THE MEXICAN POPULAR HEALTH INSURANCE: MYTHS AND REALITIES

Universal health coverage (UHC) is today a dominant issue in the global health policy debate. The hegemonic proposal is UHC that recommends universal health insurance with an explicit service package and a payer-provider split with public and private managers. The Mexican Popular Health Insurance (PHI) is widely presented as a UHC success case to be followed. This article reviews critically its achievements after a decade of implementation. It shows that universal coverage has not been reached and about 30 million Mexicans are uninsured. Access to needed services is quite limited for PHI affiliates given the restrictions of the service package, which excludes common high-cost diseases, and the lack of health facilities. Public health expenditure has increased 0.36 percent of Gross National Product, favoring the PHI at the expense of public social security. These funds are, however, lower than legal specifications and the service package under-priced. Private health expenditure as a percentage of total expenditure has not varied much and PHI affiliates' out-of-pocket payment is larger than the whole PHI budget. There is no evidence of health impact. The Mexican health reform corresponds to neoclassic-neoliberal reorganization of society on the market principle. Although some of the PHI problems are particular to Mexico, it illustrates some of the overall flaws of the UHC model.