Health Equity: 07/02/09

Thursday, July 2, 2009

[EQ] The democratization of health in Mexico: financial innovations for universal coverage

The democratization of health in Mexico:
financial innovations for universal coverage

Julio Frenk a, Octavio Gómez-Dantés b & Felicia Marie Knaul c
a. Harvard School of Public Health, Boston, MA, United States of America.
b. National Institute of Public Health, Cuernavaca, MO, Mexico.
c. Mexican Health Foundation, Mexico, DF, Mexico.
Bulletin of the World Health Organization Volume 87, Number 7, July 2009, 485-564

Available online as at: http://www.who.int/bulletin/volumes/87/7/08-053199/en/index.html

“……In Mexico, important strides have been made in increasing people’s access to comprehensive health care, thanks to a health reform that made health care a legal right, as prescribed by amendment to the Mexican Constitution in 1983. Through the new Seguro Popular, by 2010 high-quality health care will have been extended to everyone in Mexico. Thus, the democratization of health care – defined as the application of democratic norms and procedures to individuals deprived of the benefits and duties of citizenship, such as women, youngsters, ethnic minorities or workers of the informal sector of the economy²⁹ – will have been attained.

This paper has provided evidence that the financial innovations linked to the Sistema de Protección Social en Salud are improving insurance coverage, the availability of health infrastructure and basic health inputs, health-service utilization, effective health-care coverage, and the levels of financial protection enjoyed by the Mexican population, especially among the poor.

However, Mexico continues to face important challenges, mainly in connection with emerging diseases. Disease control efforts before the epidemiological transition yielded important improvements, but as immunization coverage increased and deaths from diarrhoea, acute respiratory infections and reproductive events dropped, non-communicable diseases began to take a proportionately larger toll. As a result, there is a critical need for additional public funding to extend access to costly interventions for non-communicable health conditions not yet covered by the FPGC, such as cardiovascular diseases, adult cancers and the complications of diabetes.

The benefits offered by the Seguro Popular in public outpatient clinics and general hospitals are very similar to those provided by comparable services in social security agencies. However, there is still a need to extend the coverage of costly interventions, which is still higher at IMSS, ISSSTE and other social security agencies……”

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[EQ] WHO Guide to Identifying the Economic Consequences of Disease and Injury

WHO Guide to Identifying the Economic Consequences of Disease and Injury

Department of Health Systems Financing Health Systems and Services

World Health Organization - Geneva, Switzerland, 2009

Available online as PDF file [136p.] at:
http://www.who.int/choice/publications/d_economic_impact_guide.pdf

“……Distinct from but complementary to clinical or epidemiological approaches to disease burden assessment, analysis of the economic impact of ill-health can address a number of policy questions concerning the consequences of disease or injury. Some of these questions relate to the microeconomic level of households, firms or government – such as the impact of ill-health on a household’s income or a firm’s profits – while others relate to the macroeconomic level, including the aggregate impact of a disease on a country’s current gross domestic product or its future growth prospects.

Resulting estimates - for a particular disease, injury type or for diminished health status in the population generally - can usefully inform decision makers about the overall magnitude of economic losses and their distribution across a number of key drivers or categories of cost. Although insufficient as a basis for setting priorities and allocating resources in health – for which data on effectiveness are also needed – economic burden studies may help to identify possible strategies for reducing the cost of disease or injury via appropriate preventive action or treatment strategies….”

TABLE OF CONTENTS

EXECUTIVE SUMMARY

1. INTRODUCTION

1.1. Policy context: why measure the economic consequences of disease?

1.2. Motivation, scope and objectives

2. CONCEPTUAL FOUNDATIONS

2.1. Ill-health and its economic consequences

2.2. The quantity of interest for economic impact studies in health

2.3. The choice of counterfactual for economic impact studies in health

2.4. Conceptual foundations: key points

3. MEASUREMENT AND VALUATION: MACROECONOMIC LEVEL

3.1. The impact of health shocks on national economies

3.1.1. The impact of health expenditures

3.1.2. Labour and productivity losses

3.1.3. Effects on human, physical and financial capital formation

3.2. Measuring the impact of disease on national income or product

3.2.1. Regression-based estimation models

3.2.2. Simulation approaches: Calibration and CGE models

3.3. Measuring the impact of disease on economic welfare

3.4. Macroeconomic impact: key points

4. MEASUREMENT AND VALUATION: MICROECONOMIC LEVEL

4.1. Microeconomic impact of disease and injury at the household level

4.1.1. The impact of disease and injury on the household

4.1.2. Expenditures on health by households

4.1.3. Labour and productivity losses

4.1.4. Effects on human, physical and financial capital formation

4.1.5. Non-market impacts

4.1.6. Economic welfare losses

4.2. Microeconomic impact of disease and injury at the level of the firm

4.2.1. The impact of disease and injury on the firm

4.2.2. Expenditures on health by firms

4.2.3. Labour and productivity losses

4.2.4. Opportunity cost of reduced investment

4.2.5. Non-market impacts

4.3. Microeconomic impact of disease and injury at the governmental level

4.3.1. Expenditures on health by government

4.3.2. Labour and productivity losses

4.4. Microeconomic impact: key points

5. CONCLUSION

REFERENCES

Appendix A Ill-health and its economic consequences for the household

Appendix B Critical overview of the cost of illness methodology

Appendix C Macroeconomic approaches to measuring the impact of disease and injury

Appendix D Time Preferences in an Expected Utility Model

Appendix E Technical and allocative efficiency effects of adverse health shocks for firms

Appendix F Glossary of main terms and definitions

For more information, please see:

- Development of WHO Guidelines on Generalized Cost-Effectiveness Analysis [pdf 146kb]
- Generalized Cost Effectiveness Analysis: A Guide [pdf 5.12Mb]
- Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis

The work is now focusing on the country contextualisation tools and subsequent policy dialogue. For more information, please see:

Generalized Cost Effectiveness Analysis for national-level priority- setting in the health sector [pdf 357kb]

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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.