Health System Reform in Mexico 5 Assessing the eff ect of the 2001 – 06 Mexican health reform : an interim report card

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included fi ve actions: legislation of entitlement per family affi liated which, with full implementation, will increase public spending on health by 0·8–1·0% of gross domestic product; creation of explicit benefi ts packages; allocation of monies to decentralised state ministries of health in proportion to number of families affi liated; division of federal resources fl owing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the eff ect of this reform on diff erent dimensions of the health system. Key fi ndings include: affi liation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affi liates used more inpatient and outpatient services than uninsured people; eff ective coverage of 11 interventions has improved between 2000 and 2005–06; inequalities in eff ective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affi liates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.