FINANCIAL PROTECTION AND IMPROVED ACCESS TO HEALTH CARE:

PEER-TO-PEER LEARNING WORKSHOP

FINDING SOLUTIONS TO COMMON CHALLENGES FEBRUARY 15-19, 2016

ACCRA, GHANA

D ay I , S e s s i o n V I

February 2016

Improving health coverage for the poor in Mexico: the role of Seguro Popular

Accra, Ghana

3

Contents

1. Why was Seguro Popular created?

2. What were its main goals?

3. How was it implemented?

4. What did Seguro Popular achieved?

5. What are the main challenges ahead?

4

1. Why was Seguro Popular created?

5

It was unfair that more than half of the population was not protected by a public insurance scheme

Seguro Popular

Social security

Formal workers & mostly not poor

Assistance 1943

Informal workers &

mostly poor

2003 IMSS & ISSSTE

6

Health insurance coverage in Mexico before Seguro Popular

Source: National Health Survey, 2000

58.6

31.8

5.7 2.9 1

Coverage by institution (%)

Uninsured

IMSS

ISSSTE

Other

Private

7

Out-of-pocket was the main source of health care funding

42%

3%

55%

Public expenditure

Out-of-pocket

Private insurance

Social

Security

61%

Federal 32%

States

7%

8

Mexico needed more money for health

Health expenditure as percentage of GDP

%

LA average :

6.9

13.9

9.6

9.3

7.2

5.8 4.0

0

2

4

6

8

10

12

14

16

EUA Argentina Colombia Costa Rica Perú México

$ 36,948 US $ 356 US per cápita

9

2. What were its main goals?

1. Moving forward towards enforcing the right to universal health protection

2. Increasing public health expenditures gradually, fiscally responsibly, and financially sustainable

3. Providing health financial protection to everyone, specially the poor

4. Achieving a better allocation of resources between medical care and public health

5. Creating incentives to meet health expectations and needs of the population

Main goals were financial protection oriented

11

3. How was it implemented?

12

5 pillars were used to build Seguro Popular

13

Defining an explicit benefit package was useful for estimating costs, planning, and tailoring to population needs

Be

ne

fits

Health Promotion

Essential health

care services

Prevention

Expanding coverage

CATASTROPHIC

FUND

78 (US$14)

285 diseases

(US$168) 151

(US$64)

59 diseases

14

4. What did Seguro Popular achieve?

Seguro Popular has reduced the uninsured population in Mexico in the past decade

Fuente: Elaboración propia con base en CNPSS (2012)

14.6

30.53

40.78 43.46

48.50

29.2

21.5 18.2

0

10

20

30

40

50

60

70

2006 2010 2012 2014

% o

f p

op

ula

tio

n b

y ty

pe

of

affi

lati

on

Population affiliated to Seguro Popular Population with no affiliation

Seguro Popular increased public health expenditures

Public health care expenditures (pesos 2012)

Bill

ions

of

peso

s

Fuente: PEF & public account

/1 Budgeted

17

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Por

cent

aje

Año

67.6

32.4

55.1

44.9

67.3

32.7

Seguro Popular begins

With social security

Without social security

% of financial resources by type of population covered

It also reduced financial inequities between public health institutions

Effective access to prescribed drugs has improved in most states

18 Fuente: ENSANUT 2012. Estudio de satisfacción de usuarios del Sistema de Protección Social en Salud 2014.

NAY

QROO

HGO DF CAM

COAH GRO COL

VER MICH

OAX QRO

ZAC TLAX SLP

SIN NACL DGO AGS TAB TAM YUC BC SON CHIH

MOR BCS

JAL PUE GTO

MEX NL CHIA

40

50

60

70

80

90

100

40 50 60 70 80 90 100

% S

urt

imie

nto

co

mp

leto

de

rece

tas

20

14

% Surtimiento completo de recetas 2012

25 of 32 states need to improve to achieve the 90% goal

Both OOP and catastrophic health expenditures have been reduced

19

51.7 47.1

44

3.6 2.8 2.1

0

10

20

30

40

50

60

2004 2010 2014

%

OOP Catastrophic

¿Were the goals achieved?

1. Moving forward towards enforcing the right to universal health protection

2. Increasing public health expenditures gradually, fiscally responsibly, and financially sustainable

3. Providing health financial protection to everyone, specially the poor

4. Achieving a better allocation of resources between medical care and public health

5. Creating incentives to meet health expectations and needs of the population

21

5. What are the main challenges ahead?

22

To move forward, the Mexican system needs to address three key structural challenges

Using resources more efficiently

Ensure effective access with quality

More responsive to health care needs

23

People use private services even if they have public insurance coverage

Source: ENSANUT 2012

Outpatient services Hospital services

It is essential to strengthen • Effective access • Primary care

Utilization of services by affiliation, Mexico 2012

65.3 65.9 65.9 72.8

4.1 5.6 3.0

30.9 28.4 31.1 27.2

0

20

40

60

80

100

IMSS ISSSTE SeguroPopular

PEMEX

%

Institution of affiliation Other public institutions

Private institutions

79.9 67.7

77.3

100.0

7.8 13.8

10.9 12.1 18.3 11.4

0

20

40

60

80

100

IMSS ISSSTE SeguroPopular

PEMEX

%

Institution of affiliation Other public institutions

Private institutions

Main strategies to address challenges: the next stage of reform after Seguro Popular

24

Challenges Strategies

Using resources more efficiently

New legal framework to enforce more effective and transparent use of resources

Bulk purchasing of drugs at federal level to ensure resources from savings to improve health care delivery

Ensure effective access with quality

New autonomous federal regulatory agency to enforce quality of health care

Reliable and useful information systems for permanent monitoring and evaluation

More responsive to health care needs

Strategic purchasing of good quality care Strengthen primary care thru more effective

allocation of resources

25

Thank you very much

adolfomartinezvalle@gmail.com

Appendix 1: Contributions

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Public insurance scheme

Contributions

Shared State Total

Mexican Institute of Social Security

Employee $220

Employer $2080

Government $1100

3400

Seguro Popular Beneficiary $0

Federal & state $1300

Government $1100

2400