Felicia Marie Knaul

Comprehensive Reform to Improve Health System Performance in Mexico

Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.

Evidence-based health policy: three generations of reform in Mexico

The Mexican health system has evolved through three generations of reform. The creation of the Ministry of Health and the main social security agency in 1943 marked the first generation of health reforms. In the late 1970s, a second generation of reforms was launched around the primary health-care model. Third-generation reforms favour systemic changes to reorganise the system through the horizontal integration of basic functions-stewardship, financing, and provision. The stability of leadership in the health sector is emphasised as a key element that allowed for reform during the past 60 years. Furthermore, there has been a transition in the second generation of reforms to a model that is increasingly based on evidence; this has been intensified and extended in the third generation of reforms. We also examine policy developments that will provide social protection in health for all. These developments could be of interest for countries seeking to provide their citizens with universal access to health care that incorporates equity, quality, and financial protection.

Marking Time: An Analysis of Youth Hours of Work and Study in Urban Mexico

This paper argues that a more complex view of work and schooling is critical to poor countries as they implement policies to increase educational attainment. In this analysis of 12-17-year-old girls and boys in urban Mexico, we expand the traditional approach in two dimensions by (1) moving from an analysis of participation to one of hours of participation, and (2) broadening the definition of work to include youths household responsibilities. Copyright

Impoverishing and Catastrophic Household Health Spending Among Families with Older Adults in Mexico: A Health Reform Priority

One of the most important challenges facing health systems is population aging. International estimates suggest that the aging process will increase the cost of health by 41% between 2000 and 2050, so that health spending could reach 11% of work GDP (United Nations, 2002).

Non-Communicable Diseases in the Global Health Agenda

For a long time non-communicable diseases (NCDs) have been a major cause of death and disability worldwide. However, the profile of this health challenge is changing: Having dominated the epidemiologic contour of high-income countries in the 20th century, it is now increasingly affecting the developing regions of our planet. Unless we start implementing measures to reduce the burden of NCDs in lowand middle-income countries, the pressure on their health systems will be unbearable and will limit the prospects for economic development.1