Healthcare in Mexico

Logo for the Mexican Social Security Institute, a governmental agency dealing with public health

Public health issues were important for the Spanish Empire during the colonial era. Epidemic disease was the main factor in the decline of indigenous populations in the era immediately following the sixteenth-century conquest era and was a problem during the colonial era. The Spanish crown took steps in eighteenth-century Mexico to bring in regulations to make populations healthier.[13] In the late nineteenth century, Mexico was in the process of modernization, and public health issues were again tackled from a scientific point of view.[14][15][16] As in the U.S., food safety became a public health issue, particularly focusing on meat slaughterhouses and meatpacking.[17]

Even during the Mexican Revolution (1910–20), public health was an important concern, with a text on hygiene published in 1916.[18] During the Mexican Revolution, feminist and trained nurse Elena Arizmendi Mejia founded the Neutral White Cross, treating wounded soldiers no matter for what faction they fought. In the post-revolutionary period after 1920, improved public health was a revolutionary goal of the Mexican government.[19][20] The Mexican state promoted the health of the Mexican population, with most resources going to cities.[21][22]

Concern about disease conditions and social impediments to the improvement of Mexicans' health were important in the formation of the Mexican Society for Eugenics. The movement flourished from the 1920s to the 1940s.[23] Mexico was not alone in Latin America or the world in promoting eugenics.[24] Government campaigns against disease and alcoholism were also seen as promoting public health.[25][26]

The Mexican Social Security Institute was established in 1943, during the administration of President Manuel Avila Camacho to deal with public health, pensions, and social security.

The Instituto Nacional de Cancerología (The National Oncology Institute) located in Mexico City.

Total health expenditure represented around 5% of GDP in 1995, which went up to around 6.2% in 2012; however, in 2015 it declined to 5.6%. Historically, out-of-pocket expenditure has been a big portion of health expenditure, going from around 56% in 1995 to below 50% since 2008, with the most recent data being 40.6% in 2015.[4][44] Recent reform has seen the establishment of new special funding programs, as well as more progressive limits on patient contribution was also included. Funding was restructured in a manner that both promoted coverage through incentives directed towards state-level governments and reassessment of funding on a need-level basis.[46]

Susana Lopez Charreton virologist specialized in understanding the mechanisms of infection of rotavirus.

According to recent international statistics, Mexico has an estimated population of 130 millions of inhabitants, with a reported annual population growth rate of 1.2%. Since 1990 there was an increment of about 45 million people.[4]

Demographic transition have been notorious in the last 7 decades in Mexico. Life expectancy at birth (general) changed from being 45 years in 1950 to 71.5 years in 1990, and to actually reach 77.5 years, close to some high-income countries in America and the World.[44][47] Child mortality rate, as one of the major health trends, have improved most notoriously after 1950, when an average of 252 children under-five years were dead per 1000 live births, decreasing to 44.5 in 1990 and reaching 14.6, in 2018.[44][47] Finally, after 1970, at least 20 years after the major changes in life expectancy and child mortality rate, there was a decrease in fertility rate. In 1950 it was estimated that for every woman, around 6.67 babies were born; in 1970, it increased to 6.8 and then, steadily decreased to 3.4 in 1990 to finally end in 2.1, which is below the world average.[44][47]

The IMSS La Raza Medical Center, a well known public hospital in Mexico City

Besides this demographic transition, there have been major changes in the principal causes of death and morbidities among Mexicans. Epidemiological transition has been notorious in the history of Mexico when it comes to Disability-adjusted life year (DALY) but not when comparing causes of death, with most data coming since 1990.[48][49] According to the Institute for Health Metrics and Evaluation, in 1990 the leading causes of death in the country were also cardiovascular diseases, neoplasms and diabetes, which remain the same until recent data. Some infectious diseases (respiratory infections, tuberculosis and enteric infections) were also among the most common causes in the 90's, which were displaced for other non-communicable diseases in 2017. Taking into consideration the burden of disease according to the years lost due to disability (DALY), in 1990, the three most common causes of disability were communicable and maternal diseases (maternal and neonatal disorders, respiratory infections, tuberculosis and enteric infections). In 2017, these 3 diseases were replaced by diabetes and kidney diseases, cardiovascular diseases and self-injuries, displacing most of the communicable diseases out of the top ten.[45][48]

The prevalence of diabetes is rapidly increasing on a global scale. One of the countries in which such precipitous growth has been observed is in Mexico. The proportion of the country with diagnosed diabetes mellitus increased roughly four times from 1993 to 2006, where it directly affected close to a quarter of the population. The impact of this disease on overall mortality increased by over twenty times in the same thirteen-year period, and future projections see this figure only increase.[50] In 2011 alone, health spending attributed to diabetes in the country amounted to almost eight billion dollars. A staggering amount of this spending is in the form of out-of-pocket expenses. This economic burden is most strongly pronounced on the uninsured population. The prominence of this disease in national healthcare system, and especially the financial implications derived from this are significant. A study conducted by Arredondo and Reyes found that the financial aspects of this alone have been observed to generate independent health disparities.[50] Additionally, a large proportion of severe health complications, such as heart attacks and renal disease, can be determined to stem directly from this epidemic. In Mexico, where the health system is subject to unique segmentation, this issue poses an amplified public health and economic challenge. The public healthcare system is overwhelmingly utilized in the management of this disease and its secondary developments— with only ten percent of population depending on the private sector for care.[50]

