The Mexican Health Care System Enrique Rios M.D. Dr.P.H.

July 2008

ContentsContents

1.Health Situation in Mexico

2.Organization of the Mexican Health Care

System

3.The Health Care Delivery Model

4.The Migrant Health Program

Health Situation in Health Situation in MexicoMexico

4

Demographic Transition in Mexico

Men Women

Millions

7 6 5 4 3 2 1 0 1 2 3 4 5 6 77 6 5 4 3 2 1 0 1 2 3 4 5 6 7

1975 2000 2025

Annual growth rate65 years and older: 3.8%Under 5 years old: -1.3%

85 +80-8475-7970-7465-6960-6455-5950-5445-4940-4435-3930-3425-2920-2415-1910-14

5-90-4

5

CHANGES IN THE DISTRIBUTION OF CAUSES OF DEATH IN MEXICO, 1955-2005

0

10

20

30

40

50

60

70

80

90

100

1955 1960 1970 1980 1990 2000 2006 2030

PER

CEN

TA

GE

Communicable diseases, reproductive and malnutrition related diseases.

Non communicable diseasesInjuries

6

Epidemiological Transition in MexicoEpidemiological Transition in Mexico Selected causes of deathSelected causes of death

Mexico, 1955-2005Mexico, 1955-2005

Source: INEGI/Sec Salud. Mortality Database

Ill-defined

Diabetes

Congenital A.

Maternal Cond.

Neuropsychiatric Cond

Genitourinary Dis.

Chronic Respiratory Dis.

Malignant Neoplasms

Malnutrition

Injuries

Cardiovascular Dis.

Perinatal Dis.

Respiratory Inf.

Diarroheal Dis.

Infectiuos and Parasitic

35% 25% 15% 5% 5% 15% 25% 35%0%

20051955

EpidemiologicEpidemiological backlogal backlog

Emerging Emerging problemsproblems

Ill-definedIll-defined

7

0 5 10 15 20 25

ChisMexOaxPueTlaxGro

MEXICOSLPDF

ChihVerYucMorZac

MichQroTabGto

CoahHgoNayJal

SonBC

TampsColSin

CampBCS

QrooDgoNL

Ags

PERCENTAGE

PORCENTAGE OF DEATHS IN CHILDREN UNDER 5 CAUSED BY INFECTIOUS DISEASES BY STATE, MEXICO 2005

In Chiapas one of every four deaths in children under 5 is caused by diarrhea or a respiratory disease. In Nuevo Leon, one on twenty.

Challenges to the Health Care Challenges to the Health Care SystemSystem

Increasing costs to treat the demand of chronic diseases and longer treatments

Continue to deal with infectious diseases

Emerging health risks: obesity, depression and smoking

Coping with re-emerging diseases (TB, SARS, Influenza Pandemic, HIV, etc)

Organization of the Organization of the Mexican Health Care Mexican Health Care

SystemSystem

Mexican Health Care SystemBasic Components

1. Governmental organizations: providing services for the uninsured population (Ministry of Health and IMSS-Oportunidades)

2. Social Security: covering workers in the formal private sector of the economy, state and federal workers, the armed forces and employees of the national oil company (IMSS, ISSSTE, PEMEX)

3. Private sector: made up of an unorganized myriad of health care providers working in hospitals and clinics on a for-profit basis

The Mexican Health Care SystemThe Mexican Health Care System

What is known in Mexico as “Social Security System”, provides the following services to their beneficiaries:

Health care coverage including medicines

Unemployment insurance

Disability insurance

Life insurance

Retirement benefits

50 million

50 million

5 out of 10 Mexicans lack social security

due to their labor or social status

Population without social Population without social

security coveragesecurity coverage

Mexican Mexican Population Population

100 100 millionmillion

Mexican Health Care SystemMexican Health Care System

The Mexican Health Care System

Main Problems :

Fragmentation and lack of coordination

Inequity in access to care

Dissatisfaction with services provided

Imbalance in resources

The Health Care The Health Care Delivery ModelDelivery Model

Institutional Health Services

Tertiary Care

Secondary Care

Primary Care

Population

Health Care Delivery ModelHealth Care Delivery Model

The Migrant Health The Migrant Health Program Program

BackgroundBackground

In September 2000, the Joint Statement for Migrant HealthJoint Statement for Migrant Health was signed by the Head of

Department of Health and Human Services of the United States of America (HHS) and the

Mexican Ministry of Health.

