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INSP - NATIONAL INSTITUTE OF PUBLIC HEALTH OF MEXICO Center for Health Systems Research. Salud Migrante Developing a Proposal through Binational Health Systems Integration Planning Project. Outline. Social protection: progress in Mexico Social protection & migration U.S.A. Mexico

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slide1

INSP - NATIONAL INSTITUTE OF PUBLIC HEALTH OF MEXICO

Center for Health Systems Research

Salud Migrante

Developing a Proposal through Binational Health Systems Integration

Planning Project

outline
Outline
  • Social protection: progress in Mexico
  • Social protection & migration
    • U.S.A.
    • Mexico
    • Development capacity for social protection in health
  • Salud Migrante proposal
  • Conclusion
family affiliation to seguro popular
Family Affiliation to Seguro Popular

14,000

11,500*

12,000

10,000

8,000

Thousands of families

6,000

5,000

4,000

3,000

2,000

295.5

0

2002

2003

2004

2005

2006

2007

2008

2009

2010

* Ley General de Salud projection

Source: Ministry of Health of Mexico 2005

seguro popular subscriber outpatient services state level analysis 2006 according to hdr

80

Col

Nay

BCS

Ags

Sin

Tamps

70

Son

Jal

BC

QRoo

Dgo

60

DF

Tab

Mich

Hgo

Camp

Ver

Tlax

50

Oax

Zac

Gto

NL

Yuc

SLP

Mex

Coah

Mor

40

Chih

Chis

Pue

Gro

30

Qro

.7

.75

.8

.85

.9

Seguro Popular Subscriber Outpatient ServicesState-Level Analysis 2006 according to HDR

%

HDR

r=0.3584 (0.0440)

Source: NHS (Ensanut) 2006 & HDR prepared by UNDP

seguro popular impact on catastrophic expenditures according to source
Seguro Popularimpact on catastrophic expenditures according to source

Not insured

Insured with Seguro Popular

12

10

8

% of Catastrophic expenditures

6

4

2

0

NIEHS (ENIGH)

NHS (Ensanut)

Impact Eval. SP

Source: Galarraga O; Sosa-Rubí SG; Salinas A.; Sesma S. Impact of Universal Health Insurance on Catastrophic & Out-of-Pocket Health Expenditures in Mexico. Working Paper. 2008

tendency of the authorized budget from the ministry of health of mexico
Tendency of the authorized budget from the Ministry of Health of Mexico

90

81.3

80

70

60

Thousands of millions

of pesos

49.2

50

35.4

40

30

20

10

0

2000

2001

2002

2003

2004

2005

2006

Year

Source: Ministry of Health of Mexico 2005

slide7

Ministry of Health expenditure - distribution in deciles

2002

1996

2000

18%

16%

14%

12%

10%

8%

6%

4%

2%

0%

1

2

3

4

5

6

7

8

9

10

Decile of expenditure

Source: John Scott, CIDE – Center for Economics Research & Education

toward a financial balance in health 2000 2004
Toward a financial balance in health, 2000-2004
  • GDP in health from 5.7% to 6.3%
  • Annual increase in health expenditure
    • Public for non-insured: 23%
    • Out-of-pocket:13%
  • Reason for federal per capita expenditure according to insurance condition
    • From 3.0 in 2000 to 2.1 for 2005

Source: Ministry of Health of Mexico 2005

u s population without medical security 2004

11.2

11.2

18.1

18.1

23.0

23.0

24.0

24.0

42.8

42.8

64.4

64.4

U.S. population without medical security, 2004

100%

100%

80%

80%

60%

60%

56.2

56.2

48.1

48.1

75.7

75.7

60.9

60.9

40%

40%

41.4

41.4

23.3

23.3

20%

20%

28.9

28.9

25.7

25.7

13.1

15.7

15.7

12.4

15.0

15.0

12.4

13.1

0%

0%

Recent

Recent

Longer

Longer

-

-

stay

stay

Mexican

Mexican

U.S.

U.S.

-

-

Born

Born

U.S.

U.S.

-

-

Born

Born

Immigrants

Immigrants

Mexican

Mexican

Mexican

Mexican

American

American

Whites

Whites

Non

Non

-

-

Whites

Whites

from other

from other

immigrants

immigrants

immigrants

immigrants

than Mexico

than Mexico

Private

Public

Not insured

Wallace 2007

dimension of the 11 8 million mexican migrants in the u s
Dimension of the 11.8 million Mexican migrants in the U.S.
  • 11% of the Mexican population
  • 5.8% annual growth
  • 56% without health insurance
  • 60% without documents
  • 21% with U.S. citizen status

DIAGNOSIS

migrant contribution to the uninsured population in the u s
Migrant contribution to the uninsured population in the U.S.
  • Migrants (of any nationality) and their U.S.-born children contribute as follows:
    • 32% of the total population with no health insurance (46 million)
    • 86% of the growth of the population with no health insurance
  • Mexican migrants contribute 13% of the total population with no health insurance in the U.S.

