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wellbeing of Australia

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1 2 4 5 6

7 8 9 10 11 12

3

An overview of the

Mexican health system

Eduardo González Pier

Undersecretary of Integration and Development of the Health Sector September 2nd, 2015

5

Outline

Introduction

Health challenges

Health system response

Takeaways

6

Health challenges

Note: * Fertility rate: children per w oman.

Source: World Bank.

Life expectancy at birth and fertility rate,* Mexico and United Kingdom, 1960-2014

71.1

80.9

57.0

74.7

2.7

1.9

6.7

2.1

0

1

2

3

4

5

6

7

8

0

10

20

30

40

50

60

70

80

90

1960

1963

1966

1969

1972

1975

1978

1981

1984

1987

1990

1993

1996

1999

2002

2005

2008

2011

2014

Fer

tility

rat

e

Life

exp

ecta

ncy

Life expectancy UK Life expectancy MEX

7

Years lived with disability

Composition of DALYs by years lost to premature death and years lived with

disability, Mexico, 1990-2013 and OECD, 2010

México, 1990

Years lost to premature death

28%

72% 60%

40%

México, 2013

40% 60%

OCDE, 2010

Source: Institute of Health Metrics and Evaluation. http://www.healthdata.org/results/data-v isualizations for 1990 and

http://models.ihme.w ashington.edu/gbd-compare/ Resultados Preliminares for 2013.

Health challenges

8

Functions

Populations Subsystem Seguro Popular

(without social security) With social security

With access to

private services

Stewardship

Ministry of Health

Financing

Federal Government taxes

Individuals

(affiliation

contributions)

Employers Households

Salaried w orkers

(mandatory contributions)

High-income

non-

salarie

d

worker

s

Service

provision

Health centers, Hospitals (general, reference and

regional), National Health Institutes.

Family medicine units

General hospitals

Specialized hospitals

Private providers

Service

administration

IMSS

Prospera

State Health

Serv ices

Sy stem for Social

Protection in Health

Ministry of

Health

IMSS

ISSSTE

PEMEX Other

Priv ate

health

insurers

Man

dato

ry

cont

ribut

ions

Vol

unta

ry

prem

ium

s

Pre

miu

ms

Less Income level population More

State

government

taxes

Out

-of

pock

et

expe

nditu

re

Health system response

Source: Adapted from Ursula Giedion, Ricardo Bitrán y Ignez Tristao, editores. 2014. Planes de beneficios en salud de America Latina. Una co mparación

regional. Washington D.C.: Banco Interamericano de Desarrollo.

Mexican Health System

9

Source: OECD Health Statistics 2013, http://dx .doi.org/10.1787/health-data-en; WHO Global Health Ex penditure Database.

1. In the Netherlands, it is not possible to clearly distinguish the public and private share related to investments.

2. Current health ex penditure.

3. Data refers to 2010.

4. Data refers to 2008.

8,50

8 5,

669

5,64

3 5,

099

4,

546

4,52

2

4,49

5 4,

448

4,

246

4,

118

4,

061

3,92

5 3,

800

3,70

0 3,

405

3,

374

3,32

2 3,

305

3,

213

3,18

2 3,

072

3,

012

2,61

9

2,42

1 2,

361

2,

239

2,19

8 1,

966

1,91

5

1,68

9

1,56

8

1,45

2 1,

316

1,30

3 1,

043

977

942

90

6 43

2 14

1

127

Uni

ted

Sta

tes

Nor

way

Sw

itzer

land

Net

herla

nds

1A

ustr

iaC

anad

aG

erm

any

Den

mar

kLu

xem

bour

gF

ranc

eB

elgi

um 2

Sw

eden

Aus

tral

ia 3

Irel

and

Uni

ted

Kin

gdom

Fin

land

OE

CD

34Ic

elan

dJa

pan

3N

ew Z

eala

nd 2

Spa

inIt

aly

Por

tuga

lS

love

nia

Gre

ece

Isra

elK

orea

Cze

ch R

epub

licS

lova

k R

epub

licH

unga

ryC

hile

Pol

and

Rus

sian

Fed

erat

ion

Est

onia

Bra

zil

Mex

ico

3S

outh

Afri

caT

urke

y 4

Chi

naIn

dia

Indo

nesi

a

US

D P

PP

s

Public Private

Health system response

Health expenditure per capita, 2011 (or nearest year)

10

Hospital beds, 2000 and 2011 (or nearest year)

(per 1,000 population)

14.7

4.

7 10

.7

9.1

8.0

7.8 8.0

7.9

7.5

7.2

5.5 6.

3 4.

7 4.

8 5.4

4.0 4.3 4.7

3.7 4.

3 4.

0 3.

7 3.

5 3.3

2.1

3.1

2.7

1.8

0.6

13.4

9.

