Team 7 __MEXICAN HEALTH CARE SYSTEM

Healthcare Comparison: Mexico and the United States:

By: Holly Hartman, Jamie Piotrowski , Melissa Ziesman , and Sara Kuhn Healthcare Comparison: Mexico and the United States

Population:

Mexico Population: 113,724, 226 Gender: 0.96 males/females Ethnicity: mestizo (Amerindian-Spanish) 60%, Amerindian or predominantly Amerindian 30%, white 9%, other 1% Age: 0-14 years: 28.2% 15-64 years: 65.2% 65 years & over: 6.6% United States Population: 313,232,044 Gender: 0.97 males/females Ethnicity: white 79.96%, black 12.85%, Asian 4.43%, Amerindian and Alaska native 0.97%, native Hawaiian and other Pacific islander 0.18%, two or more races 1.61% Age: 0-14 years: 20.1% 15-64 years: 66.8% 65 years & over: 13.1% Population

Population (continued):

Mexico Language: Spanish only 92.7%, Spanish and indigenous languages 5.7% Literacy rate: 86.1 % Net migration rate: -3.24 migrant(s)/1,000 population United States Language: English 82.1%, Spanish 10.7%, other Indo-European 3.8%, Asian and Pacific island 2.7%, other 0.7% Literacy rate: 99% Net migration rate: 4.18 migrant(s)/1,000 population Population (continued)

Health Statistics:

Mexico Birth rate: 19.13 births/1,000 population Death rate: 4.86 deaths/1,000 population Life expectancy: total population: 76.47 years , male: 73.65 years, female: 79.43 years Infant mortality: 17.29 deaths/1,000 live births United States Birth rate: 13.83 births/1,000 population Death rate: 8.38 deaths/1,000 population Life expectancy: total population: 78.37 years , male: 75.92 years , female: 80.93 years Infant mortality: 6.06 deaths/1,000 live births Health Statistics

Health Stats, (continued) :

Mexico Major causes of death in order include heart disease, diabetes mellitus or complications of it, cancer, and liver failure Major causes of illness include bacterial diarrhea, hepatitis A, and typhoid fever United States Major causes of death and illness in order include heart disease, cancer, stroke, chronic obstructive pulmonary disease, diabetes, and Alzheimer's disease Health Stats, (continued)

Economics:

Mexico GDP: $1.567 trillion Employment: agriculture: 13.7% , industry: 23.4% , services: 62.9% Imports: $306 billion Exports: $303 billion Per capita income: $13,900 Poverty: 18.2% Unemployment rate: 5.6% Major religions: Roman Catholic 76.5%, Protestant 6.3% Quality of living United States GDP: $14.66 trillion Employment: agriculture: 1.2% , industry: 22.2% , services: 76.7% Imports: $1.903 trillion Exports: $1.27 trillion Per capita income: $47,200 Poverty: 12% Unemployment: 9.7% Major religions: Protestant 51.3%, Roman Catholic 23.9%, unaffiliated 12.1% Standard of living Economics

Government:

Mexico Federal republic Organized in 3 branches: executive- president, legislative- Senate or Camara de Senadores/ Chamber of Deputies or Camara de Diputados , and judicial- supreme court of justice People vote in approximately 2/3 of members by popular vote with remaining members chosen from party with popular vote Seven major political parties United States Constitution-based federal republic Organized in 3 branches: executive- president, legislative- senate/house of representatives, and judicial- supreme court People vote in all members of executive and legislative branches by popular vote Two major political parties: Republican and Democratic Government

Health Care Organization:

Health Care Organization Mexico Social security sector: Mexican Social Security Institute (IMSS) Social Security and Services Institute for State Workers (ISSTE) Governmental Services: Seguro Popular Private Sector: United States Governmental Services: Medicare Medicaid State Children’s Health Insurance Program (SCHIP) Veteran’s Administration (VA) Patient Protection and Affordable Care Act (PPACA) Private Sector: Employer-sponsored: For-profit (Aetna, Cigna) Not-for-profit (Blue Cross/Blue Shield) Private Non-group (individual market)

Health Care Organization:

Health Care Organization Mexico Authority Federal Commission for Protection Against Health Risks The Secretariat of Health United States Authority Department of Health and Human Services (Federal) Food and Drug Administration Centers for Disease Control State government

Organization (continued) :

Organization (continued) Mexico Providers: physicians, nurses, and specialists Doctor-to-patient ratio: 2:1000 Nurse-to-patient ratio:2.4:1000 Providers: education, licensure Government role in research United States Providers: physicians, nurses, and specialists Doctor-to-patient ratio: 2.4:1000 Nurse-to-patient ratio: 10.7:1000 Providers: education, licensure Government role in research-Agency for Healthcare Research and Quality (AHRQ)

Delivery:

Delivery Delivery of care: Clinics and hospitals Gatekeepers Providers Services provided-specialist (cardiac, neuro , obstetrics etc.) Process for referrals Access to health care

