The Decentralization of Human Resources and the Health System in Mexico

The Mexican health system has embarked on a reform process where one of the challenges of the health system is to provide care for the 95 million inhabitants of the country. Since 1943, the Mexican health system has developed to its present structure, which is divided in the following ways: a) the social security system covers 47.7% of the national population; b) public assistance covers 43%; and c) the rest is covered by a broad variety of private services (10%). Within the social security system, the most important institution is the Mexican Institute of Social Security (IMSS), and within the public assistance sector we have the Health Secretariat (SSA). The health system has presented multiple problems, including a marked institutional stratification, an impressive financial differentiation between the social security institutions and other public institutions, the duplication of coverage of the uninsured population and the existence of population groups that have no coverage. At the beginning of 1995, 10 million people were estimated as having no real access to health services. According to official data, by 1998, thanks to the actions of the Coverage Expansion Program, the SSA reported 7 million more Mexicans receiving coverage. On the other hand, during the past 15 years, Mexico has gone through a series of economic difficulties which have made it impossible to fully carry out its social policy objectives. One of the most critical situations was in 1995, when the Gross National Product (GNP) decreased 6.2%. The social public expenditure, as a percentage of the GNP, has not shown substantial growth in the last few years: it went from 6.6 in 1991 to 8% in 1996. This is also reflected in the total health sector expenditures, where in 1991, the percentage with respect to the GNP was 3.8 and in 1996 was recorded as 3.9.