Mexico achieves universal health coverage in less than a decade

Mexico has achieved universal health coverage in less than ten years, with more than 50 million previously uninsured Mexicans enrolling on a public medical insurance scheme since 2004.

Writing in The Lancet, a group of public health experts – including Julio Frenk, Dean of the Harvard School of Public Health and former Minister of Health of Mexico – highlight the progress that Mexico has made towards achieving comprehensive health coverage, as well discussing some of the healthcare challenges that remain for the country, which has a population of more than 100 million.

According to current Minister of Health of Mexico Salomón Chertorivski, a co-author on the report, "Mexico devised and implemented a reform and then demonstrated, with evidence, how a large, middle-income country can transform its health system and successfully achieve universal health coverage in one decade".

Until 2004, adequate medical insurance was only available to Mexican citizens who could access social security schemes through their employment, or via expensive private insurance. Those people who were not in regular salaried employment and could not afford private health insurance were unable to access adequate health care, unless they were able to meet significant out-of-pocket expenses.

However, in 2003, the Mexican Congress approved reforms to Mexico's health legislation, establishing the Sistema de Protección Social en Salud ('System of Social Protection in Health', or SSPH). These reforms enabled the introduction of Seguro Popular ('popular health insurance'), an ambitious government-funded scheme which aimed to ensure that even the poorest Mexican citizens have access to an adequate standard of health care – from treatment for the most pressing chronic and catastrophic illnesses, to preventative healthcare such as vaccination and diabetes screening.

According to lead author Professor Felicia Knaul, of the Mexican Health Foundation and Director of the Harvard Global Equity Initiative, "In 2012, the 9th year of implementation, the country reached a major milestone in universal coverage. As of April, 52.6 million Mexicans, previously uninsured, were incorporated into the SSPH and the budgetary allocation for universal coverage was achieved. Every Mexican, regardless of their socio-economic situation, has access to the financial protection in health that shields them from facing the terrible choice between impoverishment and suffering or even death."

According to Dr Julio Frenk, architect of the original reform, "The quest for universal health coverage in Mexico has produced remarkable progress and many valuable lessons. It shows the value of sound evidence in fuelling a virtuous upward spiral of policy formulation, implementation, evaluation and back to the formulation of new and improved policies on the basis of lessons learned. This experience is relevant to countries of both high and lower income."

Examining the evidence for the effect that Seguro Popular has had on the nation's health, the authors point out that it may be too soon to say whether specific successes in Mexican health care are due to the successful implementation of universal financial protection in health, but health indicators have steadily increased in the nine years since Seguro Popular was introduced. Coverage of several key interventions rose significantly since the implementation of the reform. Antenatal care increased 14% to cover more than 81% of women, treatment of acute respiratory infections in children under age 5 increased almost 6%, and cervical cancer screening in women 25 to 64 more than 7% to cover almost half of the population in addition to introducing HPV vaccination in 2011.

Significant challenges remain – there are still disparities between the quality of healthcare in different states due to the way funding is distributed, and ensuring that populations in remote rural areas have effective access to healthcare are just two ongoing difficulties. However, according to Professor Knaul, "Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health bills for the poor."

"The Mexican experience is especially noteworthy for having continued despite and throughout economic downturn and periods of economic crisis. The challenge now for Seguro Popular and for the Mexican health system as a whole is to achieve more health for money."

In a Lancet Editorial accompanying the paper, Mexico's health reforms are described as a "remarkable feat", with the journal pointing out that "crucially, Mexico has demonstrated how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development."