Teaching Comparative Government and Politics

Wednesday, February 09, 2011

Health insurance in Mexico

Mexico's program of health care insurance illustrates the capacity of the state and its limits.

Mexico’s Universal Health Care Is Work in Progress

A decade ago, half of all Mexicans had no health insurance at all. Then the country’s Congress passed a bill to ensure health care for every Mexican without access to it. The goal was explicit: universal coverage.

By September, the government expects to have enrolled about 51 million people in the insurance plan it created six years ago — effectively reaching the target, at least on paper.

The big question, critics contend, is whether all those people actually get the health care the government has promised…

Even critics who argue that the government is failing to live up to the promise of universal health coverage acknowledge that Mexico’s program saves lives and protects families from falling into poverty in many cases of catastrophic illness.

But the task of covering so many people’s care, with a budget of about $12 billion this year, is enormous…

This month, Mexico’s health minister, José Ángel Córdova, acknowledged... gaps, noting that 8 percent of the country’s municipalities still lacked any kind of health facility. “There is still first-, second- and third-class medicine,” he said in a speech.

While the undertaking is relatively young, the Health Ministry’s own statistics show that it is behind its own targets in reducing infant and maternal mortality — key health indicators — in the poorest states…

The money goes from the federal government to state governments, depending on how many people each state enrolls. From there, it is up to state governments to spend the money properly so that patients get the promised care.

That, critics say, is the plan’s biggest weakness. State governments have every incentive to register large numbers, but they do not face any accountability for how they spend the money…

The result is that how Mexicans are treated is very much a function of where they live…