Public HealthEvidence-based health policy: three generations of reform in Mexico
Section snippets
Three generations of reform
Mexico is an upper middle-income country with a gross domestic product (GDP) per head of US$6215 in 2002. With about 100 million inhabitants, it is the third largest country in the Western hemisphere. Although about three quarters of its inhabitants live in urban areas, about 11 % dwell in 180 000 scattered small rural communities (1–499 inhabitants) according to data from the 2000 census.
Although most Mexicans have access to basic health-care services through public institutions, the range and
First-generation reforms
The Mexican health system dates back to 1943, when three important institutions were created: the Ministry of Health, the Mexican Institute for Social Security (IMSS), and the Children's Hospital (the first of the now ten National Institutes of Health, charged with complex tertiary care, training of specialists, and scientific research). The introduction of these institutions marked the appearance of the first generation of health reforms, which aimed to address the demands of industrialisation
Second-generation reform
The late 1970s mark the beginning of a second generation of reforms with efforts to extend basic health care to poorly served rural and urban-poor populations. A key input to this process was the design of policies and programmes based on evidence and evaluation. To improve the evidence-base for decision making, several measures to support health research were implemented. In 1987, the National Public Health Institute was created to enhance the work begun in 1922 when Mexico broke new
Third-generation reforms
A worldwide movement for health reform in the early 1990s marked the beginning of a third generation of health reforms. The prescribed solutions included: separation of financing from the provision of services to stimulate competition and accountability; evaluation of health interventions with the goal of designing cost-effective benefit packages; programmes for the continuous improvement of quality of care; and increased participation of citizens in their care.
In Mexico, decentralisation of
Policies for the new century
The present administration has developed the evidence-based approach to health care. The National Health Program 2001–2006 (NHP 2001–2006), in line with the WHO framework on health system performance, identifies equity, quality, and financial protection as the major challenges facing the Mexican health system and has designed specific policies to address them. These policies are consistent with the idea of reorganisation of the system by function.
Equity is an especially important goal.
Conclusions
Modern health systems aim to guarantee universal access to services that respond to the needs and expectations of citizens based on the goals of equity, quality, and financial protection. The reform of health systems has been a continuing process of change to approach these goals in the face of health transitions, technological innovation, and political and economic development at the national and international levels. The Mexican health reform process has increasingly been based on evidence to
References (25)
- et al.
Structured pluralism: towards an innovative model for health system reform in Latin America
Health Policy
(1997) - et al.
Health transition in middle-income countries: new challenges for health care
Health Pol Plann
(1989) Ten observations about mortality in Mexico
Salud Publica Mex
(1970)Observations about general mortality in Mexico from 1922 to 1969
Gac Med Mex
(1972)- et al.
Las cuentas nacionales de salud
- et al.
The health care reform in Mexico: Before and after the 1985 earthquakes
Am J Public Health
(1986) - et al.
Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico
Bull World Health Organ
(1996) - et al.
- et al.
The startegy of preventing blood transmission of HIV-AIDS in Mexico
Salud Publica Mex
(1995) - et al.
AIDS in Mexico: lessons learned and implications for developing countries
AIDS
(2002)
Stunting and emaciation in children under 5 in distinct regions and strata in Mexico
Salud Publica Mex
Encuesta Nacional de Nutritión 1999. Estado Nutricional en Niños y Mujeres en México
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