2013年-世界发展银行全球_The_Mexican_Social_Protection_System_in_Health_34页_2mb

报告摘要

Summary of the Mexican Social Protection System in Health

Core Content

The Mexican Social Protection System in Health (SPSS) is a key component of the country's efforts to achieve Universal Health Coverage (UHC). This case study, part of the World Bank's UNICO Studies Series, provides an in-depth analysis of the SPSS and its main pillar, Popular Health Insurance (PHI), which was established in 2003 through the reform of the General Health Law. The study outlines the structure, objectives, and challenges of the SPSS, highlighting its role in improving health outcomes, reducing financial barriers, and promoting equity.

Main Objectives of the SPSS

The SPSS was created with the following main objectives:

Increase public health funding and reduce disparities in public expenditures across social insurance schemes and states.
Improve health outcomes and reduce out-of-pocket (OOP) payments for health services.
Provide protection against catastrophic health expenditures.
Reform the organization and functioning of state health systems to enhance efficiency and responsiveness.

Key Features of the SPSS

The SPSS consists of three main pillars:

Popular Health Insurance (PHI): A subsidized health insurance scheme targeting the uninsured population, offering a package of primary and secondary care services.
Fund for Protection against Catastrophic Health Expenditure (FPGC): Provides coverage for high-complexity services and antiretroviral drugs for HIV/AIDS patients.
Health Insurance for a New Generation (SMNG): Offers a comprehensive package of services for children under five born after December 1, 2006.

The PHI is the largest component, covering approximately 52 million people by 2012. It is funded by the federal and state governments through general government revenues, with a fixed share of contributions allocated to the PHI (89%), the FPGC (8%), and infrastructure and reserve funds (3%).

Financing and Management

Funding Sources: The SPSS is funded by the federal and state governments. The federal government provides two contributions: the "social contribution" and the "federal solidarity contribution," while the states provide the "state solidarity contribution."
Premium Calculation: The PHI premium is calculated as a fixed percentage of the social contribution, which is based on the minimum general salary in the Federal District.
Resource Allocation: A portion of the transferred resources is allocated to specific uses, including payroll (up to 40%), drugs (up to 30%), promotion and prevention (minimum 20%), and administrative costs (up to 6%).
Management: The SPSS is managed by the National Commission for the Social Protection in Health (CNPSS) and its state-level counterparts, the Estate Regimes for Social Protection in Health (REPSS). The CNPSS reports directly to the Minister of Health and often to the President of the country.

Implementation and Challenges

Coverage Expansion: The PHI expanded rapidly, particularly after 2010, to cover nearly all of its target population.
Reduction in OOP Payments: The reform significantly reduced OOP payments and catastrophic health expenditures for PHI affiliates compared to the uninsured.
Persistent Challenges:
- Regional Inequalities: Large disparities in health outcomes and resources remain between Mexican states.
- Fragmentation: The health system remains fragmented, with multiple insurance schemes offering different benefits and funding sources.
- Underfunding: Despite increased funding, the overall OOP burden remains high, among the highest in upper-middle-income countries.
- Institutional Weaknesses: The reform aimed to separate financing and provision, but this has not been fully realized. State providers still largely receive historical budgets rather than performance-based payments.

Impact and Outcomes

Health Outcomes: Infant and under-five mortality rates have decreased significantly, and the country is on track to meet the Millennium Development Goal (MDG) for under-five mortality.
Life Expectancy: Life expectancy in Mexico has increased, reaching 73.2 years for men and 77.9 for women in 2011.
Non-Communicable Diseases: The burden of non-communicable diseases, such as diabetes and cardiovascular diseases, is increasing due to aging populations and lifestyle factors.

Conclusion

The SPSS represents a major step forward in Mexico's pursuit of UHC, with significant achievements in expanding coverage and reducing financial barriers. However, challenges such as regional inequalities, fragmentation of the health system, and the persistence of high OOP payments remain. The World Bank's UNICO Studies Series aims to support countries in addressing these challenges through knowledge and operational tools.

Key Information

Total Health Expenditure (THE): Increased from 2.4% to 3.1% of GDP between 2000 and 2009.
Public Health Expenditure: Rose from 2.4% of GDP in 2000 to 3.1% in 2009, with a more equitable distribution across states.
Catastrophic Expenditure: Reduced among PHI affiliates, though still relatively high.
PHI Coverage: Reached approximately 52 million people by February 2012.
Entitlements: Explicitly defined and fully funded, including a package of 284 primary and secondary care interventions (CAUSES) and 57 high-complexity services (FPGC).
Future Agenda: The study identifies areas for further reform, including improving the efficiency of service delivery, enhancing coordination between subsystems, and addressing the high OOP burden.

References and Annexes

Annex 1: Brief Description of Public Health, Primary Care, and Key Supply-side Efforts.
Annex 2: Spider Web (a tool for analyzing the health system structure and performance).
Key Abbreviations:
- PHI: Popular Health Insurance
- CAUSES: Universal Health Services Catalogue
- FPGC: Fund for Protection against Catastrophic Health Expenditure
- SMNG: Health Insurance for a New Generation
- CNPSS: National Commission for the Social Protection in Health
- REPSS: Estate Regimes for Social Protection in Health