As in Argentina, Colombia, and Chile, the provision of health services in Mexico is not simple. It is a fragmented and complex system, composed of several public and private players. This means that Mexicans, like the others mentioned, are dealing with infrastructure problems, long waiting lines, and quality as a whole.
According to a 2022 report from the OECD (Organization for Economic Cooperation and Development), Mexico is the member country with the lowest health coverage. In practice, this means that for every 10 citizens, 3 are not entitled to health services. In other words, only 72% of the population has access to medical services - a lower rate than other countries such as Chile and Costa Rica, which, respectively, have 77% and 86% of the population included in health coverage.
This is because the Mexican health system is based on three main pillars: social security, popular insurance, and private services. Within “social security”, there are also two other divisions: the IMSS (Instituto Mexicano del Seguro Social) and the ISSSTE (Instituto de Segugridad y Serviços Sociales de los Trabajadores del Estado).
The IMSS serves formal workers and their families, who represent about 44.5% of the population. Meanwhile, the ISSSTE is designed to serve public servants - and their families -, who represent 10.6% of citizens.
For those who are not affiliated with social security institutions, there is “Seguro Popular”, a government program that serves about 40% of Mexicans. Then there is private health, which works as a complement for those in the public system or as main coverage for those who do not fit the other plans. Currently, about 11% of the population benefits from the private system.
The history of the Mexican health system
Em 1917, the Mexican government inserted into the constitution the first articles that guaranteed the protection of workers' health. However, it was only in 1943 that the Secretaria de Salubridad y Asistencia (SSA), now the Department of Health, was created. In the same year, the Mexican Social Security Institute (IMSS) was also created, with the objective of providing health and social security services for workers in the formal sector and their families.
Already in 1959, the Institute for Security and Social Services for State Workers (ISSSTE) was created to serve only federal public employees and their dependents.
Em 1973, the Social Security Law was amended, which made it possible to expand the audience served by the IMSS. In this way, the population living in extreme poverty also began to enjoy the institution's services — this branch of the IMSS has received several names, such as IMSS-Solidarity, IMSS-Opportunities, IMSS-Prospera and now IMSS-Bienestar.
Between the years 1980 and 1990, Mexico underwent several economic and structural reforms that also ended up impacting the health sector. Even so, health coverage and health institutions were expanded.
Another major milestone took place in 2003, with the arrival of Seguro Popular, which had cheap or free health services.
Free health services in Mexico
At the end of 2019, President Andrés Manuel López Obrador inaugurated the Institute of Health for Wellness (INSABI), whose purpose was to offer free and comprehensive health services to all people in the country. The INSABI project also envisaged that it would replace Seguro Popular, which despite being cheaper, still requires regular payments for usufruct.
However, the arrival of the Covid-19 pandemic affected the debut of INSABI, leading the system to present the same problems as Seguro Popular, such as the lack of medications and insufficient consultation, in addition to not being able to meet the demands of elderly Mexicans, who are not affiliated with social security institutes.
Thus, in 2023, government allies and opponents agreed to the extinction of INSABI. Thus, the structure of the INSABI, which became an arm of the IMSS, which in addition to serving more than 40% of the population, has its own health units.
Transforming into “IMSS-Bienestar”, the resources will be allocated to the same institution, but allowing those not affiliated to social security institutions to enjoy the services free of charge. In general, unaffiliated people are people in informal employment.
Until last year, the more than 3,900 IMSS-Bienestar units were present in 19 of the country's 32 federal units, serving around 11.6 million people. By 2024, the end of the resource transition foresees that 23 states will transfer their resources to the IMSS-Bienestar.
Overview of Mexicans' health
According to the 2017 report “Health in the Americas+” by the Pan American Health Organization, Mexico saw systematic improvements in health and human development indicators throughout 1990 and 2015, reaching 0.756 in 2013 and 0.779 today.
Life expectancy ranges from 72 to 78 years, and is higher among women than for men. As in most countries, the trend is also towards an increasingly older population.
What will affect the quality and longevity of these lives are mainly Chronic Non-Communicable Diseases (NCDs), such as diabetes, cardiovascular diseases, chronic respiratory diseases, and cancer. According to data from the National Institute of Statistics and Geography (INEGI), in 2020, DCNTs were responsible for 71.2% of deaths in the country.
Within this issue, according to the World Health Organization (WHO), about 15.3 million adult Mexicans have diabetes mellitus, which represents 14.3% of the adult population. The disease is the leading cause of death among women and the second among men in Mexico.
In parallel, cardiovascular diseases - such as heart attacks and strokes - caused 21.1% of deaths in Mexico in 2020. In the same year, another 10.2% of deaths were associated with chronic respiratory diseases, mainly caused by smoking and air pollution, as indicated in the report “Respiratory diseases in the world”, from United for Lung Health.
The third leading cause of death in Mexico is cancer. The WHO estimates that at least 9.4% of people died in 2020 as a result of the disease. In the country, lung, breast, cervical, and prostate cancers are more common.
Problems x Solutions
As in other Latin American countries, the financing of the health system is not sufficient in Mexico. However, discussions on the topic also indicate that decentralization impairs the distribution of resources.
Along with this, they also point out the need to improve the infrastructure of Primary Health Care (PHC) units, which includes the modernization of equipment and information systems. All of this also requires more service units and better professional training.
With regard to funding, Mexicans discuss the increase in investments in health by both the public and private systems. Within this issue, the collection of progressive taxes to finance the system is also under debate.
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