Global Health Force in Mexico, 2006

In the early 1990s, Mexico showed clear signs of having entered a transitional stage in the health of its population. When compared with 1940 or even 1970, Mexico in the 1990s exhibited mortality patterns that more closely approximated those found in developed societies (see table 5, Appendix). Health officials have also reported substantial reductions in morbidity rates for several diseases typically prevalent in poorer countries.

At the same time, however, government officials recognize that this transition is, at best, incomplete. Diseases associated with unsanitary living conditions, minimal access to health care, or inadequate diet continue to affect those in the lowest economic strata. Reductions in government health care expenditures during the economic crisis of the 1980s slowed progress in several areas. In addition, persistent underreporting of diseases in rural areas masks the true dimension of the health care challenge.

Mexico’s social security program provides health care to formal-sector workers and their families, some 50 percent of the national population in 1995. This figure represented a drop from the 56 percent coverage rate in 1992. The Mexican Institute of Social Security (Instituto Mexicano de Seguro Social–IMSS) covers approximately 80 percent of these beneficiaries (all employed in the private sector). The Institute of Security and Social Services for State Workers (Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado–ISSSTE) covers government workers and accounts for 17 percent of the beneficiaries. The Secretariat of National Defense (Secretaría de Defensa Nacional), the Secretariat of the Navy (Secretaría de Marina), and Mexican Petroleum (Petróleos Mexicanos–Pemex) have their own health programs, which cover military and naval personnel, and petroleum workers, respectively (see Personnel, ch. 5). A tripartite funding arrangement finances IMSS operations, with contributions from the employee, employer, and government. ISSSTE programs, as well as those offered by the military and Pemex, are financed through employee and government contributions.

Those outside the social security network–the so-called “open population”–receive health care from a wide array of government agencies. Approximately one-third of the population is served by IMSS-Solidarity (IMSS-Solidaridad), the successor of IMSS-Coplamar (see Structure of Society, this ch.) IMSS-Solidarity is funded by general government revenues, although IMSS provides administrative direction. As part of President de la Madrid’s decentralization effort and corresponding federal budget reduction, the population served by IMSS-Coplamar in fourteen states was reassigned to state health agencies under the overall direction of the Secretariat of Health (Secretaría de Salud–SS). The SS also serves as coordinator of the National Health System, which includes the health programs offered by the social security agencies. In keeping with its commitment to a new federal partnership, the Zedillo administration announced that it would transfer facilities and operations of IMSS-Solidaridad and the SS to the states in 1996.

Social security beneficiaries had greater access to health care than did their counterparts among the open population. In 1995 the rates of doctors and hospital beds per 100,000 persons stood at 121 and ninety, respectively, for social security beneficiaries but only 105 and eighty, respectively, for the open population. Social security beneficiaries were also nearly twice as likely as the open population to have consulted a doctor during 1995 and twice as likely to have had surgery that year.

Notable regional disparities in health care are also evident. In 1983 the government surveyed health care access nationwide as measured by thirteen basic indicators, including medical facilities, prenatal consultation, medical attention to various illnesses, and vaccination programs. The Federal District and three northern and northwestern states–Coahuila, Colima, and Nuevo León–recorded levels exceeding eighty out of a possible 100 points. In contrast, Oaxaca, Chiapas, and Puebla in southern and central Mexico averaged between forty and fifty points. Guerrero in the southwest posted a score of only thirty-nine.