Payment for Health Services in Mexico - Essay Example

? PAYMENT FOR HEALTH SERVICES IN MEXICO (EXECUTIVE SUMMARY) al arrangements for sufficient, efficient, sustainable and fair financing are a major determinant of the performance of any healthcare system; moreover, due to the technical complexities, political sensitivities and ethical implications, the solution to the main financing challenges faced by health sectors has been hard to pin down (Tracy 2011). There are a number of countries like Mexico that have been facing financial problems in the health sector since the beginning of times, with efforts being made to try and alter the tradition but failing. For instance, in 2003 a significant number of the Mexican Congress approved a reform to the Mexico’s General Health Law establishing the System of Social Protection in Health which increased public funding that guaranteed universal health care coverage with poor families that were initially excluded from the past social Protection could now enrol in the People’s Insurance (Sheila 2009). The People’s Insurance, known to the Mexicans as Seguro Popular, was a new public insurance scheme that assured legislated access to comprehensive health care by most of the citizens in Mexico including the ones in the rural areas. Concurrently, in 2009, the swine flu outbreak in Mexico came testing the country’s complex health system as thousands of apprehensive people poured into hospitals and clinics for diagnosis and care. Significantly, the health-care system in Mexico is a collage of developing and frequently confusing services as a hundred and five million people in the country continue to suffer from ailments of the developing world like tuberculosis and malaria, with other emerging maladies such as diabetes being listed by the World Health Organization as the leading cause of death in the country followed by liver and heart disease (Tracy 2011). More pressure prevailed as the influenza crisis caused by the H1N1 virus unfolded with the ill frequently visiting local hospitals and clinics but one getting the facilities depended on a few factors i.e. where they lived, their employee and their total income. All the same, Mexicans have everything from a small private system to enormous global health insurance programs that comprise of private, public and employer funding; however, despite the selection of facilities, it is still an unequal system according to the Pan American Health Organization stating that since the different care providers get different levels of payment, they also provide different levels of care at various levels of quality (Sheila 2009). Extensively, even though public health care in Mexico has been rising, it still has the lowest per capita expenditures among the OECD countries having just a 6.6 per cent of gross domestic product (GDP) which worked out to be about 800 dollars per person in 2006 while Canada spent close to $3,700 per person which has duly increased to $5,000. Mexican private health system is structured in a way that about three million wealthy and middle class Mexicans, which includes the foreigners employed in Mexico, pay private insurers to gain access to high quality state of the art medical services and facilitates; on the other hand, most of the Mexicans insured through the public insurance system pay from their pockets to get better services through the private care (Tracy 2011). The private sector is booming with new clinics and specialized hospitals growing hastily in Mexico City, Guadalajara, and the most affected Monterrey that is becoming a major centre for medical tourism for the many Americans who are trying to escape their own expensive health care system. The Americans and other foreigners are gathering to the city’s growing number of glinting new hospitals to get services like obesity surgery, angioplasty, hip replacements etc; for instance, replacing a hip in the United States goes for about $43,000 to $63,000, but in Mexico one can bargain at around $12,000. The Mexican health system also has public sector where about 50 million working Mexicans pay into an insurance scheme including the employers and the government through the Institute of Social Security with every employee paying a progressive amount according to their age (Julio et. al 2009). The Institute of Social Security governs its own primary care units and state hospitals for workers that have insurance cover even though most people consider the quality of their services; in tandem, critics claim that some of its establishments are not managed properly and lack adequate equipment. On the other hand, roughly 17 million state employees have a separate parallel scheme that is paid through the Institute of Security and Social Services for State Workers that also manages its own clinics and hospitals located in different parts of Mexico. There are also insurance programs that are kept aside for the army and navy, partly funded through social services just like the employees at Mexico’s petroleum company owned by the state, Pemex. This health care system has left roughly 40 million Mexicans lacking insurance cover, which are also the country’s poorest; however, a program called Popular Health Insurance came to their rescue in 2003 after which they all began moving toward