6 9.

4 8.

3 7.

7 7.

2 6.

8 6.

6 6.

4 6.

4 6.

1 5.

5 5.

4 5.

3 5.

0 4.

9 4.

9 4.

7 4.

6 3.

8 3.

5 3.

4 3.

4 3.

3 3.

3 3.

3 3.

2 3.

1 3.

0 3.

0 2.

8 2.

8 2.

8 2.

7 2.

5 2.

4 2.

4 2.

2 1.

7 0.

7 0.

6

Japa

n

Rus

sian

Fed

.

Aus

tria

Cze

ch R

epub

lic

Fra

nce

Slo

vak

Rep

ublic

Luxe

mbo

urg

OE

CD

25

Gre

ece

Slo

veni

a

Den

mar

k

Por

tuga

l

Nor

way

Spa

in

Irel

and

New

Zea

land

Chi

na

Tur

key

Sou

th A

fric

a

Mex

ico

Indi

aBed

s pe

r 100

0 po

pula

tion

2000 2011

Source: OECD Health Statistics 2013

Health system response

11

46.9 31.5

23.7 22.6 21.9 21.3

20.2 19.3 18.6

15.4 13.9 13.5 13.3 13.1 12.9

11.1 10.8 10.7 10.5 9.7

8.5 8.3 7.5 7.0 6.9

6.0 5.9 5.7

4.8 4.1

3.0 2.5 2.1

0 10 20 30 40 50

JapanUnited States

ItalyGreeceIcelandKorea

FinlandSwitzerland¹

AustriaDenmark

SpainLuxembourg

OECD28Ireland

NetherlandsNew Zealand

Germany¹Belgium¹

TurkeyEstoniaCanada

SloveniaFrance

Slovak RepublicCzech Republic

Portugal¹United Kingdom

Australia²Poland

ChileHungary²

IsraelMexico

Hospital

Per million population

101.3 44.4

40.9 40.8

35.9 34.3 33.6 32.1

29.5 29.3

25.1 23.6

21.3 19.2 18.3 17.3 16.4 15.7 15.4 15.0 14.8 14.7 14.6 13.6 13.5 13.0 12.5 12.5

10.2 9.0 8.9 7.3

4.8

0 25 50 75 100 125

JapanAustralia²

United StatesIcelandKorea

GreeceSwitzerland

ItalyAustria

DenmarkLuxembourg

OECD29Finland

Portugal¹Germany¹

SpainEstoniaIreland

New ZealandSlovak RepublicCzech Republic

TurkeyCanada

SloveniaPoland

Belgium¹France

NetherlandsChileIsrael

United KingdomHungary²

Mexico

Hospital

Per million population 1. Equipment outside hospital not included.

2. Only equipment eligible for public reimbursement

Source: OECD Health Statistics 2013

MRI units, 2011 (or nearest year) CT scanners, 2011 (or nearest year)

Health system response

12 12

Source: OECD Health Statistics 2013, http://dx .doi.org/10.1787/health-data-en.

1. Data include not only doctors providing di rect c are to patients, but also those working in the health sector as managers , educators, researchers , etc. (adding another

5-10% of doctors). 2. Data refer to all doctors licensed to practice (resulting in a large over-estimation of the number of practising doctors in Portugal).

6.1

5.0

4.8

4.1

4.0

3.

9 3.

8 3.

8 3.

8 3.

7 3.

6 3.

5 3.

5

3.3

3.3

3.3

3.3

3.

3

3.3

3.2

3.0

3.0

2.9

2.8

2.8

2.

7 2.

6 2.

5 2.

5 2.

4 2.

2 2.

2 2.

2 2.

0

1.8

1.7

1.6

1.5

0.8

0.

7 0.

2

Gre

ece¹

Rus

sian

…A

ustr

iaIt

aly

Por

tuga

l²S

wed

enG

erm

any

Sw

itzer

land

Spa

inN

orw

ayC

zech

Rep

.Ic

elan

d¹D

enm

ark

Aus

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iaF

ranc

e¹S

lova

k…E

ston

iaF

inla

nd¹

Isra

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EC

D34

Net

herla

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unga

ryB

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d…Lu

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bo…

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and

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love

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Uni

ted…

Can

ada¹

Japa

nM

exic

oP

olan

dK

orea

Bra

zil

Tur

key¹

Chi

le²

Chi

naS

outh

…In

dia

Indo

nesi

a

2011 2000

Practicing doctors, 2000 and 2011 (or nearest year)

(per 1,000 population)

Health system response

13

Source: OECD Health Statistics 2013, http://dx .doi.org/10.1787/health-data-en.

16.6

15

.4

15.4

14

.8

12.9

12

.2

11.8

11

.4

11.3

11

.1

11.1

10

.3

10.1

10

.0

10.0

9.