The two main objectives were:

to develop activities to meet the health needs of Mexican migrants and

to strengthen binational collaboration on Migrant Health issues

Therefore, the Ministry of Health included in its National Health Plan 2007-2012 two Programs

to address the health of the migrant population

Programa de Salud del Migrante (Migrant Health Program)

Programa Vete Sano Regresa Sano

ObjectiveObjective

To protect the health of the migrant

population and their families in their transit

and final destination, with specific

strategies for binational collaboration on

health promotion and health care delivery

services that are culturally appropriate.

Activities:

Workshops for Health Professionals (Jornadas Informativas, IME) Border Health Commission Mexico – USA Border Health Commission Mexico - GuatemalaCollaboration with the National Institute of Migration (INAMI)Collaboration with the Vete Sano Regresa Sano Program

Strategy 1. Strategy 1. To strengthen Mexican institutional To strengthen Mexican institutional

collaboration on migrant healthcollaboration on migrant health

Strategy 1. Strategy 1. To strengthen Mexican institutional To strengthen Mexican institutional

collaboration on migrant healthcollaboration on migrant health

Border Health Commission Mexico – USA

The United States-Mexico Border Health Commission was created in July 2000 between the US and Mexico governments.

Objective:To provide international leadership to optimize health and quality of life along the U.S.-Mexico border.

Main Programs:

• EWIDS – Early Warning Infectious Disease Surveillance• BIDS – Border Infectious Disease Survelillance• Healthy Border 2010

Strategy 1. Strategy 1. To strengthen Mexican institutional To strengthen Mexican institutional

collaboration on migrant healthcollaboration on migrant health

Border Health Commission Mexico – Guatemala

May 2003

Sign of the Agreement between Mexico-Guatemala.

Objectives:

• To support health promotion and disease prevention activities.

• To strengthen migrant health delivery and information systems .

• Provide protection against sanitary risks and laboratory infrastructure.

Strategy 1. Strategy 1. To strengthen Mexican institutional To strengthen Mexican institutional

collaboration on migrant healthcollaboration on migrant health

Collaboration with the National Institute of Migration (INAMI)

November 2006.

Sign of the Collaboration Agreement focus on actions that

guarantee the health protection and prevention of risk for those

foreigners assured in the 52 migratory stations in 22 States of

Mexico through a Specific Program.

Priority Topics:

- Health promotion and prevention of diseases

- Medical treatment

Strategy 2.Strategy 2. To promote binational public awareness of To promote binational public awareness of

migrant health issuesmigrant health issues

Activities:

Signing of binational health collaboration agreements (Oregon and New Mexico)

Collaboration with the Initiative of the Americas of California

Training workshops and health information sessions for “promotoras” (health promoters) within the migrant population.

Strategy 2. To promote binational public awareness

of migrant health issues

Binational Health Week and Binational Public Policy Forum:

An annual weeklong series of health promotion and education activities geared to the migrant population.

The goal is to highlight the cooperation between our two

countries to improve the health of Mexican migrants

Strategy 3. To provide support servicesStrategy 3. To provide support services to the migrant population and their families to the migrant population and their families

Activities:

Creation of a Binational Health Insurance

Collaboration with the National Center for Farmworker Health

Ventanillas de Salud (Health Windows): at the Mexican Consulates more than 150 thousand people have received counseling and referrals to medical services

Collaboration Program Mexico – California (Prevention of Cervical Cancer, Diabetes, Occupational Health, etc)

Strategy 3. To provide support servicesStrategy 3. To provide support services to the migrant population and their families to the migrant population and their families

Activities:

Mexico-Canada Temporal Agricultural Workers Program (PTAT) : 15,000 Mexican workers were employed in Canada in 2006

Sick Nationals Program

PAHO/WHO Regional Office in Chiapas

Affiliation of the Mexican migrant population to Popular Health Insurance

Strategy 4. Strategy 4. To foster binational research To foster binational research

on migrant healthon migrant health

Activities:

Publication of the results and conclusions of the Public Policies Forums on Health and Migration.

Financing binational research in collaboration with the UC

Collaboration and academic linkage with Mexican and American Universities

Publication of Migrant Health Fact Sheets, in collaboration with The Iniciative of the Americas

Thank you