Health Insurance For More Than 52 million Mexicans Without Social Security

Sandra Ayala Reyes, 18, is a domestic worker in Mexico City. If she gets sick, she says she cannot afford to pay a doctor to see her.

One day, Sandra tells us, she felt dizzy and nauseated. She went to a clinic and asked for the “Seguro Popular” or Popular Health insurance. Doctors examined her, undertook blood tests and gave her a treatment, for free. She is fine now.

That would have been more difficult over ten years ago. In 2003, a revision of the General Health Law created the Popular Health insurance, designed for all those who are not insured otherwise.

Before, the uninsured didn´t have a special assigned health package to them, services would depend on the local budget and the availability of personnel.

“I feel safe”

“I feel safe,” says Sandra, “because I know that anytime I have access to specialists for my health.”

The program covers now more than 52 million people, includes over 250 types of medical procedures and over 500 pharmaceutical products. On top of that, almost 60 complex interventions are offered to affiliates, in case it is needed – this covers, for example, HIV antiretroviral treatments.

The insurance has grown over the years: it started with 78 types of treatments. Based on how frequently they were needed, cost – effectiveness and the opinion of scientists, among other things, the number of medical procedures covered by the insurance were expanded to the current 250.

Thanks to the Seguro Popular, less money was spent on health services by the patients themselves and there were fewer cases of people falling into poverty because they had to pay for a major health treatment, according to a World Bank analysis.

Bridging the remaining gaps

But some challenges remain. Although the number of doctors, nurses and hospital beds has increased, health resources and health outcomes in different states are still unequal, according to a World Bank study on the Mexican Social Protection System in Health, published in January 2013.

The study also points out that the overall health system is fragmented – different health insurance schemes have different funding sources, insurance pools, provider networks, and administrative structures – and that results in inefficiencies and inequalities.

According to another World Bank analysis, a more coordinated and integrated system could help bridge these remaining gaps.

Meanwhile, Sandra is content. Without the service, she says, ”the situation would be more difficult, as seeing a doctor is expensive, and my family doesn´t have enough resources.”

About the World Bank in Mexico

The World Bank is collaborating with Mexico on development issues like social protection by offering a whole array of knowledge and convening activities, including giving technical assistance and analysis, and bringing key stakeholders together.