Mexico’s Right to HealthBy Miriam Bello | Thu, 02/25/2021 - 14:27
In February, Mexico commemorates the enactment of its Constitution, written in 1917. The document specifies the rights that all Mexicans enjoy regardless on their situation, including the right to health:
“Everyone has the right to health protection. The law will define the bases and modalities for access to health services and will establish the role of the Federation and the federative entities in matters of general health…”
Many reforms were made to this original paragraph, which has added in 1983 to the 1917 Constitutions. The most important of them might be the one from 2011, which recognized the protection of health, not just as a guarantee for equality but a as a constitutionally recognized human right, which is to be promoted, respected, protected and guaranteed.
The constitution also states that it is the State’s responsibility to ensure medical assistance once health, for whatever reason, has been compromised, which makes up the “right to healthcare or assistance.” It also forces individuals, for example private medical facilities, to provide emergency services to anyone who requires them, regardless of whether or not they can afford it. If the person does not have the financial resources to remain in the private hospital or clinic, it is the obligation of the establishment to stabilize the person, providing the medication they need immediately and ensuring their correct transfer to a public institution.
The Constitution establishes that federal, local and municipal authorities have the obligation to ensure effective access to health services by expanding the coverage of the national system. The same article later derived on a more specific law to guarantee health in Mexico: the General Health Law. In particular, this law targets seven general aspects:
- The physical and mental well-being of people to contribute to the full exercise of their capacities.
- The improvement of the quality of human life.
- The protection and enhancement of values that contribute to the creation, conservation and enjoyment of health conditions that contribute to social development.
- Solidary actions for the preservation, conservation, improvement and restoration of health.
- Access to health and social assistance services that efficiently and timely meet the needs of the population.
- Knowledge on the proper use and utilization of health services.
- The development of education, scientific research and technology for health.
With the General Health Law, Mexico began the creation of a more consolidated health system. One of the objectives was to develop a unified system that could bring together the existent mechanisms that the Ministry of Health had, prior to the establishment of a general health system.
To date, the Mexican heath system includes the public and private sector. The public sector is composed by many social security institutions: the Mexican Institute of Social Security
(IMSS), the Institute of Safety and Social Services for Federal Workers (ISSSTE), PEMEX, Ministry of National Defense (SEDENA) and Ministry of the Navy (SEMAR), as well as institutions and programs that serve the population without social security like the Ministry of Health (SSA), State Health Services (SESA), IMSS-Bienestar and the recently created Health Institute for Welfare (INSABI). Meanwhile, the private sector includes insurance companies and service providers that work at private clinics and hospitals, including providers of alternative medicine services.
Despite health being a recognized human right and the diverse number of institutions available in the country, rightsholders receive inconsistent health attention. Breaking down the numbers, formal workers, whether active or retired, as well as their families can receive care from IMSS, ISSSTE, PEMEX, SEDENA or SEMAR. IMSS is the institute with the largest rightsholder base, representing almost 80 percent of the population. Prior to the creation of INSABI, ISSSTE would follow with around 18 percent of the population.
Self-employed people, workers in the informal sector, the unemployed and people outside the labor market and their families would be covered by SSA, SESA and IMSS-Bienestar. However, this would still leave out about 69 million people without social security. With the creation of INSABI, the federal government offers, since 2020, primary and secondary healthcare for free. This is expected to escalate to third level care once the institute is fully established.
Is the System Actually Effective?
IMSS offers basic social security to its affiliates, including sickness and maternity insurance, occupational risk insurance, disability and life insurance, retirement and old-age insurance, social benefits and childcare insurance. The sickness and maternity insurance guarantees medical, surgical, pharmaceutical and hospital care from first to the third level, breastfeeding assistance and wage payments for temporary disabilities.
ISSSTE follows a very similar scheme. The institution guarantees access to preventive medicine, maternity, medical, surgical, hospital, pharmaceutical and physical and mental rehabilitation services.
PEMEX, SEDENA and SEMAR workers have the right to first, second and third level attention, surgical and hospital care, pharmaceutical and rehabilitation coverage, insurance for occupational hazards, retirement and disability.
INSABI, regarding primary care services, covers the following: preventive healthcare, health promotion, disease prevention and outpatient care for the most common illnesses, provided by general practitioners and nurses. In the secondary level, the institute covers basic specialties at general or specialty hospitals, laboratory and imaging diagnostics, general surgery, gynecology, obstetrics, internal medicine and pediatrics. People affiliated to INSABI can go to public medical facilities, such as health centers, health centers with extended services (CESSA), IMSS-Bienestar medical units, medical specialties units (UNEMES) and rural, community and general hospitals.
Though this is the ideal scenario for all healthcare provision in paper. However, the reality in Mexico is much more complex and not all population segments can access healthcare services.
