The Mexican Health Care System Enrique Rios M.D. Dr.P.H. July 2008

1. The Mexican Health Care System Enrique Rios M.D. Dr.P.H. July 2008

2. Contents • Health Situation in Mexico • Organization of the Mexican Health Care System • The Health Care Delivery Model • The Migrant Health Program

3. Health Situation in Mexico

4. 85 + 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Demographic Transition in Mexico Men Women Annual growth rate 65 years and older: 3.8% Under 5 years old: -1.3% 7 7 6 6 5 5 4 4 3 3 2 2 1 1 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 Millions 1975 2000 2025

5. 100 90 80 70 60 PERCENTAGE 50 40 30 20 10 0 1955 1960 1970 1980 1990 2000 2006 2030 Communicable diseases, reproductive and malnutrition related diseases. Non communicablediseases Injuries CHANGES IN THE DISTRIBUTION OF CAUSES OF DEATH IN MEXICO, 1955-2005

6. Infectiuos and Parasitic Diarroheal Dis. Epidemiological backlog Respiratory Inf. Perinatal Dis. Malnutrition Maternal Cond. Cardiovascular Dis. 1955 2005 Injuries Malignant Neoplasms Emerging problems Chronic Respiratory Dis. Genitourinary Dis. Neuropsychiatric Cond Congenital A. Diabetes Ill-defined Ill-defined 35% 25% 15% 5% 0% 5% 15% 25% 35% Epidemiological Transition in MexicoSelected causes of deathMexico, 1955-2005 Source: INEGI/Sec Salud. Mortality Database

7. PORCENTAGE OF DEATHS IN CHILDREN UNDER 5 CAUSED BY INFECTIOUS DISEASES BY STATE, MEXICO 2005 Ags NL Dgo Qroo BCS Camp Sin Col Tamps BC Son Jal Nay Hgo Coah Gto Tab Qro Mich Zac Mor Yuc Ver Chih DF SLP MEXICO Gro Tlax Pue Oax Mex Chis 0 5 10 15 20 25 PERCENTAGE In Chiapas one of every four deaths in children under 5 is caused by diarrhea or a respiratory disease. In Nuevo Leon, one on twenty.

8. Challenges to the Health Care System • Increasing costs to treat the demand of chronic diseases and longer treatments • Continue to deal with infectious diseases • Emerging health risks: obesity, depression and smoking • Coping with re-emerging diseases (TB, SARS, Influenza Pandemic, HIV, etc)

9. Organization of the Mexican Health Care System

10. Mexican Health Care SystemBasic Components 1.Governmental organizations: providing services for the uninsured population (Ministry of Health and IMSS-Oportunidades) 2. Social Security: covering workers in the formal private sector of the economy, state and federal workers, the armed forces and employees of the national oil company (IMSS, ISSSTE, PEMEX) 3. Private sector: made up of an unorganized myriad of health care providers working in hospitals and clinics on a for-profit basis

11. The Mexican Health Care System What is known in Mexico as “Social Security System”, provides the following services to their beneficiaries: • Health care coverage including medicines • Unemployment insurance • Disability insurance • Life insurance • Retirement benefits

12. Population without social security coverage Mexican Population 100 million 50 million 50 million 5 out of 10 Mexicans lack social security due to their labor or social status

13. Mexican Health Care System

14. The Mexican Health Care System Main Problems : • Fragmentation and lack of coordination • Inequity in access to care • Dissatisfaction with services provided • Imbalance in resources

15. The Health Care Delivery Model

16. Health Care Delivery Model Institutional Health Services Tertiary Care Secondary Care Primary Care Population

17. The Migrant Health Program

18. Background • In September 2000, the Joint Statement for Migrant Health was signed by the Head of Department of Health and Human Services of the United States of America (HHS) and the Mexican Ministry of Health. • The two main objectives were: • to develop activities to meet the health needs of Mexican migrants and • to strengthen binational collaboration on Migrant Health issues • Therefore, the Ministry of Health included in its National Health Plan 2007-2012 two Programs to address the health of the migrant population • Programa de Salud del Migrante (Migrant Health Program) • Programa Vete Sano Regresa Sano

19. Objective To protect the health of the migrant population and their families in their transit and final destination, with specific strategies for binational collaboration on health promotion and health care delivery services that are culturally appropriate.

20. Strategy 1. To strengthen Mexican institutional collaboration on migrant health Activities: • Workshops for Health Professionals (Jornadas Informativas, IME) • Border Health Commission Mexico – USA • Border Health Commission Mexico - Guatemala • Collaboration with the National Institute of Migration (INAMI) • Collaboration with the Vete Sano Regresa Sano Program

21. Strategy 1. To strengthen Mexican institutional collaboration on migrant health • Border Health Commission Mexico – USA The United States-Mexico Border Health Commission was created in July 2000 between the US and Mexico governments. Objective: To provide international leadership to optimize health and quality of life along the U.S.-Mexico border. Main Programs: • EWIDS – Early Warning Infectious Disease Surveillance • BIDS – Border Infectious Disease Survelillance • Healthy Border 2010

22. Strategy 1. To strengthen Mexican institutional collaboration on migrant health • Border Health Commission Mexico – Guatemala May 2003 Sign of the Agreement between Mexico-Guatemala. Objectives: • To support health promotion and disease prevention activities. • To strengthen migrant health delivery and information systems . • Provide protection against sanitary risks and laboratory infrastructure.

23. Strategy 1. To strengthen Mexican institutional collaboration on migrant health • Collaboration with the National Institute of Migration (INAMI) November 2006. Sign of the Collaboration Agreement focus on actions that guarantee the health protection and prevention of risk for those foreigners assured in the 52 migratory stations in 22 States of Mexico through a Specific Program. Priority Topics: • Health promotion and prevention of diseases • Medical treatment

24. Strategy 2.To promote binational public awareness of migrant health issues Activities: • Signing of binational health collaboration agreements (Oregon and New Mexico) • Collaboration with the Initiative of the Americas of California • Training workshops and health information sessions for “promotoras” (health promoters) within the migrant population.

25. Strategy 2.To promote binational public awareness of migrant health issues Binational Health Week and Binational Public Policy Forum: An annual weeklong series of health promotion and education activities geared to the migrant population. The goal is to highlight the cooperation between our two countries to improve the health of Mexican migrants

26. Strategy 3. To provide support services to the migrant population and their families Activities: • Creation of a Binational Health Insurance • Collaboration with the National Center for Farmworker Health • Ventanillas de Salud (Health Windows): at the Mexican Consulates more than 150 thousand people have received counseling and referrals to medical services • Collaboration Program Mexico – California (Prevention of Cervical Cancer, Diabetes, Occupational Health, etc)

27. Strategy 3. To provide support services to the migrant population and their families Activities: • Mexico-Canada Temporal Agricultural Workers Program (PTAT) : 15,000 Mexican workers were employed in Canada in 2006 • Sick Nationals Program • PAHO/WHO Regional Office in Chiapas • Affiliation of the Mexican migrant population to Popular Health Insurance

28. Strategy 4. To foster binational research on migrant health Activities: • Publication of the results and conclusions of the Public Policies Forums on Health and Migration. • Financing binational research in collaboration with the UC • Collaboration and academic linkage with Mexican and American Universities • Publication of Migrant Health Fact Sheets, in collaboration with The Iniciative of the Americas

29. Thank you