The Right to Health in Mexico: Seguro Popular
The Right to Health in Mexico: Seguro Popular
by: Hanna Jaff
During the past few years, Mexico has proven to be one of the most important advocates with regards to the notion of the right to health: through legal reforms and public program implementations, the State has proved how it is truly committed to ensuring its population’s health needs are met. By the year 2000, after a major change in the political direction and democratization of the State, Mexico was catalogued by the World Health Organization as having major issues with financial justice, with regards to healthcare, resulting in its people having little access to the health system. In other words, economic burdens were so unequally concentrated that most people did not have any access to the health system, which is why by 2003, the now famous Seguro Popular was proposed.
In 2003, most Mexican families had no access to the health system, for a number of reasons, primarily including a lack of economic resources and unemployment. Before the installment of the Seguro Popular, more than 50% of Mexico’s population was uninsured (Knaul et. al., 2003), which not only resulted in massive out-of-pocket expenses, but also less access to the health system for the entire population, reduced quality in health services, and inefficient use of resources. The creation of the Seguro Popular was a response to the lack of effectiveness of the Mexican health system, as well as the lack of access most of the population had to health insurance. It was intended to assure that the entire population was insured and could have access to healthcare, regardless of their conditions. It was specifically designed to target the population’s poorest sectors
Mexico’s public health system is quite noteworthy, which is why I will briefly explain how it works. Mexico has a history of structural inequalities and income concentration that have led to inequities in access to basic services, including the health system. Healthcare providers are both public and private, though the public system is notoriously more popular, and it includes the Instituto Mexicano del Seguro Social or IMSS (Mexican Institute of Social Security) and the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado or ISSTE (Institute of Security and Social Services for State Workers).
According to Mexican law, all workers have a right to be affiliated to the IMSS, through a system by which employers have to pay a minimum quota for each worker. This excludes workers hired on a non-contract basis that are paid only for services rendered, hence having no right to the health benefits provided by the law. The ISSSTE works in the same way, but it is only for State workers. Workers also insure their families through these public institutions. Those who are left out from any of these public providers, either because they are unemployed, or because their jobs exclude them from being affiliated, have to either purchase private health insurance, or have none at all. The latter seemed to be the majority of the cases before the Seguro Popular was instated in 2003.
By 2003, the Ley General de Salud (Health Law) was reformed so as to create the Sistema de Protección Social en Salud (System of Social Protection for Health). The Seguro Popular is implemented through the Sistema de Protección Social en Salud. The latter had anticipated that by 2010, 100% of the population would have health coverage (WHO, 2006). The Seguro Popular is in no way a mandatory insurance that all uninsured Mexicans must acquire. It is actually a voluntary public insurance for people without access to Social Security. The Seguro Popular represents the Mexican government’s compromise and obligation to provide healthcare to its entire population, regardless of each person’s particular conditions, which is reminiscent of the notion of the right to health, from a human rights perspective.
Article 4 of the Mexican Constitution stipulates that all persons have a right to the protection of their health, for which laws will provide the ways in which the federation and the states will concur to provide health services (2009). Furthermore, this article (as part of the Mexican Constitution’s Bill of Rights) establishes the right that every person has to an environment for his or her development and wellbeing, which further alludes to the human rights perspective. This shows how Mexico’s most important legal document, the Constitution, from which all other laws and treaties must derive, and under which the entire State is organized, recognizes the right to health, or at least, the right to the protection of health and the State’s obligation to provide the means by which it should be realized.
Thus, in accordance with article 4 of the Constitution, the Seguro Popular was created in 2003, but it was not until the beginning of 2004 that it was implemented on the national and state levels. As mentioned above, the Seguro Popular is not mandatory, but is intended to cover all families that have otherwise no access to the health system, which are generally lower income families. By insuring the country’s less fortunate population, combined with the public health institutions already in place, the Mexican government is surely providing the means by which to assure the right to health is respected.
The financial aspect of this insurance policy is threefold: one part is paid for by the Federal government, another is paid by one of the states, and the individual pays an annual cuota, which is calculated on the basis of the particular person’s socioeconomic possibilities, and some people’s individual cuotas are even waived. In perspective, the highest annual cuota charged amounts to less than $1000 dollars, and covers about 266 interventions, which in turn cover 95% of diseases and illnesses, diagnostics, and hospital services, as well as 100% of primary healthcare. Lower income families are not charged a cuota (Informe de Resultado del Segundo Semestre de 2009, 2009). To determine how much each family is to pay per year, the Sistema de Protección Social en Salud has come up with 10 categories, in reference to income percentile, the first of which are exempt from paying cuotas.
From a national budget perspective, in 2009 the Federation allocated 21.1% more capital to the Sistema de Protección Social en Salud than it did in 2008, in accordance to one of the goals of this program: to affiliate up to 14.3% of qualifying new families into the program (Informe de Resultado del Segundo Semestre de 2009, 2009). As proposed by the Sistema de Protección Social en Salud, one of the major goals to be met by implementing the Seguro Popular is to prevent millions of families from financial ruin derived from healthcare costs. By 2009, there were close to 11 million families affiliated to the Sistema de Protección Social en Salud, which accounted to about 31 million beneficiaries (Informe de Resultado del Segundo Semestre de 2009, 2009), which is roughly about 28% of the entire population.
The 2000 change in political structure in Mexico was certainly one of the major decisive moments in the country, in terms of a shift towards greater governmental accountability, which is why there has been a gradual more social-oriented policies ever since. The health system was one of the most important aspects to be dealt with for the newer administrations, and the creation of the Seguro Popular surely provides a governmental commitment in meeting the Mexican’s healthcare needs. If the right to health not only indicates people are to be able to access the health system, but also that the State must provide the means by which this is to be realized, then Mexico is undoubtedly making great strides to achieve success. By eliminating financial burdens of lower income families that used to pay mainly out-of-pocket expenses for healthcare, the State guarantees universal access to health services, as well as financial freedom.
Constitución Política de los Estados Unidos Mexicanos (2009), Cámara de Diputados del Honorable Congreso de la Unión, retrieved from http://www.diputados.gob.mx/LeyesBiblio/doc/1.doc (Accessed 28 February 2010).
“Informe de Resultado del Segundo Semestre de 2009”, (2009), Comisión Nacional de Protección Social en Salud, retrieved from http://www.seguro-popular.gob.mx/index.php?option=com_weblinks&view=category&id=45&Itemid=153 (Accessed 28 February 2010).
“Mexico”, (2006) World Health Organization, retrieved from http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_mex_en.pdf (Accessed 26 February 2010).
“WHO Statistical Information System”, (2009) World Health Organization, retrieved from http://www.who.int/whosis/whostat/EN_WHS09_Tables.xls (Accessed 26 February 2010).
© 2010, Hanna Jaff. All rights reserved.