3

8.8

8.

7 8.

6 8.

3 8.

0 8.

0 7.

8 6.

3 6.

2 6.

2 6.

1 5.

9 5.

5 5.

2

4.8

4.7

4.2

3.3

2.7

1.7

1.7

1.

5 1.

1 1.

0 0.

9

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Den

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1. Data include not only nurses prov iding direct care to patients, but also those w orking in the health sector as managers, educators,

researchers, etc.

2. Data refer to all nurses w ho are licensed to practice.

3. Austria reports only nurses employ ed in hospital.

Practicing nurses, 2011 and change between 2000 and 2011

(per 1,000 population)

Health system response

14

High maternal and infant

mortality rates and

infectous diseases that

can be preventable

Financial protection

agenda

Demographic change

and transition to non-

communicable diseases

and injuries

Emerging agenda

Impoverishing health

expenditures and

increased costs

Unfinished agenda

Source: Jamison D. et al. (2013). Global Health 2035: a w orld conv erging w ithin a generation. The Lancet Commission on Inv esting in

Health. Lancet, v ol. 382, No 9908, p1898-1955.

Takeaways

15

Under-five children mortality convergence, 1970-2013

21

4.6

108.4

15.7

0

20

40

60

80

100

120

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

Rat

e pe

r 1,

000

live

brith

s

United Kingdom Mexico

Source: World Bank, 2015 . Differs from official Mex ico statistics

Takeaways: unfinished agenda

16

10 8

88

38.2

0

10

20

30

40

50

60

70

80

90

100

1990

1995

2000

2005

2010

2015

United Kingdom Mexico

Maternal mortality ratio, 1990-2013

(modeled estimate, per 100,000 live births)

Source: World Bank, 2015. Difers form oficial Mex ico statistics

Takeaways: unfinished agenda

17

4.1

4.3

8.1 10

.0

10.0

11

.0

11.4

12

.4

12.9

13

.4

13.8

14

.7

15.0

15

.4

15.7

15

.8

16.6

16

.6

16.9

16

.9

17.2

17

.7

20.0

21

.0

21.0

23

.5

24.8

25

.1

27.8

28

.3 32

.4 36

.5

Japa

n ¹

Kor

ea ¹

Sw

itzer

land

Nor

way

Italy

Sw

eden

Net

herl

ands

Aus

tria

Fra

nce

Den

mar

kB

elgi

umG

erm

any

Irel

and

Por

tuga

lIs

rael

Pol

and

Fin

land

Spa

inT

urke

yE

ston

iaO

EC

D (3

1)C

anad

aH

unga

ryC

zech

…Ic

elan

dLu

xem

bour

…U

nite

d…C

hile

¹

Aus

tral

ia ¹

Mex

ico

¹U

nite

d…

% o

f pop

ulat

ion

aged

15

year

s an

d ov

er

2000 2011

Increasing obesity among adults in OECD countries, 2000 and 2011

(or nearest year)

1. Data are based on measurements rather than self-reported height and w eight.

Source: OECD Health Data 2013.

Takeaways: emerging agenda

18

3.3 4.

4 4.7

4.8

4.9

5.

2

5.3

5.

3 5.

4 5.

4 5.

5

5.6

5.7

5.9

6.0

6.0

6.2 6.5 6.8

6.8

6.9

7.1

7.

2 7.6

7.7

7.8 8.1 8.

7 8.

8 9.

0 9.

2

9.2

9.

6 9.

8 9.

8 10.0

10

.4

15.9

Icel

and

Luxe

mb…

Bel

gium

Gre

ece

Uni

ted…

Ger

man

y

Den

mar

k

Sw

itzer

l…

Hun

gary

Aus

tral

ia

OE

CD

…

Est

onia

Kor

ea

Tur

key

New

…

Indi

a

Uni

ted…

Por

tuga

l

Bra

zil

Perc

enta

ge

Prevalence estimates of diabetes, adults aged 20-79 years, 2011

Source: International Diabetes Federation 2011.

Takeaways: emerging agenda

19 Sources: 1. World health Report 2010. Health Sy stems Financing. The Path to Univ ersal Cov erage.

2. OECD Health Data 2013.

Who is covered?

Which serv ices

are covered?

What proportion

of the costs is

covered?

Population

Co

sts

In Mexico, 47% of the total health expenditure is private.

95% of private health expenditure is out-of pocket.

4.2% of Mexican households face catastrophic health expenditure due to out-of pocket

payments and 1.7% face empovershing health expenditure.

Takeaways: financial protection agenda

Ministry of Health

http://portal.salud.gob.mx/

Inder Secretariat of Integration and

Development of the Health Sector

http://www.sidss.salud.gob.mx/

@SSalud_mx

https://www.facebook.com/SecretariadeSaludMX

Contact details