Mexico s Health Care Reform

Transcription

1 Session Code M25 This presenter has nothing to disclose Mexico s Health Care Reform Dr. Enrique Ruelas December 10 th 8:30 4:30 pm CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS 1

2 CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS Basic demographic indicators Population (2010): 112,336,538 (1 in the world) Men/women relationship: 95/100 Urban population: 78% Rural population: 22% Indigenous population: 6,695,228 2

3 Demographic transition in Mexico Population structure 2000 Population structure 2050 >85 80 to to to to to to to to to to to to to to to 14 5 to >85 80 to to to to to to to to to to to to to to to 14 5 to Men Women Men Women 6 3

4 Basic economic indicators GDP: US$ ppp 1657 trillion (12 in the world) GDP per capita: US$ ppp 15,100 Income level: upper-middle-income country GDP composition by sector: Agriculture: 13.5% Industry: 23.2% Services: 63.3% Population below poverty line: 18.2% Gini index: 51.7 (19 in the world) Mexican health system (MHS) 8 4

5 Coverage of the MHS Population Population affiliated to social security institutions Population affiliated to Seguro Popular Population with private insurance only* Number % Number % 38.7 million million million million million million 3.0 Un-insured population 61.2 million million 16.1 Total population million million 100 * Half of the population with private insurance is also affiliated to a social insurance institution. Benefits offered by public institutions in Mexico Ambulatory care Hospital care High-specialty care Population affiliated to social security institutions Population affiliated to Seguro Popular Un-insured population

6 CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS Financial imbalances Level: insufficient investment (5.1% of GDP) 2. Source: predominance of out-of-pocket payments (55% of THE) 3. Distribution 3.1 Among populations:1.5 times between insured and uninsured 3.2 Among states 8 to 1 between the state with the highest and lowest per capita federal expenditure 4. State contributions: 119 to 1 between the highest and the lowest 5. Allocation of funds: increasing proportion to payroll at the expense of investment 6

7 High prevalence of catastrophic expenditure - Mexico millon Mexican housholds incurred in catastrophic and/or impoverishing health expenditures 1.5 millon 0.5 millon 1.7 millon Households with catastrophic expenditures (over 30% of disposable income) Households with impoverishing expenditures (expenditures that push them below the poverty line) A Comprehensive Country-wide Strategy Towards Quality and Safety in a Health Care System 14 7

8 A Comprehensive Country-wide Strategy Towards Quality and Safety in a Health Care System 15 Challenges NATIONAL HEALTH PLAN Equity Even care access at birth to QualityTechnical quality Reduce health inequalities Objectives Strategies Improve health Financial Interpersonal quality conditions for the Mexican population protection Responsiveness National for Healthcare Quality Crusade in Assure for healthcare financial justice Insurance Popular 8

9 CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS Seguro Popular 18 In response to these financial imbalances, the Mexican Congress approved in 2003 the creation of the System for Social Protection in Health (SSPH) and its operative branch, Seguro Popular. The main purpose of the SSPH was to mobilize additional public resources to extend social protection in health to all the population. 9

10 Seguro Popular 19 Seguro Popular is financed with federal, state and individual resources (individuals in the lowest income quintiles are exempted from the contribution) Guarantees legislated access to a package of 270 essential interventions provided in public ambulatory units and general public hospitals. Also guarantees access to 57 costly interventions, including treatment for cancer in children, HIV/AIDS, and cervical and breast cancer provided mostly in highspecialty public hospitals. CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS 10

11 The National Crusade for the Quality of Health Care 21 Crusade: Vigorous, concerted action for for some cause or or idea, or or against some abuse.. (Webster s Dictionary) 22 11

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13 LEVELUSERS PROVIDERS Strategies ORGANIZATION SYSTEM LEVEL 3.Information 2.Education, 1.Codes of Ethics 4. for and of quality 5. CQI Incentives b)on a)towards b)towards processes for and improvement from the users Regulation Process Outcome Accreditation Social Standarization Monitoring Certification and Monitoring Action Participation plans Action plans Action plans 25 Strategies For Stakeholders Engagement INVOLVEMENT Design-Assessment of the strategy Quality improvement committees National Health Council meetings INCENTIVES National Quality Award Performance agreements Requirement of basic accreditation for funding VISIBILITY Ceremonies National Quality Forum TRAINING Team training FEEDBACK Indicators information system on line CIVIC PARTICIPATION Citizen endorsement groups 13

14 CONTENTS CONTEXT EVIDENCE BASED PUBLIC POLICY FINANCIAL PROTECTION QUALITY IMPROVEMENT CITIZEN ENDORSEMENT GROUPS 28 CITIZEN ENDORSEMENT GROUPS 14

15 OBJECTIVES 29 Transparency Improvement Sustainability CRITERIA 30 Willingness to participate Honorability Social representation Political neutrality 15

16 PROCESS 31 Selection Training Visits Recommendations Formal agreements Accomplishment Endorsement Awards to the best performers VISITS 32 Checklist for observation of key amenities and behaviors. Surveys to patients Matching with local surveys results 16

17 Citizen endorsement March ,754 Citizen groups 32 States Universities Business Professional Chambers and associations educational institutions 332 1,153 NGOs Private companiesand federations Valid units Community groups 3,724 Monitored 1,210 units Professional NGOs Private companies associations Community groups 1,210 1,000 1,200 1, September 2005 Progress of the citizen endorsement 1,260 strategy Units endorsement with citizen endorsed Units Units up with visits follow- Units 505 indicators improved with 17

18 Providers and jun users responsiveness -04 that -sep know -05 the outcomes of AN INTERESTING OUTCOME 10,000 12,000 14,000 16,000 18,000 # Personas 2,000 4,000 6,000 8,000 Usuarios Personal0Jun-04Jun-04 3,147 2,437 Dic-04 7,019 4,811 Dic-04 Jun-05 9,416 6,745 Jun-05Sep-05Sep-05 15,776 11,264 Session Code M25 This presenter has nothing to disclose Mexico s Health Care Reform Dr. Enrique Ruelas December 10 th 8:30 4:30 pm 18