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Ministry of Health, Mexico
Mexico´s experience with using NHA
data in the Policy-making Process
Reform of the General Health Law
October 2003
OECD, Paris
SICUENTAS
Ministry of Health, Mexico
Outline
Background on the use of NHA in Mexico
Setting the scene – providing evidence
Objectives of the Reform
 SICUENTAS and the Reform
Conclusions
SICUENTAS
Ministry of Health, Mexico
Background
FUNSALUD conducted the first NHA analysis in Mexico (1992 – 1998)
Public and private expenditure as percentage of GDP, Mexico 1992-1998
7
6
5
4
3
2
1
0
1992
1993
1994
Public expenditure
SICUENTAS
1995
1996
1997
Private expenditure
1998
Ministry of Health, Mexico
Evidence provided was used in prospective policy
formulation
National Health Program 2001 – 2006 identified
three challenges of the health system:
1. Equity
2. Quality
3. Financial protection
SICUENTAS
Ministry of Health, Mexico
National Health Program 2001 – 2006
Strengthen the stewardship function of MOH
System of National and State Health Accounts
(SICUENTAS)
General Direction for Information and Health System
Performance Asssessment
(National Health Information System)
SICUENTAS
Ministry of Health, Mexico
Setting the scene
Providing evidence
FINANCIAL IMBALANCES
• Level
Insufficient investment 5.8% of GDP
• Origin of expenditure
Out-of-pocket expenditure (55%)
• Distribution
Between institutions: one and half times between
• State effort
A difference of 119 to 1 between highest and lowest
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insured and uninsured population
Between States: 11 to 1 between highest and
lowest
Ministry of Health, Mexico
Objectives of the reform
 Order the current allocation of resources
 Correct the financial imbalances and historic inercia
 Move towards a framework of public insurance to finance
medical care
 Establish co-responsibility between different levels of
government and the population
 Provide effective content to the full exercise of social
rights as part of the reform of the State
SICUENTAS
Ministry of Health, Mexico
Proposal – towards a new financial architecture of
the health system
Public Insurance
Schemes
IMSS – Medical
insurance
ISSSTE – Medical
insurance
Popular Health
Insurance
SICUENTAS
Contributors
Employee
Employer
Employee
Federal
Government
Family
Nation
Nation
Nation
State
Gov.
Federal
Gov.
Ministry of Health, Mexico
SICUENTAS and the Reform
Classification of health services
Public Goods
Health
Goods
Individual
health services
(medical care)
SICUENTAS
• Stewardship
• Information and
research
• Community health
services
•
•
•
•
Prevention
Diagnosis
Treatment
Rehabilitation
• Epi surveillance
• Environmental
health
• Collective
services
• Disaster
management
Ministry of Health, Mexico
Public Health Expenditure by Function and Source of Funds, Mexico
2002
70%
60%
50%
40%
30%
20%
10%
0%
Health administration
Prevention and public
health
Federal contributions
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Personal health care
State contributions
Resourse generation
Ministry of Health, Mexico
Examples of modifications
National Health Accounts
Ministry of Health Classification
Health Related Expenditures
•To train personnel
• HC.R.2 Education formation of
health care provider institutions
•To conduct scientific and
technologic research
• HC.R.3 Research and
development in health
•To conduct sanitary regulation
• HC.R.4 Food, hygiene and
drinking water control
TOTAL HEALTH EXPENDITURE
SICUENTAS
Ministry of Health, Mexico
• Stewardship has been added to the list of functions
of the health system, AS A DIFFERENT FUNCTION
FROM ADMINISTRATION
• MOF has agreed to a health expenditure reporting
format that is more closely related to the functions of
the health system, including stewardship
• Health related functions are included as part of the
total health expenditure
•Improve quality of reporting on pharmaceuticals
•Include information from municipalitites
•Manual for the Mexican SICUENTAS
•Informatio to be produced every three months
SICUENTAS
Ministry of Health, Mexico
SICUENTAS, as part of the National
Information System, is an important tool
providing evidence for policy
formulation, accountability, resource
allocation
INFORMATION THAT IS NOT USEFUL IS NOT USED
SICUENTAS
Ministry of Health, Mexico
SICUENTAS