universal access to full health coverage (Sheila 2009). This health program was the most ambitious ever launched in Mexico since the beginning of social security, it was set to decrease the inequality of health services/ facilities and help the poor families that were being financially wiped out by an illness. The federal government had set the year 2010, as the target date by which the all uninsured Mexicans would get the coverage but were uncertain if this would be achieved; nonetheless, families were suppose to pay a premium based on their income to join, though about 20 per cent of the poorest families would pay nothing (Gabriel et. al 2009). A study conducted by the British Medical journal roughly an year after the program was introduced, showed that the program had achieved some of its objectives by lowering appalling health costs by as much as 9%, but this was for those who participated; additionally, the members also used more in-patient and outpatient services that included hypertension checkups which was a common problem then. In addition, the special programs helped reduce malaria rates, TB mortality and that Mexico was on track to reduce child mortality by two thirds as of 2015 (Jim &Richard 2006). Noticeably, Mexican children have been receiving the same vaccination during childhood just as Canadian children with there being an annual flu for both the young and old but the effect has not yet been established. Appreciably, the Popular Health Initiative made a lot of impact in reducing the costs for those that applied, offering childhood vaccines; however, this impact is only to those that were able to apply but those who were unable to apply are not considered yet they are still experience the high cost of the healthcare services (Gabriel et. al 2009). Research shows that most of these endemics like swine flu started of from the rural areas where there are fewer services for people than in the urban centres; moreover, the facilities and resources in these areas are limited hence expensive. Health care programs that have been initiated in the past like Popular Health Initiative only cover the urban centres, concentrating more in these areas living out the rural areas where the hospitals have not been renovated for more than fifty years yet they are still expensive despite the limited resources. Healthcare organisations in Mexico must address the root causes of their predicament i.e. high costs, poor and inconsistent quality of services and the inaccessibility of timely care in some of the areas; additionally, if they found ways to counter the underlying drivers of globalization, consumerism, changing demographics and lifestyles, this would set a foundation for the solutions of their problems. Significantly, they should start of in the rural areas by first addressing the diseases that are more expensive putting into consideration the increased prevalence of chronic diseases, followed by a proliferation of new treatments and technologies eliminating factors that worsen the challenges. Nonetheless, over the years significant strides have been made in increasing people’s access to comprehensive health care through initiating new programs and making reforms aiming at the democratization of healthcare where democratic norms and procedures have applied to individuals deprived of the duties and benefits of citizenship, such as ethnic minorities, women, the youth or even workers in the informal sector who get health care coverage (Julio et.al 2009). All the same, the challenges are still there and progress is required in mobilizing resources, insurance coverage, service delivery and quality of care; moreover, HCOs in Mexico need to evaluate the progress keenly to ensure that the state meets the ultimate criterion of a successful health reform leading to better health through equality and fair financing (Jim &Richard 2006). The quality of care is also expected to make a grave improvement with all the areas (urban and rural) being considered, but this will only happen if some of these significant areas are strengthened and given more attention: the technical quality of care, drug availability in all hospitals and clinics, the prescription guides and patterns, care provision during evenings and weekends in outpatient clinics and emergency services. References Sheila, W (2009) How Mexico’s Health System Works: CBS News/ Technology and Science. Retrieved 20th October 2013, from http://www.cbc.ca/news/technology/how-mexico-s-health-system-works-1.777348 Julio. F, Octavio, G &Felicia, M (2009) Democratization of Health in Mexico: World Health Organization. Retrieved on 20th October 2013, from http://www.who.int/bulletin/volumes/87/7/08-053199/en/ Tracy, F (2011) Perspectives on Health in Latin America: McKinsey &Company. Vol.1 (1), p. 3-39. Gabriel. M, Nelly, A &Dov, C (2009) Mexican Healthcare System and the Emerging Paradigm in Modern Systems: Guilford Glazer School of Business and Management. Retrieved on 20th October 2013, from http://www.ihf-fih.net/newsletter2/images/Mex_reform_submitC_4May09.pdf Jim, A &Richard, B (2006) Healthcare 2015 and Care Delivery: IBM Institute of Business Value. Retrieved on 20th October 2013, from http://www-03.ibm.com/industries/ca/en/healthcare/files/hc2015_full_report_ver2.pdf Read More