DIAGNOSIS

US

relevance of health insurance for migrants in the u s
Relevance of health insurance for migrants in the U.S.
  • Health in the U.S., the most expensive in the world, + 14% of the GDP
  • 5.6% of hospital expenses are not covered
    • ¿Migrant responsibility?
    • Represents 0.2% of the GDP

DIAGNOSIS

US

transnational population
Transnational population
  • 45% of the Mexican migrants are recent
    • Less than 10 years, 5.38 million of total figure
  • 85% of the migrants send remittances
    • to 1.3 million homes in Mexico
  • 16% of married migrants have wives in Mexico
  • 27.3% of migrants have at least one child in Mexico
    • 18% have all of their children in Mexico
  • Constant migration flow
    • 700,000 migrate annually
    • 250,000 return
remittances spent in health services in mexico 2002 percentage
Remittances spent in health services in Mexico, 2002percentage

ALL

Urban

Rural

Head of the household

Primary healthcare

8.9

9.4

4.9

6.2

8.9

Hospitalization

15.9

20.9

12

8.2

17.5

Pregnancy & birth

4.5

7.6

2.1

0.2

0.5

OTC drugs

2.5

4.2

1.4

1.3

2.7

TOTAL

31.8

42.1

20.4

15.9

29.6

Revision of Amuedo-Dorantes et al 2007, based on NIEHS (ENIGH) 2002

reference population for binational insurance
Reference population for binational insurance

11.8 million migrants

4.3 million migrant children born in U.S.

5.5 million dependents in Mexico*

21.6 million in transnational communities

DIAGNOSIS

willingness to pay for binational health insurance
Willingness to pay for binational health insurance
  • 57% of migrants are willing to pay
    • US$75 - $125 per month
  • Willing to cross the border
    • Deprived of primary healthcare in the U.S.
    • Public in Mexico
  • Cost represents 1/4 to 1/3 of insurance plans in the U.S.
    • US$ 3,000 & US$ 4,500 per family per annum**
    • Vs. US$ 12,000

DIAGNOSIS

US

*Vargas-Bustamante A, Ojeda G, Castañeda X. Willingness to pay for cross-border health insurance between the United States and Mexico. Health Affairs27, no. 1 (2008): 169–178.

**Tim Waidmann & Saad Ahmad. Improving Access In a Binational Population. The Potential Role for Binational Health Insurance. Academy Health Research Meeting, Orlando, FL. 2007.

u s response capacity
U.S. response capacity

DIAGNOSIS

  • Community healthcare centers in the U.S.
    • 1,200 in total
    • 6,300 points of service in all states
    • 17 million persons attended
    • 147 healthcare centers for migrants
      • 800,000 clients
    • Very interested in binational health insurance
  • Non-profit insurers
    • Located strategically for providing binational health insurance
  • Hometown clubs
    • Broad experience in health
    • Not always available
    • Problematic relation with Mexico
mexico response capacity
Mexico response capacity
  • Ministry of Health services in high- migrant locations
  • State-level governments very interested in supporting migrants
  • Seguro Popular Program
    • Interest & capacity to focus on migrants
    • Need for new affiliation mechanisms

DIAGNOSIS

salud migrante components
Salud Migrante Components
  • Doctrine
  • Policy
  • Articulating agency
  • Insurance agencies
  • Service networks
  • Community-level support

PROPOSAL

salud migrante doctrine
Salud Migrante doctrine
  • Migrants are entitled to health protection in the U.S.
  • Temporary residence abroad should not restrict Mexicans’ constitutional right to health in Mexico.
  • Constitutional obligation to guarantee migrants access to health services, wherever he may reside temporarily.

PROPOSAL

slide25

Transportation

Insurance Departments

Decree/Agreement

Regulation

Salud Migrante Agency

Seguro Popular

Non-profit insurers

Cap. Constr.

Concession

Affiliation

Sale

Contract

Pay-ment

Community agencies

Migrants

Promotion

Providers Mexico

Healthcare centers in the U.S.

Guarantee

Service networks

Salud Migrante policy

Salud en el Norte

Primary healthcare in the U.S.

Seguro Popular Affiliation in the U.S.

  • Diffusion of the Salud Migrante doctrine in Mexico & the U.S.
  • Capacity building & development: “Servicios de Salud Amigos del Migrante” (“Migrants’ Friends” Health Services)
    • Insurers & Seguro Popular
    • Binational health service networks
    • Civil society organizations
  • Salud en el Norte insurance
    • Sale of policies to migrants
    • Dealer / franchiser for insurance agencies
conclusions
Conclusions
  • Migration requires far-reaching government policies with a broad vision.
  • Mexico can lead a binational health insurance program.
  • Key actors from both countries have the capacity & are interested to collaborate in this regard.
  • Model can be partially adapted to migrants from other countries.
possible next steps
Possible next steps
  • Development of a model for workers with H2A visas
  • Promotion of services already guaranteed for migrants in the U.S.
  • Establishment of the Salud Migrante agency at state level