INSABI vs. Seguro Popular
The Politics Behind the Switch from Seguro Popular to INSABI
When current president of Mexico Andres Manuel Lopez Obrador (AMLO) was the mayor of Mexico City in the early 2000s, he believed that Seguro Popular was “neither safe nor popular,” a common leftist criticism of the program at the time. AMLO’s main criticisms of Seguro Popular were incomplete coverage of the population, incomplete coverage of services, not enough reduction of out-of-pocket spending, widespread corruption, and overall failure to improve the well-being of citizens by failing to improve health conditions and failing to reduce poverty (Reich 2020).
So, when AMLO became president of Mexico in 2018, he envisioned a new healthcare system based on three core ideas: universality, free services, and anti-corruption. In January 2020, this new healthcare system manifested in the Instituto de Salud para el Bienestar, or INSABI for short (Reich 2020).
Differences between Seguro Popular and INSABI
Formerly, Seguro Popular offered healthcare access to those who were registered with the program, which had its own set of bureaucratic obstacles. Under INSABI, the registration system was entirely abandoned, and all that you need to have medical care through INSABI is some form of proving citizenship, whether that be a birth certificate, voter card, or a government-issued Unique Population Registry (Clave Única de Registro de Población or CURP) card (Vallejo 2020).
In accordance with the principle of free services, INSABI does not require any out-of-pocket expenses for the covered supplies and medical services. Seguro Popular used to require registered members to pay an income-adjusted fee (Vallejo 2020).
Despite the income-adjusted fee, Seguro Popular covered a wider range of health services than INSABI currently does. Specifically, Seguro Popular covered first, second, and third level services, meaning that everything from basic clinic visits to hospitalizations to more specialized procedures like chemotherapy and dialysis were covered. Under INSABI, only first and second level services are covered, so more complex services like chemotherapy, radiotherapy, organ transplants, and dialysis require out-of-pocket expenses (Vallejo 2020).
Barriers to Healthcare Access in Maclovio Rojas
From focus group interviews with community leaders, FISH has found several barriers to healthcare access in Maclovio Rojas. Residents do not receive adequate healthcare services from the health clinic in Maclovio Rojas. For more advanced treatments and medical services, residents must travel to the next nearest health clinic, which is 60-90 minutes away with transportation and temporal costs some cannot afford.
The doctor visit itself also has various financial costs associated with it. Some cannot afford the long wait times for medical visits or the out-of-pocket costs for services and medications. Although general health insurance should cover these services in theory, the reality is that coverage is inadequate. Due to these financial barriers as well as social factors such as fear and insecurity, many residents do not seek medical attention for serious health issues.