Dr. Sofía Charvel stood excitedly at the door of GHELI’s front conference room, welcoming staff and faculty members trickling in, eager to hear her speak about the Mexican health care system. Charvel is a professor and Acting Director of the Bachelor of Law Program at the Instituto Tecnológico Autónomo de México (ITAM). Charvel’s lunchtime talk coincided with a broader visit to advance a collaboration with GHELI’s Senior Scholar in Residence, Alicia Ely Yamin, at the nexus of health and human rights. Thinking beyond the “right to health” enshrined in different constitutions, Charvel and Yamin’s ongoing work focuses on the nuance and context needed to truly operationalize rights within the health system.
“The collaboration that Dr. Charvel has undertaken with Professor Alicia Yamin is an integral part of GHELI’s transdisciplinary work on global health,” shared Faculty Director Sue J. Goldie.
During the informal talk, Charvel highlighted some of the major issues currently afflicting Mexico’s health care system, some of which may be stemming from the country’s decreasing public expenditure on its health system in recent years. In 2017, Mexico spent only 5.4 percent of its GDP on health, falling well below the OECD average of 9 percent. Noncommunicable diseases remain some of the primary causes of death and disability in the country.
Currently in Mexico, an individual’s health insurance coverage depends on his or her employment status. For example, individuals receiving income from a private business are affiliated with the Mexican Institute of Social Security (IMSS), and their family members are beneficiaries as well. Individuals in public office receive care, along with their family members, under a separate public Social Security scheme. Seguro Popular is a coverage scheme for individuals with no formal employment, who receive care from a set of 32 public providers. The structure and efficiency of Seguro Popular has been a contentious topic in Mexican politics and civil society, with President Lopez Obrador announcing a new integrated health system to replace Seguro Popular.
Charvel underscored concerns about health equity and health system fragmentation. Primary, secondary, and tertiary levels of care do not have interoperable, electronic health records to allow doctors from one hospital to see reports from a primary care visit or vice versa. With a system that is underfunded and fragmented, the three levels of care are not able to communicate cohesively, thereby complicating a patient’s treatment.
Besides issues with fragmentation, the Mexican health system faces challenges with distribution and quality. For example, Charvel emphasized that some tertiary care clinics in remote areas possess cutting-edge technology but lack the appropriate personnel to operate the surgical equipment. Funding and resource allocation does not always reflect geographic need or needs at different levels of care. Mexico has the potential to improve its health system with its technology, but currently is lacking the logistics to efficiently distribute resources and finances.
Dr. Charvel concluded with a reminder that it is not only about protecting and guaranteeing the right to health for all Mexicans, but it is also about promoting policies and programs which reduce inequality and inequity in health.