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APHA Scientific Session and Event Listing

People's Health Insurance: Increasing access or perpetuating segmentation

Antonio Ugalde, PhD, Sociology, University of Texas, 1808 Glenncliff, Austin, TX 78704, 5124446031, augalde@mail.la.utexas.edu and Nuria Homedes, MD, DrPH, Global Health Program, University of Texas, School of Public Health, 632 Skydale, El PAso, TX 79912.

Background: The Mexican health system has undergone a series of reforms in the last 20 years. The first attempt to decentralize the health system occurred in 1984, the process was halted in 1988 and in 1996 there was a second decentralization wave. More recently, in April 2003, a new law created the People's health insurance to expand health coverage and provide free access to medications to the uninsured population.

Objectives: 1. Analyze the impact of the decentralization efforts in the state health systems; 2. Understand how the people's health insurance scheme affects the organization of state health systems; 3. Explore the People's insurance implementation mechanisms and the capacity of the states to implement the program; 4. Discuss how the People's Insurance Scheme may affect equity and access to health services; and 5. Explore the future of the program.

Methods: 1. Review of official documents and evaluations of decentralization efforts; 2. Participation in national discussion forums; 3. In-depth interviews with program administrators, academicians, and health providers.

Discussion: Although the implementation of the program is behind schedule, there are about 3,6 million families affiliated, 93% belonging to the lowest two income deciles. The states are receiving capitation funds and have an incentive to enroll families. Federal funds are to be used to purchase equipment, pharmaceuticals and supplies, and on personnel. The services are provided in the state health services clinics. There is little information on how states are using the federal funds, there are reports of shortages of supplies and medicines, and there are questions regarding the financial sustainability of the program and its impact on equity. The program has large administrative costs, is being implemented as a vertical program and contributes to the fragmentation of the health system. The authors question the use of a health insurance model instead of strengthening the state health systems or expanding the IMSS-Oportunidades model. The impact of the program on the appropriate use of medications deserves special attention. The program has benefited from a healthy economy due to the high cost of oil but its future is highly dependent on the results of the federal elections in July 2005.

Learning Objectives:

Keywords: Access to Health Care, Health Reform

Presenting author's disclosure statement:

Any relevant financial relationships? No

Community Health Insurance and Health Care Financing in Decentralized Health Systems

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA