Remarks by Angel Gurría,
7 January 2016
Mexico City, Mexico
(As prepared for delivery)
Secretary of Health, General Director of IMSS, General Director of ISSSTE, ladies and gentlemen:
It is a pleasure to present the OECD's second Health System Review of Mexico. This is a key issue for our country, and it has a direct impact on the well-being and life expectancy of the Mexican people. I would like to thank the Secretary of Health and the General Directors of IMSS and ISSSTE for their commitment to carrying out this review, which we hope will help lay the basis for a better-coordinated national health system.
A decade ago we published the first OECD Health System Review of Mexico. Since then, a great deal has changed, and for the better. Over the last 10 years, the publicly-subsidised health insurance plan (Seguro Popular) has extended coverage to more than 50 million people who were previously unprotected, whilst numbers reporting impoverishing health expenditure have fallen from 3.3% to 0.8% of the population. Health service users today report a satisfaction rate of 97%.
There have also been some major advances in terms of coordination and efficiency. The agreement among the various health institutions to pool their purchases of medicines has produced cumulative savings of 8.350 billion pesos in 2014 and 2015. Indeed, this has become a model of best practices for other OECD economies that are facing similar challenges in financing their health systems.
To all this we may add efforts undertaken to improve the health of the Mexican people, through taxing sugary beverages and foods with high caloric content, more detailed labelling about the nutritional content of foods and beverages, and better regulation of food advertising targeted at children. These are bold measures in the face of deeply ingrained inertia as well as powerful business interests, and they have generated great interest among OECD countries.
Despite this positive record, Mexico's health services still face a series of important challenges.
In the first place, there is much room for improvement in access to health services. Mexico has 2.2 doctors for every 1 000 inhabitants, well below the OECD average of 3.3, and the number of nurses per 1 000 inhabitants is only one-third the OECD average.
Also, patients’ out-of-pocket spending on health services is still very high in comparison to the OECD average, and this reflects the problems in providing effective insurance and high‑quality services.
Another real challenge lies in the fact that the Mexican health system functions as a cluster of sub‑systems that operate in isolation. Each offers different levels of care, at different prices, and with outcomes that are also very uneven. In effect, people are unable to choose their type of insurance or their service provider, as these are predetermined by their employment status – public, private, formal, informal, or none.
Every year, around a third of persons affiliated with IMSS and ISSSTE are obliged to switch their provider, institution and doctor, simply because they have changed employment. This situation affects the continuity of medical care, which is especially important for persons with chronic diseases such as diabetes. It also results in a waste of resources. In short, with its current structure the Mexican system is not achieving a good price/quality ratio.
Mexico needs to build a public health system that is more equitable, efficient and sustainable. The challenges still outstanding must be addressed through ambitious reforms such as those that Mexico has undertaken in other fields.
The OECD considers that the reform of the Mexican health system should focus on three priorities.
First, it must extend service-exchange agreements (convenios) between IMSS, ISSSTE and Seguro Popular, so that members can more readily move from one system to another.
What is needed is a system under which all Mexicans, regardless of where they live or what kind of work they pursue, can access the same level of service without having to worry about placing a greater financial burden on the household.
The Mexican authorities should continue moving toward a unified health system that is financed in a fair and sustainable manner. To achieve this, priority should be given to extending service-exchange agreements to high-cost diseases, maternity care, and elective surgical procedures.
It will not be enough, however, to focus only on medical care. The agreements must also address the most urgent public health issues such as obesity, diabetes and other chronic illnesses.
Second, greater emphasis should be placed on improving quality of care and outcomes.
It is essential here to build information systems for monitoring the quality of service and promoting improvements throughout the system. Generating and publishing more reports on the quality of the various hospitals and clinics will give beneficiaries the information and incentives they need to choose one service provider over another. Sharing good practices for improving performance will also help enhance the quality of service.
Mexico must encourage insurance providers, doctors and patients to identify and reward excellence in the system, and in this way help to develop incentives for proving quality and challenging poor performance.
Third, it is time to align the various areas of care and medical service - for example, care pathways, prices, information systems and administrative practices across sub-systems.
A better preventive system would promote sustained and coordinated efforts between Seguro Popular and social security institutions, especially when people are constantly changing regimes and moving back and forth between the formal and informal sectors. OECD studies show, for example, that with individual counselling for patients at high risk of diabetes, one person in every eight could achieve one more year of life in good health, at a cost of approximately 50 pesos per person.
Our study recommends that Mexico establish a commission that would bring Seguro Popular and the other health insurance schemes together to ensure the implementation of the actions needed to consolidate a system aligned in its various components. The commission could also promote measures that would gradually equalise the benefits offered by each institution providing health services, and thereby pave the way to a fairer and and more efficient health care system.
These are a few of the main recommendations of the study. I invite you to read it carefully, to focus on the challenges but also on the constructive recommendations it contains. It represents an effort that we have undertaken with the support of Mexico's health institutions.
Ladies and gentlemen,
I thank you for allowing the OECD to take part in this important and necessary reform of the Mexican health system. You can count on us to help build a more solid and fairer system that will allow Mexicans to obtain high‑quality service at a reasonable and affordable cost.
The debate now under way on reforms to the Ley General de Salud (General Health Act) constitutes a unique opportunity to bring about a historic change that will make for a healthier, more inclusive and more sustainable Mexico.
Thank you very much!