Assessment and recommendations

Ten years after the introduction of publicly-funded universal health insurance, the Mexican health system finds itself at a critical juncture. Unquestionably, some measures of health and health system performance have improved: those previously uninsured now use health services more often, whilst numbers reporting impoverishing health expenditure have fallen from 3.3% to 0.8%. Infant mortality fell to 13.0 deaths per 1 000 live births in 2013, a 38% reduction since 2000. Other indicators, however, remain worrying. Rates of survival after heart attack or stroke are markedly worse than in other OECD countries. Failure to modify lifestyles which harm health is a particular concern: with 32% of the adult population obese, Mexico ranks as the second most overweight nation in the OECD and almost one in six adults are diabetic. Other key metrics imply deep-rooted inefficiencies in the system: administrative costs, at 8.9% of total health spending, are the highest in the OECD and have not reduced over the past decade. Likewise, out-of-pocket spending is around 45% of total health spending1 – the highest in the OECD.