How the Health System Works in Mexico
Currently, in Mexico, there are two types of health care coverage: one public and one private. Today the number of health professionals exceeds the 360,000 mark, of which 58% are women and 42% are men.
The National Health System of Mexico, in its operation, presents segmentation and fragmentation. Different insurers coexist that act independently and disarticulated, and access to one or the other is a function of the employment insertion and payment method of the families.
The main insurers are:
- The Mexican Social Security Institute (IMSS), which covers 43.3% of the country's total population;
- The Institute of Security and Social Services for State Workers (ISSSTE), which covers about 7% of the population;
- The Petróleos Mexicanos (PEMEX), the Armed Forces, the Secretariat of the Navy, and several insurers of state workers, cover about 5.9% of the population.
People who work in informal jobs or are unemployed have as an alternative the services offered by the Secretariat of Health (SSA) through Popular Insurance (SP), which includes 266 interventions according to the Universal Catalog of Health Services (CAUSAS). It is important to note that it is the Health Department itself that performs the administrative function of the National Health System.
Currently, there are 4,354 hospitals, of which 1,182 are public and 3,172 are private. About 86% are general hospitals and the remainder are specialty hospitals.
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Public Health
Public health services in Mexico are covered by the IMSS (Mexican Social Security Institute). This organization guarantees the right to cover illnesses, medical assistance, social protection, and social services.
Social Security consists of a mandatory system and a voluntary system, which differ in their benefits and costs:
- The mandatory regime corresponds to employed workers;
- The voluntary regime corresponds to self-employed workers and workers in public administrations.
Social protection is enjoyed by the insured, his spouse or partner, their children (under 16 or 25 if they are students), and their parents (if they live with the insured).
Disease coverage offers preventive and curative benefits. To enjoy the benefits of health insurance, you must have previously contributed for at least 4 weeks.
IMSS Solidarity: what it is and how it works
For people without resources, there is a program called IMSS-Solidaridad whose mission is to provide free medical assistance at clinics or solidarity institutes.
As an insured, you will enjoy coverage for hospitalization, medical care, surgical operations, and medications. In the event of illness or accident at work that leaves you unable to work, IMSS will pay part of your salary for a maximum period of 52 weeks.
When you sign up for Social Security, it assigns you to a general practitioner, who you will not be able to change (except in special and justified cases).
How much does IMSS cost?
In Mexico, there is a salary limit below which Mexicans are exempt from Social Security payments. If a worker does not reach this limit, it is the employer who fully pays Social Security payments. On the other hand, if you exceed the limit, about 10% of your salary will be withheld each month to help pay Social Security contributions.
What requirements do you need to meet
To be a Social Security beneficiary, your employer will need to register you with the IMSS. If he doesn't, you can do it yourself by going to the IMSS and filling out the registration form.
Once this is done, you will receive a Social Security enrollment certificate and receive an insured number. This number is essential to be eligible for disease coverage.
Main and Best IMSS Hospitals according to Global Health Intelligence (GHI)
- Women's hospital;
- General Hospital of Mexico;
- Hospital 20 de Noviembre (Hospital November 20th);
- Ignacio Chávez National Institute of Cardiology;
- XXI Century Medical Center;
- National Institute of Perinatology Isidro Espinosa de los Reyes.
Private Health System
A good part of the Mexican population uses private sector services, through private insurance plans or pocket payments. It is noted that both people with social security and the rural and city poor who regularly use SSa, SESA, or IMSS-O services also use private-sector health services, in particular outpatient services.
In Mexico, there is a profitable private sector of health services. When people are left without access to any of the aforementioned insurers, or even those who have access, they often prefer to have this expense in search of a better answer.
The insured can choose to quote to a private insurer. In that case, you can go to any doctor and any clinic. Expenses paid for medical care will be reimbursed according to the terms of your insurance policy.
Limitations for public health strategies
These differences in insurers also marked differences in the benefits that the population receives, but the greatest difficulty that this model offers is the limitation to implement uniform public health strategies at the national level and maintaining an adequate epidemiological record.
Despite having a National Epidemiological Surveillance System to which insurance companies are obliged to report, it was not possible for the profitable private sector to adhere to this obligation and, consequently, fundamental information about the country's health situation and national strategies limit its impact.
In general, services are organized at three levels. They are not fully articulated and have difficulties with referral and counter-referral mechanisms.
At the first level, health promotion, disease prevention, and outpatient care for the most frequent morbidities are provided by general practitioners and nursing staff.
The second level of care offers basic specialties in general or specialized hospitals and has diagnostic and imaging services.
The care provided at the third level is specialized, more complex, and combined with clinical and basic research activities, and this group includes the National Institutes of Health.