Challenge
In 2002, before the creation of Seguro Popular, only half of the Mexican population benefitted from health insurance, largely through their employer. The self-employed, underemployed and unemployed accessed health services through public providers with a co-pay, or they paid for private care.
Poor and uninsured families, whose well-being was vulnerable to the financial consequences of illness or accidents, financed their health-care expenditures out-of-pocket. The budgets for public health care were uncertain and there was no defined package of free health services for the beneficiaries.
In fact, more than half of all health-care expenditures in Mexico were paid for out-of-pocket. By 2008, Seguro Popular counted over 27 million beneficiaries, who could access health services without a co-pay.
However, in 2009 the economic crisis led to a deep, though brief, contraction of over 6 percent of GDP, with increased poverty and pressure on the finances of vulnerable families. Seguro Popular was expanded in order to protect the health and finances of families who lost health insurance when they lost their jobs, as well as families who still lacked health insurance coverage.
Solution
The Social Protection System in Health Project supported the expansion of Seguro Popular, using the Program’ existing financial architecture, control mechanisms and management structure.
The National Commission of Social Protection is in charge of implementing the policy of Social Protection in Health, but the Federal contributions to the premiums are transferred to the 31 State Health Systems, which are then responsible for providing services to beneficiaries.
The Project also aimed to improve the administration of the Seguro Popular entitlements by supporting technical assistance to the Commission and the State Health Systems.
Results
The Project supported the expansion in coverage of Seguro Popular for people without health insurance from the contributory social security system, and helped set the basis for reform of the system.
- Between 2009 and 2013, the number of individual beneficiaries of Seguro Popular grew from 31.1 million to 55.6 million.
- The states started a new program of preventive visits to screen new beneficiaries for a variety of conditions including high blood pressure and diabetes. By 2013, 22.8 million people had received a screening.
- The percentage of poor individuals that benefited from Seguro Popular, as a percentage of those not affiliated to a contributory social security system, grew from 42.3% in 2008 to 72.32% in 2012.
- Between 2006 and 2012, the gap in insurance coverage rates between indigenous and non-indigenous populations was virtually eliminated, and significant advances were made in narrowing service utilization gaps and even health outcomes, even though there remain significant service utilization differences.
Bank Group Contribution
The estimated cost of Seguro Popular over 2010-2013 was US$26,825 million. World Bank financing amounted to US$ 1,250 million . Mexico’s general policy regarding external financing is that the executing agencies do not receive additional resources to their budget. Rather, Project funds were part of the Federal Expenditure Budget and subject to national financial and budget framework. As per usual practice, the Mexican government pre-financed the Project, in this case, with the Federal Social Contributions to Seguro Popular, and the World Bank subsequently reimbursed part of the eligible expenditures recorded under the corresponding budgetary lines.
Moving Forward
The focus going forward is to strengthen the program’s organization, functioning, and supervision of the use of the resources in the states. Although the World Bank currently does not have an investment project in health in Mexico, it continues its policy dialogue with the National Commission of Social Protection, the Ministry of Finance, the Ministry of Health and the Mexican Social Insurance Institute (Instituto Mexicano del Seguro Social, IMSS) around improving the efficiency and coordination among the different insurance schemes.
Beneficiaries
Cuetzalan is a remote town about a five-hour drive from the city of Puebla, in the state of Puebla. Just a few years ago, its antiquated public hospital was located in an area that was vulnerable to landslides.
Using Seguro Popular funds, a new rural hospital was built in a safer area. It now includes a modern pharmacy, an ambulance service and a comprehensive traditional medicine unit. In this unit, pregnant women who are enrolled in Seguro Popular can receive free prenatal and delivery care from traditional birth attendants, who work in partnership with the hospital’s delivery service.
In the disperse communities in the mountains around Cuetzalan, several mobile clinics reach out to Seguro Popular beneficiaries on a regular basis. The off-road vehicles include a fully equipped doctor’s consultation room and some even include a dentistry unit.
