Harvard Global Equity Initiative, Boston, MA, USA.
Lancet. 2012 Oct 6;380(9849):1259-79. doi: 10.1016/S0140-6736(12)61068-X. Epub 2012 Aug 16.
Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.
墨西哥将于 2012 年实现全民医保。2003 年推出的全民医疗保险计划 Seguro Popular，为 5000 多万以前被排除在保险范围之外的墨西哥人提供了获得综合医疗服务和经济保障的机会。墨西哥的全民覆盖等同于健康的社会保护。本报告从三个保护维度分析了通往全民覆盖的道路：抵御健康风险、通过医疗保健质量保证为患者提供保护，以及抵御疾病和伤害的经济后果。我们提出了从劳动型社会保险向健康社会保护转变的概念性讨论，这意味着将获得有效的医疗保健作为一项基于公民身份的普遍权利，这是墨西哥改革的伦理基础。我们讨论了促使改革的条件，以及改革的设计和启动，并描述了 9 年的循证实施过程，包括对原始计划的更新和改进。报告的核心部分集中在改革的效果和影响上，这是基于对所有已发表和公开可用的科学文献和新数据的分析。证据表明，Seguro Popular 正在改善获得医疗服务的机会，并减少灾难性和贫困性医疗支出的流行，尤其是对穷人而言。最近的研究还表明有效覆盖有所改善。然后，本研究解决了一些持续存在的挑战，包括需要将财政资源转化为更有效、公平和响应性的医疗服务。需要进行下一代改革，其中包括通过职能完成卫生系统重组的系统性措施。本文最后讨论了墨西哥实现全民健康覆盖的意义及其对其他低收入和中等收入国家的启示。
