Health System Reform Strategies and Health Social Protection in Mexico, part two: effects on equity, efficiency, accessibility and health conditions

Abstract

Objective: To identify health system reform effects on populations’ health conditions indicators, and on equity, efficiency, coverage and health system performance. Methods and data sources: A design of evaluative research based on rapid assessment was developed. The research object it was the health system for uninsured population in Mexico, focusing on six States selected considering technical, political and financial feasibility: Baja California Sur, Jalisco, Tabasco, Oaxaca, Hidalgo y Colima. For primary data gathering structured interviews with key informants of selected States were done; for secondary data official statistics and research results of the macro project on health system reform, health policy, equity, financing and health governance in Mexico were used. Data processing was carried out using three software packages, Atlas-Ti and Policy Maker for qualitative information, and Stata for quantitative data. Results / Conclusions: Health system reform has produced an important increase in health financing amounts and changes in major effective coordination mechanisms among government levels in selected states. These changes have also coincided with positive gains in some social indicators and improvements in infant mortality, maternal mortality and morbidity of infectious and chronic diseases. There are evidences of improvement of health system performance which are coincident with implementation of the changes. The Popular Health Insurance is a financing strategy with a solid equity principle; it is the first time that money follows health services users if he or she moves from one State to another, a relevant situation because of internal migration of informal sector workers. In some States low income users do incur in catastrophic health expenditure. The measures implemented so far for the advance in equity in resources allocation for uninsured population aren’t sufficient, as shown by higher inequity indicators in the poorest States.