many nations, yet putting rhetoric into practice is a struggle shared on a global level. Indeed, one just has to look at Mexico's northern neighbours to see what a quagmire it can be. Given the herculean task, Mexico's quest, although replete with challenges and still shrouded in uncertainty, can still be lauded. The health reform was built on the premise that healthcare is a right of citizenship and not a privilege reserved for salaried workers. One reason that the goal may not have been abandon despite the economic hardship and downturns that the county has endured is the perception that the goal of implementing healthcare has far reaching implications that go beyond health, but is viewed as something that is a human right. Other nations considering similar measures will have to think long and hard on the idealogical stance on whether healthcare is a privilege or a right of any citizen. In any case, Mexico's next steps vis-à-vis universal healthcare coverage will be closely monitored by emerging markets and developed markets hoping to have similar outcomes.