Catastrophic Health Expenditure Fund

Overview

Two parallel subsystems operate in Mexico: one provides comprehensive health care to formal sector workers and their families, funded mainly through social security payroll contributions; the second subsystem for poorer, uninsured persons representing nearly half the population, provided limited health services funded by state and national health budgets, but were consistently underfunded.

In 2003, the Government legislated creation of the Social Protection System in Health, including the Seguro Popular (People’s Health Insurance) which guaranteed defined health service benefits to all people who are not covered by formal social security schemes. One part of the reform package was the establishment of a specific fund for protection against catastrophic health expenditure for people covered by Seguro Popular. In 2013, it is estimated that 53 million people were covered under this fund guaranteeing access to 284 interventions, 522 medicines and services for 57 catastrophic conditions. This led to a decrease in out-of-pocket expenditure as a share of income, especially among families newly covered by Seguro Popular. The paper analyses this reform in terms of resource allocation to meet health needs of the population and incentives of accredited health care providers to deliver the benefit package.

Synthesis report

The Mexico case study is part of a synthesis report that applied a causal framework to synthesize lessons from ten case studies of various health system reforms which aimed to improve the efficiency in health systems.