Legislative Reforms, AMASFAC Insights on Insurance Challenge

According to the Mexican Association of Insurance and Surety Brokers (Amasfac), Mexico had an increase in medical expense insurance, with annual growth rates ranging between 22% and 26%. The organization attributes this rise in part to increasing healthcare costs, including hospital fees and medical services.

One of the main challenges affecting the sector is the inflated cost of medical services, which includes extended hospital stays, pricing inconsistencies, and higher medication. The organization states that charges from doctors and hospitals differ significantly as supplies can be priced four to five times higher than in commercial pharmacies.

Another issue identified by AMASFAC is pricing discrepancies for insured versus uninsured patients. For ABC Noticias, Ricardo Rosado, Vice President of Individual Policies, AMASFAC, states that hospitals offer lower surgery costs to uninsured patients compared to those with insurance coverage. "For an appendectomy, an uninsured patient might be charged MX$60,000 (US$2960), while the same procedure billed through insurance could total MX$250,000," adds Rosado. 

In February, Federal Deputy Jericó Abramo Masso introduced a legislative initiative aimed at regulating and organizing insurance companies that provide major medical expense coverage.

Abramo Masso outlined three key points of the proposal, each addressing concerns raised by policyholders during the drafting process: the establishment of competitive fee standards for doctors outside insurance networks, a catalog of doctors within insurance networks and major medical expense plans, and a cap on premium increases, which cannot exceed inflation plus a maximum of five percentage points per year. “A crucial aspect is putting an end to excessive hospital charges for medications, which can be inflated by 10 to 20 times their actual value,” added Masso to the Chamber of Deputies. 

The Federal Deputy’s proposal includes modifying Art. 200 of the Insurance and Surety Law, the Health Law, the Contract Law, and Art. 230 of the Penal Code. "Insurance companies blame hospitals for inflating costs, while hospitals accuse insurers of not paying. In the middle of this issue, it is the policyholder who suffers," Masso emphasized for MVS.