Financing:

Financing Mexico Major payers and source of funds: 46% of health care spending was from public sources 3.1% of total expenditure on health is financed through private health insurance IMSS and ISSSTE financed by employee/employer payroll taxes and government contributions Seguro Popular financed by general tax revenues and user fees United States Major payers and source of funds: The public share of health expenditure was 46.5% Private insurance accounted for 34.1% of total health spending Medicare Medicaid

Financing – Total Health Expenditures:

Financing – Total Health Expenditures

Financing:

Financing Major expenditures Provider reimbursement— Doctors and hospitals are reimbursed for services either from patients’ or insurance coverage. In Mexico, doctors are often paid cash out-of-pocket at the time of visit.

Controlling Health Care Costs:

Controlling Health Care Costs

Brief Picture of Mexico:

Brief Picture of Mexico No welfare. No unemployment insurance. 4 of 10 Mexicans of working age unemployed. Low wages — approximately $2.00/day. Large poor to rich ratio. 2001 — approximately ½ population had health coverage. 2004 — Seguro Popular (popular insurance) established.

MEXICO – Health facts :

MEXICO – Health facts Poor nutrition — about 40 million of 90 million undernourished. Poor drinking water, poor sanitation & limited access to other basic services. High infant mortality rate High preventable illness rate

Mexico in Action:

Mexico in Action Proposals to privatize state agencies, tighten social benefits, government layoffs Privatize pension programs and allow workers to invest retirement funds Develop universal health coverage — Seguro Popular in 2004 Disease and illness prevention Use of generic drugs

MEXICO – Health Care Cost-Containment:

MEXICO – Health Care Cost-Containment Good health   educational performance   labor productivity   investment climate = economic growth Most physicians are employed by the government.

PHYSICIAN COMPENSATION (2004) $1,000s U.S. Purchasing Power Parity (Ratio to per capita GDP) :

PHYSICIAN COMPENSATION (2004 ) $ 1,000s U.S. Purchasing Power Parity ( Ratio to per capita GDP) General Practice Specialist Nurse Mexico $21 (2.1%) $25 (2.4%) $13 (1.3%) U.S. $161 (4.1%) $230 (5.7%) $48 (1.5)

MEXICO – Health Care Quality:

MEXICO – Health Care Quality Crusade for Healthcare Quality: Launched 2001 by Ministry of Health. Professional practice codes. Health care consumers rights. Clinical Tx guidelines. Improved medical education. Establish accreditation body for all health facilities .

MEXICO – Health Care Quality (continued):

MEXICO – Health Care Quality (continued) Oportunidades : Evaluated by International Food Policy Research Institute ( IFPRI ) After 3 yrs.,  school enrollment, improved diets, &  medical attention. Encuesta Nacional de Salud y Nutricion [ National Health & Nutrition Survey] Conducted in 2006; 7234 respondents; measured perceived healthcare quality. Quality assessments favored private providers over social security institutions.

MEXICAN HEALTH CARE – Conclusions:

MEXICAN HEALTH CARE – Conclusions Public health concerns – Obesity – metabolic syndrome. Hypertension. Diabetes. Aging population. Economic disparities accessing health care.

MEXICAN HEALTH CARE – Conclusions (continued):

MEXICAN HEALTH CARE – Conclusions (continued) Strengths – Universal Health Care achieved. Many bilingual physicians; many fluent in English. English a prerequisite for nurses to graduate. Many males in nursing. Many nurses have earned or are working on advanced degrees.

MEXICAN HEALTH CARE – Conclusions (continued):

MEXICAN HEALTH CARE – Conclusions (continued) Limitations – Inequities in quantities and quality of services available. Demand exceeds capacity. Mexican nurses see themselves 50-60 yrs. behind U.S. RNs. Limited access to modern health care in poorest rural areas – reliance on curanderos .

MEXICAN HEALTH CARE – Conclusions (continued):

MEXICAN HEALTH CARE – Conclusions (continued) Ethical Issues – 3 million wealthy & middle-class Mexicans pay for access to state-of-the-art medical services. 50 million workers covered by IMSS are served by facilities of varying quality. 17 million states employees covered by ISSTE , a parallel scheme to IMSS . The Army & Navy have their own separate health care programs. PEMEX, the state-owned petroleum company, covers its employees separately. Some too poor to pay the small yearly contribution required by Seguro Popular.

MEXICAN HEALTH CARE – Conclusions (continued):

MEXICAN HEALTH CARE – Conclusions (continued) Lessons for the U.S. – Health care is both a social and economic concern. Prevention initiatives promote national fiscal interests. Universal health care coverage is a viable strategy to lower the national debt.

MEXICAN HEALTH CARE – Conclusions (continued):

MEXICAN HEALTH CARE – Conclusions (continued) Policy Recommendation for the U.S. – MEXICAN MODEL of M edical malpractice arbitration

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