Mexico Has No Universal Health Coverage: INSP

Forty years after Mexico enshrined the right to health protection in its Constitution, the country has failed to guarantee this fundamental right, said Juan Rivera, General Director of the National Institute of Public Health (INSP) during the webinar ‘Access to health services: a current challenge for Mexico.’

“Our country has not achieved universal coverage or effective access,” said Rivera. Achieving effective universal coverage requires a reorganization of the system, he explains. “Thus, a strategy must be based on strengthening public health and primary care services through increased funding and reorganization.”

The limited access to healthcare services conclusion is supported by an analysis of the population that uses pharmacy adjacent medical offices (PAMOs). PAMOs in Mexico are used by those who have access to public health coverage and those who have not. “The primary reasons why PAMOs are the top choice for the people is because of their low-cost, immediate attention, high schedule availability and the chance to obtain an immediate prescription,” said Laura Flamand, Research Professor, Colegio de Mexico (COLMEX). Only 12 percent of those who use PAMOs could satisfy their ambulatory health needs through public health services, found Flamand’s study “The responsibility of the state in the access of health services.” She also found that about 63 percent of those surveyed did not even reach out to public services for attention.

However, during the pandemic, many PAMOs were forced to close and the low-income crisis caused by the pandemic pushed people to endure while sick, which was reinforced as hospitals were mainly treating COVID-19 cases.

In Mexico, social security from its largest institutions, such as IMSS, ISSSTE and PEMEX, is conditioned to formal employment. Those not affiliated one of Mexico's main public health providers can receive care from Ministry of Health’s hospitals but data shows that only 26 percent of the unaffiliated received attention at one of these hospitals. On the other hand, 24 percent visited a PAMO and paid for their care out of pocket, shared Arantxa Colchero, Researcher, CISS-INSP.

In Mexico, 49.1 percent of medical care was obtained at a private healthcare provider, a large percentage of it financed by the poorest segment of the population. “Prior to the pandemic, homes in rural zones of the country with seniors and young children were the ones with the highest expenditure on health,” explained Sergio Bautista, Researcher, CISS-INSP. People with chronic diseases had also some of the highest expenditures.

The pandemic enhanced income inequalities, leading many to be able to spend less on healthcare, said Bautista. Private healthcare expenditure contracted from 54 percent in 2018 to 46 percent in 2021. “This does not mean they reached out to the public sector for attention, which focused on COVID-19 attention.” Bautista explained if public health expenditure was to increase by a 6 percent, the out-of-pocket expenditure coming from Mexico’s most impoverished group (which accounts for 20 percent of the total population) would be covered.

“In 2020, those who spent the most in healthcare were the ones more affected by the economic impact of the pandemic. Their money was primarily directed to medical consultations, medicines and hospitalizations associated with COVID-19, whereas in the past, chronic diseases, children and geriatric needs were the main reason for expenditure,” found Bautista.