HPH NOW, Jan 19, 2007, Former Minister Frenk Describes Health Care Reform in Mexico within Framework of Human Rights

Julio Frenk

During the past six years, Mexico's health care system has been undergoing a dramatic transformation. The federal government, declaring that access to high-quality health care is a fundamental right, has undertaken to provide universal coverage for 50 million people-half the country's population -who have traditionally lacked health insurance.

The historic reforms in a country with longstanding social and economic inequalities were informed by research and analysis by Julio Frenk, who served as Minister of Health under Mexican President Vicente Fox from 2000 until the recent election of a new president.

Frenk, who also is founding director general of the National Institute for Public Health in Mexico, gave the Dean's Distinguished Lecture on December 7, "Bridging the Divide: Global Lessons from Evidence-Based Health Policy in Mexico." He holds an MPH from the University of Michigan and has been a visiting professor at HSPH.

Frenk told the HSPH audience that Mexico, like other developing countries, is undergoing an "epidemiologic transition" from largely communicable diseases and malnutrition to a greater prevalence of chronic, noncommunicable diseases such as heart disease, mental illness, diabetes, and injury from violence. The poor, he said, suffer a "double burden" from both categories of illness and can be financially wiped out by a serious illness.

"Four million households every year become impoverished by health expenses," Frenk said. He added that only half the population had health coverage-mainly employees of large private businesses or the government.

Moreover, the health system of Mexico was drastically underfunded: in 2000, the country was spending 5.6 percent of GNP on health care. Most health care consisted of private services purchased out-of-pocket. And the system was unbalanced-the country was spending three times more per capita on patients with insurance than those who lacked coverage.

In 2003 the government enacted a new program, known as the Seguro Popular, or Popular Health Insurance, with a goal of enrolling 50 million uninsured people by 2010. So far, about 22 million people have been provided with insurance, which is free to the poorest people and requires a small premium from those with more income. The government subsidy comes mainly from tax revenues.

Frenk explained that the program is based on ethical values, created through political negotiation leading to funding of technological interventions. It draws its strength from evidence-based research-some of it carried out at HSPH-on health care experiences in Mexico and other countries. First and foremost, the legislation made an "ethical commitment" that access to high-quality health care is a fundamental human right.

"The key step forward," said Frenk, "was that it is not enough to recognize the right to health care, but to make it so that every person in society can exercise that right."

To ensure this outcome, the system includes entitlements-specific packages of benefits encompassing about 250 interventions required under the law, including an accelerated effort to provide free antiretroviral therapy for HIV/AIDS.

Mexico's ambitious experiment has been the subject of a seven-part series of articles in The Lancet, whose editor, Richard Horton, said, "The Mexican health reform has been a global laboratory for proving how to give access to a range of vital services to the entire population. It is a model even rich nations can learn from." The series can be read free of charge with registration, September 9-15, 2006 issue, Vol. 368, No. 9539, pp. 891-962.

If the Seguro Popular is evidence-based, so is the mechanism designed to evaluate its performance. Researchers at the Harvard Initiative for Global Health, headed by HSPH Professor Christopher Murray, are assessing the program so far to determine how well it is achieving its goals of universal coverage and reducing health care inequalities.

In a question-and-answer session, Frenk made several additional points:

The government is investing heavily in telemedicine to bring health care to members of indigenous groups, many of whom live in remote areas.
Consumers dissatisfied with the delivery of entitlement benefits can seek remedies in court. "This is a very powerful incentive for bureaucracies to do their job well," Frenk observed. Claims of poor outcomes are handled by a separate non-court body that avoids the litigation of a malpractice tort system, he added.
An aspect of the reform effort is a new public health agency that Frenk said regulates pharmaceuticals, food safety, and occupational and environmental health issues.
The Seguro Popular is enrolling Mexican immigrants in the United States through the consulate system.

In summary, said Frenk, "What has happened in these past six years is that we began to rewrite the social contract for health, which is a social right that needs to be provided in an egalitarian and inclusive manner."

—RS