Health Insurance/Accesibility

Background, purpose, brief history

Seguro Popular

  • Implemented in 2004

  • Prior to SP, healthcare insurance was provided via employment. Those unemployed had to pay out of pocket for medical services. 

  • SP aimed to provide health coverage to more underserved populations and expand healthcare access to those who do not have formal salaried jobs

  • Government must, by law, allocate a minimum budget to each card-carrying member of SP

IMSS

  • Implemented in 1943

  • IMSS provided coverage for private sector, formal, and salaried workers and their families. 

  • This left out self-employed, unemployed, and informal sector workers.

 
 
 
 

What are the current requirements for these insurances?

Seguro Popular

  • Be a legal resident and provide official identification information

  • Socioeconomic survey to determine costs someone would have to pay for the insurance

  • Do you rent or own a home?

  • Do you have a refrigerator and stove?

  • Do you work?

  • How many TVs and bathrooms?

  • How many bedrooms? 

  • Level of education 

  • Number of people in family

  • Covers everyone in the family

IMSS

  • Be a legal resident and provide official identification information

  • No pre-existing diseases (malignant tumors, diabetes complications, heart disease, COPD). In addition, some conditions have waiting periods (e.g. orthopedic surgery has 2-year waiting period)

  • Those not in formal employment may now enroll voluntarily. However, voluntary enrollment requires the costs below (for each family member):

AGE RANGE

0-19

20-29

30-39

40-49

50-59

60-69

70-79

80 and more

ANNUAL QUOTA

$3,250

$3,850

$4,100

$5,700

$6,000

$8,700

$9,050

$9,100


What services do these insurances cover?

Seguro Popular

  • Only covers services at specific hospitals that take this insurance (General Hospitals). Patients cannot access a facility that is not in the SP network, regardless of proximity issues or demand of service. Therefore, the place where you live determines the quality of care and the quantity of care received.

  • The federal government allocates money to the states for health coverage, but some of Mexico’s most impoverished states do not receive adequate and they need to augment coverage through private sector

  • State is responsible for choosing how to use its allocated money. If it is not used wisely, there may be none available for hospitals, pharmacies, etc

  • Out-of-pocket spending of families under SP was, on average, $270, and those that are uninsured, $475.  So, on average, SP reduced OOP spending

  • Critics argue that the coverage SP provides (diseases, surgeries, etc.) are not actually the ones that the Mexican population needs

  • Critics also argue that SP only covers diseases that are simple and easy to treat and leaves out more complicated ones.

IMSS

  • IMMS only covered 40% of the population (because only for traditional salaried workers)

 

There are two ways to become enrolled:

  • Anyone (foreign resident or Mexican national) who is formally employed in Mexico must pay their employee IMSS contributions and become enrolled in the program, regardless of any other private health insurance 

  • The second is by voluntary enrollment, open to those not in formal employment and those who wish to enroll on a voluntary basis—for example, foreign residents who are retired in Mexico.

Summary of SP and IMSS

What do people in Maclovio Rojas have to say about these insurances?

total number of people surveyed - 11

Lack of appointments available/long wait times

5

No regular wellness checkups, annual physical exam (primary healthcare)

5

Hospitals and clinics too far

4

Costs of medications too expensive or not medications not available

4