Mexico's Health System: More Comprehensive Reform Needed

The article by Homedes and Ugalde in this week’s issue of PLoS Medicine is an important addition to the global discussion about Mexico’s 2003 health reform, the Seguro Popular (SP) [1]. While this reform has been controversial in Mexico [2], it has been highly praised in international circles. The Lancet ran a special series on the reform in 2006, and former U.S. President Bill Clinton lauded SP in a speech last year at the International AIDS Conference [3,4]. In spite of this high-profile attention, there has been little written about the reform by independent observers in English. The Lancet series was largely authored by the reformers themselves, along with close allies. Although a few technical studies have now come out demonstrating some impact of the reform on various outcomes [5,6], broader analysis of the institutional structure of the reform, and the context for its creation and implementation, are almost completely lacking. Homedes and Ugalde have finally given us this kind of broader analysis and historical context, and they deserve immense credit for doing so. Their piece covers a large period of time and number of variables. In this Perspective, I parse some of the key issues they raise about Mexico’s health system, and point to some areas of disagreement. I conclude with some issues that they do not address.