Gakidou Emmanuela, Lozano Rafael, González-Pier Eduardo, Abbott-Klafter Jesse, Barofsky Jeremy T, Bryson-Cahn Chloe, Feehan Dennis M, Lee Diana K, Hernández-Llamas Héctor, Murray Christopher J L
Harvard Initiative for Global Health, 104 Mt Auburn Street-3rd floor, Cambridge, MA 02138, USA.
Salud Publica Mex. 2007;49 Suppl 1:S88-109. doi: 10.1590/s0036-36342007000700011.
Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over seven years to uninsured people, nearly half the total population at the start of 2001. The reform included five actions: legislation of entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of gross domestic product; creation of explicit benefits packages; allocation of monies to decentralised state ministries of health in proportion to number of families affiliated; division of federal resources flowing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, a wide range of datasets to assess the effect of this reform on different dimensions of the health system was used. Key findings include: affiliation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38% from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affilates used more inpatient and outpatient services than uninsured people; effective coverage of 11 interventions has improved between 2000 and 2005-06; inequalities in effective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affiliates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on this interim evaluation and explore implications for other countries considering health reforms.
自2001年以来，墨西哥一直在设计、立法并实施一项重大的卫生系统改革。一个关键组成部分是创建大众保险（Seguro Popular），其目标是在七年内将保险覆盖范围扩大到未参保人群，这些未参保人群在2001年初几乎占总人口的一半。改革包括五项举措：为每个参保家庭立法规定权益，全面实施后，将使卫生方面的公共支出增加国内生产总值的0.8 - 1.0%；制定明确的福利套餐；根据参保家庭数量按比例将资金分配给下放的州卫生部；将流向各州的联邦资源划分为用于个人和非个人卫生服务的单独基金；以及设立一项基金以保护家庭免受灾难性医疗支出的影响。利用世界卫生组织的卫生系统框架，使用了广泛的数据集来评估这项改革对卫生系统不同层面的影响。主要发现包括：参保优先惠及贫困和边缘化社区；2000年至2005年，联邦非社会保障实际人均支出增长了38%；各州公共卫生支出的公平性有所改善；大众保险参保者比未参保者使用了更多的住院和门诊服务；2000年至2005 - 2006年期间，11项干预措施的有效覆盖率有所提高；在此期间，各州和财富十分位数之间有效覆盖率的不平等有所减少；尽管服务使用增加，但大众保险参保者的灾难性支出低于未参保者。我们基于这项中期评估为墨西哥提供了一些经验教训，并探讨了对其他考虑进行卫生改革的国家的启示。