Insurance coverage rates across Mexico have been marked by a recent period of large growth. The induction of Seguro Popular (Popular Health Insurance), the coverage program targeted at individuals who do not receive coverage under IMSS or ISSSTE,[38] in 2003 spurred massive growth in insurance coverage across Mexico. A couple years after the plan was introduced, Seguro Popular became the second largest health institution by coverage in the nation. Within this, the percentage of insured poor families increased by five times— to include more than a third of this demographic. Inequities between public and private expenditure, as well as the distribution of these expanded services, began to lessen.[46] In 2015, it was projected that the proportion of the Mexican population with no access to health insurance decreased by close to seventy percent across this period, with only about 18% of the population falling under this group currently. This effect has been particularly effective in treating the older demographics.[53] Furthermore, in 2012, it was observed that 4.3 million households in the nation possessed no health coverage of any kind, with an additional 7.6 million households associated with partial coverage of some members only.[38]

In Mexico, where government-sponsored health insurance coverage remains a stark limitation characteristic of the system, self-medication is observed in increased proportions. Over 30 million Mexicans, especially those associated with older, uneducated, and low socioeconomic backgrounds. This may be indicative of societal attitudes toward the current system. This notion is furthered by the large proportions of residents which postpone reception of initial services, have little-to-no connection to a preventative care specialist, and heavily utilize alternative medicinal practice. Over 500 over-the-counter drugs are available in the Mexican market. This enhanced availability of over-the-counter drugs has also contributed to this phenomenon.[55]

Cost of healthcare services in Mexico is variable and dependent on the nature of the service and the institution utilized. Generally, health costs associated with use of the public healthcare sector are higher than their private counterparts.[39] Furthermore, individuals not insured under any current health insurance scheme most often utilize private doctors instead of public institutions. A study conducted in 2015 by Doubova et al. determined that roughly four percent of the uninsured population was faced with catastrophic expenditure of some sort at some point. Additionally, it was found that over half of uninsured individuals had not accessed care despite having a health issue due to financial issues.[53] Additionally, a report by Munoz (2013) established that in the period following the implementation of the new 2003 health reform to the end of the decade, out-of-pocket patient expenditures, related to hospitalization, visit, medicine, diagnostic tests, alternative options, dental care, prolonged treatments, among others, had remained relatively similar.[53]

Comparative analysis of the cost of Mexican healthcare services costs has been performed by analysts. In 1992, the New York Times reported that residents of the United States living near the Mexican border routinely crossed into Mexico for medical care.[56] Popular specialties included dentistry and plastic surgery. In 2007, The Washington Post reported that Mexican dentists charged 20-25% of US prices,[57] and other procedures typically cost a third of the US price.[56]

Health outpost operations in Izlapalapa, Mexico City

Factors that have demonstrated influence on the magnitude of accessibility available to healthcare include sparse distribution of institutional resources, and lack of specialized care services in isolated populations.[54][58] Case studies involving clinical management of diarrheic disease in rural communities have emphasized concerns relating to the quality and range of services available to more isolated populations.[58] Accessibility as it relates to rural communities has been a heavily studied topic and work here has revealed the existence of great disparities in breadth and effectiveness of services offered. Issues related to accessibility of specialized services, especially institutions offering forms of care related to mental health, are prevalent in rural communities. Factors such as location, transportation, and the economic cost of implementation are the main factors associated with this.[54]

The 1990 Regional Conference for the Restructuring of Psychiatric Care in Latin America established guidelines that the Mexican government has sought to keep.[59] The Caracas Declaration, issued during the conference, recognized the need to protect the rights of individuals with non-physical disabilities and called for mental health to be integrated with primary care.[59] Created with the goal of aligning Mexico with global recommendations issued by the World Health Organization, the National Council on Mental Health (Consejo Nacional de Salud Mental) was created as part of the federal Health Ministry in 2004.[60] Although the restructuring of psychiatric care began in the 1990s with the Regional Conference for the Restructuring of Psychiatric Care in Latin America, psychiatric care was found to be inadequate and in need of a larger budget.[61] Though it mentioned mental health care, the 2004 Seguro Popular did not succeed in its goals of improving access to health insurance or mental health care for low-income individuals.[62] In 2003, it was projected that up to a quarter of the population was afflicted with some form of mental illness. Rural populations made up especially large proportions of this demographic.

Due to political and socioeconomic factors, Mexico's Indigenous communities are one of the groups that has faced inequities in mental health care. Indigenous communities are likely to live in remote areas where they may be unable to access health services, exposed to pollution, and live in areas being exploited for their natural resources.[63] Although studies have found that it is socio-economic status as opposed to ethnicity that influences the use of programs like SP, Indigenous communities are more likely to live in extreme poverty.[64] Treatment for mental health in Indigenous communities also encounters a cultural barrier. Although the need for services exists, treatment has been typically conducted by community "healers".[60] The negative stigma that mental health carries is seen to prevent treatment carried during early indication periods.[60]

Urban populations are also subject to unique issues and conflicts, mostly related to delivery and the ability of the institutions to service the large populations they are associated with.[30]

Preventative care is still an under-focused area across the country. A 2015 projection model found that almost a quarter of the Mexican population did not have a regular primary care provider or institution that year.[51]

On December 1, 2006, the Mexican government created the Health Insurance for a New Generation (also called "Life Insurance for Babies").[65][66][67] It was followed by a February 16, 2009, announcement by President Felipe Calderon, who stated that at the current rate, Mexico would have universal health coverage by 2011,[68] and a May 28, 2009 announcement of universal coverage for pregnant women.[69] In August 2012 Mexico achieved universal healthcare coverage.[70]