Seguro Popular: some ideas

Yesterday the Seguro Popular in Mexico, the health insurance scheme for the not salaried population, organized a meeting, first of a series of events with the focus of defining the second generation of reforms to the scheme. Several specialist participated, from the private sector, to the former Minister of Health, Julio Frenk, who implemented the Seguro Popular seven years ago. Basically, the conclusions of the presentations are that, Seguro Popular is helping to reach universal coverage, the program has helped to diminish out of the pocket spending for those families affiliated, but has failed to change the shape of the Mexican health system, basically because no operative changes have been observed. In this regard, everybody concluded that the system needs a reform that i) integrates the system horizontally, across schemes; and ii) separates functions, surveillance, financing and provision. Nevertheless, while there is an agreement of the general reorganization -horizontal integration and vertical separation of functions- there are many aspects within this model that should be discussed. Among the most important ones are: i) there should be one payer or several payers?, ii) what should be the role of the private sector at the level of insurers and providers?, iii) what level of choice will be given to affiliates and level of competition to insurers and providers?