Limited Resource Allocation Damages Public Health System

Q: How has health grown to be one of CIEP’s core areas of focus?

A: We have been working in the health arena for a little over 10 years. It has always been one of our priority areas but since 2015, we started to develop much more in-depth research, mainly due to structure, demographic changes and, eventually, the COVID-19 pandemic. We have obtained amazing results since the beginning, especially considering the kind of budget that is allocated to the industry at the international level and within the company.

Q: How can CIEP’s research positively influence decision-making in the Mexican health sector?

A: We seek to reach two main audiences: decision-makers and the general population. We try to be included in public discussions to present our findings, like in Open Parliament. Thanks to our presence in these forums, we have also benefited from media coverage, which is key to disseminating this information among the general population.

We also publish infographics or microsites for the latter group, designed to present clear and simple information in the form of images, infographics or videos.

Q: Mexico’s health system is systematically fragmented. How much does this influence the smart use of health resources?

A: A fragmented system is not necessarily a bad thing, as long as the different subsystems communicate with each other and work toward economies of scale. This is not the case, however, in Mexico. Inequality is rampant among the different systems and even the allocation of resources per capita is different. This leads to significant inefficiency. For example, PEMEX has a per capita expenditure of around MX$20,000 (US$987). IMSS-Bienestar has a 10th of that budget.

Q: What are the main differences between theoretical coverage and effective coverage established by CIEP?

A: Theoretical coverage is the concept of universal health coverage based on three dimensions: affiliated population, budget and services provided and physical and human capacity. In theory, the health system would give the entire population the services they require as well as the economic resources they need. However, this coverage model is Utopian. It is almost impossible to obtain due to the natural limitations of the system.

Health system coverage can be measured through the rate of care, which refers to the percentage of the population that received medical attention when they need it. From 2018 to 2020, it dropped from 40 percent to 30 percent, meaning that only three out of every 10 people affiliated to the public health system were able to receive care when they needed it.

Q: Mexico’s private expenditure in healthcare almost equals public expenditure. How does this issue affect the population?

A: By monitoring public expenditure we can understand how a reduction affects a household’s out-of-pocket spending. Private expenditure in healthcare increased by 40 percent due to the decrease of public services, which has a much greater impact on lower-income households. The decrease in public expenditure impacts out-of-pocket expenses and the health of citizens, putting their lives at risk when they do not have access to these resources.

Q: Based on your research, what are the emerging challenges for Mexico’s public health system?

A: A large challenge is the gap in resources. Despite the budget increase seen after the COVID-19 pandemic, Mexico’s healthcare expenditure did not reach 3 percent of GDP. We do not see fiscal reforms aimed at allocating greater resources to healthcare, affecting the sector’s governance, logistics, purchases of supplies and medicines, among other areas.  Policies to allocate more resources to health are not being implemented or discussed, while the demographic and epidemiological environment will demand more from the health system.

The low investment in health could create greater risks for the population, which will lead those who can afford it to use private services. The population that does not have the financial means to access those services will face the largest risks.

The Economic and Budget Research Center (CIEP) is a nonprofit, nonpartisan civil society research center that provides accessible, relevant and technically sound information and analysis to influence, improve and democratize discussions and decision-making around the economy and public finances.