Proposals to reform the Mexican healthcare system

Last week Mtro. Juan Molinar Horcasitas, director of Mexican Institute of Social Security (IMSS) and president of the CISS, mentioned that the Mexican health care sector must advance towards the portability and convergence of services. In his words this would mean that any person looking for healthcare should be able to be served at any health care unit, be public or private.
The Mexican health care system is highly fragmented as can be seen in the following Figure.



As part of the CISS health care insurance report produced by the CISS, we have analyzed in detail the Mexican case and we have written a paper with recommendations that are in line with Horcasitas´ view. The core of our proposal is:
* To define a core package of medical benefits (CB) to which every Mexican is entitled.
* To organize the funding, Organization and Management of Care Consumption, and provision of the CB under unified stewardship and oversight
The medical benefits in the reformed system would comprise:
* The CB, including preventive care as a key element;
* Supplemental benefits (SB), including benefits – above the CB – that are available through current intra-group mandatory insurance to members of IMSS, ISSSTE, and other plans comprising the social health insurance (SHI) framework; and
* Wholly privately funded services.
The core benefit package (CB) is to be funded by the current sources:
* Federal and state general revenues.
* Employers’ and households’ mandatory contributions, earmarked to medical care.
* Eventually, by co-payments for elements of the CB.
In terms of organization each person can choose a plan. The plan will receive from a national fund (probably virtual) an age adjusted per capita amount that covers the CB. SB and private services will be funded by workers´s contributions in excess of the cost of the CB and by private expenditures.
In this proposal: i) equity is achieved, at least for the CB and ii) persons do not need to change their provider any time they change their job status (formal vs. informal or IMSS. vs. other social security institutions).
In line with Horcasitas ideas, we also believe that the most important hurdles have to do with the implementation. We have stressed the idea that health care social security agencies must develop important functions in order to accommodate any financial or organizational reform, see our 2008 annual Report.