The CNDH in Mexico released a study that measured the true access of vulnerable groups of the population to health services. The commission reports many violations to children’s and adolescents’ right to health. According to its findings, malnutrition, low weight and other preventable risks, such as water pollution, lack of sanitation and hygiene, caused the death of millions of children. CONEVAL’s figures expose that in 2015, there were 12.5 deaths per 1,000 births, while the goal set in the Millennium Development Goals for this indicator was 10.8, which was still higher than the average of OECD member countries of 3.9. Results showed that 16.2 percent of children in Mexico lack access to health services.
According to 2020’s data from INEGI, just 44 out of 100 women are affiliated to a health institution. CONEVAL found that out of the 15.7 million indigenous people in the country, 2.8 million do not have access to health services. A study by CEAV determined that health as a right is not granted to members of the LGBT+ community. This, however, is not due to sexual preference but to socioeconomic conditions.
CEAV’s study also found that although most people are affiliated to a public health institution (61.19 percent), 47 percent prefer private services. This represents cost overruns for the public system in general, while people pay for private health services, which are generally more expensive than public ones.
The situation replicates throughout the country and it exposes the need for effective access to health services to ensure the universalization of healthcare. Animal Político found that public health institutions usually overestimate health coverage, since they do not consider the total number of people who need these services. Another problem is geographic distribution, which tends to be concentrated in urban areas, neglecting remote areas of the country that settle with less than basic levels of attention. According to the INSP, the population reports a lack of supplies and infrastructure, evidenced by the lack of medicines or laboratory tests at the same institution that provided consultation.
How Can Mexico Achieve Effective Access to Health Services?
INSABI has been characterized as the most ambitious health plan in decades. However, its fast implementation has compromised part of its value. Graciela Teruel, Director of EQUIDE-IBERO, shared with MBN that private nvestment in quality services is key to solve the high demand for healthcare in this country, as any public budget would be insufficient to cover all types of diseases and the associated treatments. “We need to start by knowing what diseases will be covered by INSABI. If it intends to cover a wide range of diseases, the pressure on the government’s budget is going to be very high,” Teruel said. It is a fact that particular diseases, such as diabetes and certain types of cancer, require expensive medications.
During Mexico Health Summit 2020/21, David Kershenobich, Director General of INCMNSZ shared the common costs of people living with a chronic disease in Mexico. The average cost of treatment for diabetes mellitus is MX$1,500 (US$74) a month. He pointed out that only 85 percent of Mexican diabetes patients receive treatment. For renal insufficiency, the cost of treatment, which can include dialysis and medications, varies between MX$8,000 (US$394) and MX$15,000 (US$739) per month. Arterial hypertension, a condition that affects an estimated 31.5 percent of Mexicans, is estimated to cost between MX$1,000 (US$49) and MX$3,000 (US$148) a month. About 70 percent of Mexicans with hypertension are said to receive treatment in some way for this condition.
Kershenobich recommended to give more tools to the already existent institutions to promote preventive healthcare, which could reduce the burden on the public sector, integrating nutritionists or mental health specialists.
A research study by German Fajardo, Director of UNAM School of Health Sciences, on effective health access in Mexico, concluded that regarding financial protection, challenges are still being identified to achieve total insurance for the population. “The three main financial health insurance systems (INSABI, IMSS and ISSSTE) still present important differences in coverage.” The resources to finance healthcare come, to a large extent, from the federal government. However, much work is still needed to homologate funds and to ensure access under the different systems.
According to Fajardo’s research, health institutions must establish common priorities in the development of both physical and human resources to achieve harmonious growth to face the challenges of the national population in terms of health and access to services. The fragmentation of the health system has been called out several times by different actors of the sector as one of the main barriers to provide health.
The health sector is also using the COVID-19 pandemic as a learning curve to improve collaboration between the public and private sector. Patrick Devlyn, President of the Health Commission at CCE shared with MBN the opportunities that can come from the pandemic. “Seeing us as enemies will never detonate investment nor foment technology,” he said. “We need to reimagine public-private investment to bring effective, efficient and universal primary, secondary and third level care.”
Héctor Valle, Executive President of FunSalud and one of the faces of the Juntos por la Salud intiative between the public and private sector to face COVID-19, shared with MBN the future this partnership can have. “Juntos por la Salud is a great initiative that came out of the collaboration between the Mexican Health Foundation, the BBVA Foundation, TecSalud and the UNAM School of Medicine. It includes more than 580 companies.” According to Valle, there is a health access gap that still needs to be addressed, which forces us to migrate to distance care models. “Juntos por la Salud has a role in helping to close these gaps and supporting the development of remote systems. Regarding infrastructure, at Juntos por la Salud we work to make donations of ventilators and even support their development. The same goes for diagnostics, medicines and devices. We have to support the government so medicine purchases are adequate to avoid crises like the lack of oncological medicines in the country.”