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Transcript of Families receiving remittances Families receiving remittances Health insurance & health spending...

  • Slide 1
  • Families receiving remittances Families receiving remittances Health insurance & health spending in Mexico: Health insurance & health spending in Mexico: Felicia M. Knaul Fundacin Mexicana para la Salud ACADEMY HEALTH Orlando; June 5, 2007
  • Slide 2
  • OUTLINE Mexico: basic data Demographic and epidemiological transition The health system Health reform, 2003 Health spending, health insurance and remittances
  • Slide 3
  • Population % Rural Localities 250 inhabitants or less 1,000 inhabitants or less GDP per capita (current US$) Health spending /capita Poverty: 20% 7.9 years
  • Slide 4
  • Rapid social transition: ej: Dramatic increase in education Source: INEGI, SISEMIN and DIE/INEE Panorama educativo de Mxico 2004. Men Women Average years of schooling 8.1 2.8 7.6 2.4 2 8 197019801990200020021960
  • Slide 5
  • OUTLINE Mexico: basic data Demographic and epidemiological transition The health system Health reform, 2003 Health spending, health insurance and remittances
  • Slide 6
  • New challenges are associated with the rapid advance of profound demographic and epidemiologic transition. Over 50 years, Mexico will complete an aging process that took two centuries in most European countries. In 2050, one-in- four Mexicans will be 65 or over a four- fold increase. Costly, chronic, non-communicable illnesses now dominate the burden of disease. 19552005 72% 22% 6%6% 73% 17% 10% Communicable Chronic, Non- communicable Injuries Source: Seplveda et al.,2006
  • Slide 7
  • Painful double burden of disease: e.g.: obesity affects all populations, but for the poor it co-exists alongside malnutrition Overweight and Obesity Mexico, 5 to 11, 2006 26% 12% 20% Urban Rural National Child malnutrition Mexico, 1988 and 2006 Under height Emaciation Under weight 23 14 18 2 8 6 19881999 13 2 5 2006 Source: Instituto Nacional de Salud Pblica, 2006
  • Slide 8
  • OUTLINE Mexico: basic data Demographic and epidemiological transition The health system Health reform, 2003 Health spending, health insurance and remittances
  • Slide 9
  • Insurance (and health care) coverage in Mexico Social Security: ~40% IMSS: ~30-35%; formal-sector employees and family. ISSSTE: ~5-7%; public sector employees and family. Others: 3%; workers in specific industries Private insurance (first insurer): 1-2% with capacity-to-pay; some public and private employees Ministry of Health (federal and state): 50+% residual or open population without access to social security; poor Lowest per capita investment in health Seguro Popular: health reform of 2003 Current coverage: 10 -15% LAW: 100% of families without social security by 2010 All persons, in the United States of Mexico, have the right to health protection. ART. 4, CONSTITUTION
  • Slide 10
  • Contrasts in health care and access
  • Slide 11
  • Effective coverage of select interventions (Lozano, 2006) % BCG immunization Skilled birth attendance Measles immunization DTP3 immunization Antenatal care Diarrhea treatment (children) Cervical cancer screening Breast cancer screening 98 93 92 86 67 66 41 22 Source: Lozano et al, 2006
  • Slide 12
  • Reliance on out-of-pocket spending to finance health systems is inversely related to GDP: Mexico is an exception at 50%+ France Germany Panama Uruguay Italy Colombia Spain Bolivia Costa Rica Argentina Venezuela Peru Brazil Korea Thailand Malaysia Paraguay Ethiopia El Salvador Congo China Vietnam India 20 40 60 80 Chile Mexico LAC OECD GDP per capita vs. OOP as a % of health system finance GDP per capita % OOP Source: Authors own estimations based on data from WHO 2006
  • Slide 13
  • 6.3 % =1.5 millions of families per trimester =~ 4 million per year Insured: 2.2% Uninsured: 9.6% Poorest quintile: 9.6% Quintiles 2-5: 3.1% Absolute and/or relative impoverishment due to health expenditure, 2000 Source: authors own estimations based on data from the ENIGH 2000 Impoverishment (Knaul et al., 2005): -absolute: fall below or further below the poverty line -relative: spend 30%+ of disposable income on health
  • Slide 14
  • OUTLINE Mexico: basic data Demographic and epidemiological transition The health system Health reform, 2003 Health spending, health insurance and remittances
  • Slide 15
  • THE VISION BEHIND THE 2003 REFORM: ELIMINATE SEGMENTATION IN ACCESS TO HEALTH INSURANCE BY GENERATING A SYSTEM FOR SOCIAL PROTECTION IN HEALTH THAT INCLUDES POPULAR HEALTH INSURANCE FOR FAMILIES EXCLUDED FROM SOCIAL SECURITY Social Security Public and private, Formal sector workers and their families: ~50% of population Ministry of Health with residual funding Poor, informal sector, non-salaried, rural areas: ~ 50% of population 1943 2001/3: Pilot of PHI 2003: Law Jan. 1, 2004: SSPH 2010: Universal coverage with Seguro Popular S ystem for S ocial P rotection in H ealth Seguro Popular Frenk et al., 2004.
