Two main versions of the organization of health insurance are observed throughout the world: employment-based social security, and a national health service. Latin America often uses the former, but remains far from universal coverage. A rather peculiar mix of public obligations with private responsibilities is found in the Netherlands. Universal coverage is achieved through a mandatory health insurance carried out by privately organized competing insurers. Competition among insurers attracting consumers and contracting care providers should guarantee low prices and high quality. After five years of experience, discussion about the achievements continues, but nobody proposes a return to the pre-2006 system. The apparent success in the Netherlands does not imply that a similar system can be introduced right-away in Mexico, because most of the preconditions are not satisfied yet. Nevertheless, several useful observations can be made.
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The document presents spending projections and projections of the distributive incidence for an Integrated Health System under three basic scenarios: status quo, a two pillar scheme (financed through general taxes and private spending) and a three pillar scheme (financed through general taxes, social security contributions and private spending). By presenting these simulations, the study enhances different existing proposals regarding this topic and discussions on an integral fiscal reform in Mexico. Results show that it is possible to implement a system where private health care spending is significantly reduced (to 30% of total spending) and inequity in health care financing and resource utilization is eliminated or even reversed. The additional fiscal resources required are substantial, amounting to around 3.5 percentage points of GDP for 2030 (under the two pillar scheme financed through general taxes relative to status quo); however, under the status quo scenario, even with universal coverage, private spending could amount to more than half of total spending and inequality would be only marginally reduced.
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This study uses Mexico’s 2008 National Household Survey of Income and Expenditure to construct an easy-to-use scorecard that estimates the likelihood that a household has income below a given poverty line. The scorecard uses ten simple indicators that field workers can quickly collect and verify. Poverty scores can be computed on paper in the field in about five to ten minutes. The scorecard’s accuracy and precision are reported for a range of poverty lines. The poverty scorecard is a practical way for local pro-poor programs in Mexico to monitor poverty rates, track changes in poverty rates over time, and target services.
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