Frenk Julio, González-Pier Eduardo, Gómez-Dantés Octavio, Lezana Miguel Angel, Knaul Felicia Marie
Fundación Billy Melinda Gates.
Salud Publica Mex. 2007;49 Suppl 1:S23-36. doi: 10.1590/s0036-36342007000700007.
Despite having achieved an average life expectancy of 75 years, much the same as that of more developed countries, Mexico entered the 21st century with a health system mared by its failure to offer financial protection in health to more than half of its citizens; this was both a result and a cause of the social inequalities that have marked the development process in Mexico. Several structural limitations have hampered performance and limited the progress of the health system. Conscious that the lack of financial protection was the major bottleneck, Mexico has embarked on a structural reform to improve health system performance by establishing the System of Social Protection in Health (SSPH), which has introduced new financial rules and incentives. The main innovation of the reform has been the Seguro Popular (Popular Health Insurance), the insurance-based component of the SSPH, aimed at funding health care for all those families, most of them poor, who had been previously excluded from social health insurance. The reform has allowed for a substantial increase in public investment in health while realigning incentives towards better technical and interpersonal quality. This paper describes the main features and initial results of the Mexican reform effort, and derives lessons for other countries considering health-system transformations under similarly challenging circumstances.
尽管墨西哥的平均预期寿命已达到75岁，与较发达国家大致相同，但在进入21世纪时，其卫生系统却存在重大问题，超过半数的公民在卫生方面得不到经济保障；这既是墨西哥发展进程中社会不平等的结果，也是其原因。若干结构性限制因素阻碍了卫生系统的运行，并限制了其进步。墨西哥意识到缺乏经济保障是主要瓶颈，因此着手进行结构性改革，通过建立卫生社会保护系统（SSPH）来提高卫生系统的绩效，该系统引入了新的财务规则和激励措施。改革的主要创新举措是大众保险（Popular Health Insurance），它是卫生社会保护系统中基于保险的组成部分，旨在为所有那些此前被排除在社会医疗保险之外的家庭（其中大多数是贫困家庭）提供医疗保健资金。这项改革使公共卫生投资大幅增加，同时将激励措施重新调整为追求更高的技术和人际服务质量。本文描述了墨西哥改革努力的主要特点和初步成果，并为其他在类似具有挑战性的情况下考虑进行卫生系统变革的国家提供经验教训。