  • Slide 16
  • Key elements of the reform: 1. Access to publicly-funded health insurance Popular Health Insurance (PHI) - for all families excluded from Social Security. 2. Progressive pre-payment through a sliding-scale subsidy based on disposable income and zero family contribution for the poorest two deciles. 3. Separate budgeting and funds for public health goods with universal coverage. 4. Package of personal health services based on cost-effectiveness and burden of disease that is expanding over time. 5. Elimination of fees and co-payments at point-of- service for health care and medications.
  • Slide 17
  • Evolution of Health Coverage in Mexico by Institution; National Surveys: 2000-2005/6 2005(4)/6(1) 2000 Source: INSP, Encuesta Nacional de Salud, 2000; Encuesta Nacional de Salud y Nutricin, 2006. 32% 60% 28% 10.5 53% 11% Seguro Popular, administrative data, end of 2006: 5.1 million families (~23,000,000 people) 28% of the population w/o social security UNINSURED IMSS SEGURO POPULAR
  • Slide 18
  • OUTLINE Mexico: basic data Demographic and epidemiological transition The health system Health reform, 2003 Health spending, health insurance and remittances
  • Slide 19
  • Families with remittances, by insurance coverage TOTAL: FAMILIES WITH REMITTANCES 3.6 12.3 5.6 IMSS ISSSTE SEG. POPULAR WITHOUT INSURANCE URBANRURALTOTAL 24 6 3 67 9 1 8 82 16 4 5 74 Source: Authors`own estimations based on data from the ENIGH 2004
  • Slide 20
  • Health spending as a proportion of total disposable household spending*, by remittances 0 6 12 19922005 5.6% of families receive income transfers; these families account for about 9.7% of total out-of-pocket health spending With remittancesWithout remittances Source: Authors`own estimations based on data from the ENIGH 1992-2005 *Disposable household spending: total spending spending on food
  • Slide 21
  • Catastrophic health expenditure in families with and without remittances, by quintile 0 5 10 QUINTILE IQUINTILE VTOTAL With remittances Without remittances Source: Authors own estimations based on data from the ENIGH 1992-2005 Average/capita health spending by households with remittances is 121 pesos; compared to 75 pesos for households without remittances. Total Household Expenditure (as a proxy for perm. Income)
  • Slide 22
  • Insurance options for Mexicans living abroad FOR HEALTH CARE IN MEXICO Health Insurance for the Family (IMSS) Popular Health Insurance for Migrant Families Private insurance (examples) Coverage consultations, medications, lab work, basic dental, hospitalization, surgery, and maternity. consultation, hospitalization, medications, lab work, surgery and maternity. consultations, Hospitalization, laboratory work, surgery and maternity. Beneficiaries Spouse, children, parents, and extended family Nuclear family: Spouse and Children Whomever is included in the quota. Price Paid once a year, cost per person: $101 to $266 USD Family quota is a function of the familys capacity to pay. individual cost based on age and sex. Restrictions Serious, pre- existing illnesses: Cancer, diabetes, cardiovascular illness Cannot be covered by other social security institution Pre-existing illnesses are not covered. Maternity and pregnancy if insurance was contracted less than 10 months prior
  • Slide 23
  • Evolution of IMSS health insurance coverage Families affiliated to IMSS through Health Insurance for the Family Source: Authors own estimations based on data from the Memoria Estadistica del IMSS, 2006 Health Insurance for the Family, the only voluntary, non-employment-based option for IMSS coverage, has grown from 20,000 to ~380,000 families over the past decade, but remains tiny compared to overall coverage and reportedly difficult to contract. 1997200020032006 400,000
  • Slide 24
  • Affiliation and location of care, most recent health problem Insured by IMSS Insured by Seguro Popular Source: Authors own estimations based on data from the Encuesta Nacional de Nutricin y Salud, 2006. 66% 24% 11% IMSS 4% 78% 18% MINISTRY OF HEALTH PRIVATE OTHERS A large proportion of people with health insurance coverage use private services and pay out-of-pocket. This is true for IMSS, ISSSTE and Seguro Popular. HEALTH CARE SERVICE RECD FROM:
  • Slide 25
  • 0 20 60 100 IMSSISSSTE SEG.POP PRIVADOS 78% 87% 97% 100% % OF MUNICIPALITIES WITH AT LEAST ONE FAMILY W/ IMSS AND/OR SEGURO POPULAR % Municipalities with insured population, by level of poverty an