Inequalities in Mexico HS
Despite the fact that life expectancy at birth in Mexico has improved from forty-two years in 1940 to seventy-three in 2000, major inequalities persist in health and access to health care. The Mexican health care system has evolved into a series of disjointed subsystems that are incapable of delivering universal health insurance.
Fragmentation and administrative complexity are often described as among the greatest weaknesses of the health system in the United States, especially in comparison with other countries such as Canada, our neighbor to the north.
The result is that half of Mexico’s 100 million citizens are uninsured and more than half of the country’s annual health spending is out of pocket. The incentives in this balkanized system tend to reinforce the entrenchment of its several disjointed sectors, impeding efforts to improve performance. Disparities in access and outcomes—a tenfold difference in infant mortality rates between the poorest parts of the country and the richest, for example—make the U.S. system seem equitable in contrast. The employment-based portion of the Mexican system is particularly problematic, since workers in some sectors of the economy enjoy a hybrid public-private system of coverage, while many others are uninsured and must depend on an uneven system of public clinics. Thecomprehensive federal funding of a core package of services across all social groups must be the basis of universal health insurance.”
Throughout the world, inequity in health status has fallen faster than would be predicted based on changes in economic inequity.3 This general improvement has many causes, including the diffusion of knowledge about safer health behavior (such as that related to water quality, sanitation, nutrition, and safer sex) and the diffusion of inexpensive, effective technologies (most importantly, vaccination and oral rehydration therapy, or ORT). Mexico has one of the world’s most successful vaccination programs (coverage rates for many vaccines exceed 95 percent) and has successfully promoted ORT, dramatically reducing morbidity and mortality from childhood infectious diseases. Unfortunately, few opportunities remain to use these types of vertical, technology-based national programs to reduce large disease burdens.
Despite these achievements, gaps in health status are still wide and are especially evident when one compares population groups and geographical areas. For example, infant mortality rates range from nine deaths per thousand live births in the richest municipalities to 103 in the poorest. Indigenous communities have an infant mortality rate that is 58 percent higher and a life expectancy five years lower than the national average and ten years lower than in Mexico City or Monterrey, the largest urban centers. Forty percent of indigenous women have been shown to be anemic, compared with a national average of 26 percent. In the indigenous communities of Guerrero state, the maternal mortality rate is 28.3 per 10,000 live births, compared with the national rate of 5.1 per 10,000 live births.4 Unfair financing is the third and final equity-related concern of the Mexican health care system. In Mexico, 52.9 percent of total health spending is spent out of pocket (for expenses not covered by insurance). This percentage is 16.6 percent in the United States, 25.9 percent in Colombia, and 3.1 percent in the United Kingdom.7 Even though almost all population groups have high out-of-pocket spending, according to the 1998 National Household Income-Expenditure Survey, 7 percent of families in the poorest decile incurred catastrophic health expenditures in the previous three months, compared with only 3 percent of those in the highest income decile. The study conservatively estimated that between two and three million (of a total of twenty-two million) households spend more than a third of their income on health care each year—an expenditure that can easily lead...
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