Twenty-Five Years of Convoluted Health Reforms in Mexico

Mexico is a large country (population 109 million) with a per capita income of US$8,300 (purchasing power parity US$12,800) in 2007, and as can be seen in Table 1, a highly stratified society [1]. In 2006, Mexico spent about 6.6% of its gross domestic product (GDP) on health care, of which 44% was public expenditure (see Table 1) [2]. Constitutionally, Mexico is a federation of 31 states and the Federal District, but the federal government has always maintained centralized political and fiscal power. During most of the 20th century Mexico was governed by one authoritarian political party, the Partido Revolucionario Institucional (PRI), which won practically all elections at all levels of government. The health system evolved along the lines of other Latin American countries (see Table 2). Per capita expenditure varied widely, from US$1,100 through the Petróleos Mexicanos (PEMEX) to US$126 through the MoH [3]. An important early innovation in health care was the extension of free Instituto Mexicano del Seguro Social (IMSS) services to very poor rural areas through a program known as the Coordinación General del Plan Nacional de Zonas Deprimidas y Grupos Marginados (COPLAMAR, General Coordination of the National Plan for Deprived Areas and Marginal Groups). Beginning in 1973 in selected regions, the IMSS-COPLAMAR program significantly broadened access to quality primary and hospital care. Users were highly satisfied with this program. In 1984, the infrastructure and care responsibilities of COPLAMAR were transferred to the 14 states that accepted the decentralization reform (see below), and services deteriorated significantly [4,5], thereby undermining Mexico’s most successful health program servicing underserved communities. The program is still active in the states that did not decentralize and is now called IMSS-Oportunidades.