MEXICO HEALTHCARE SYSTEM | DRUG PRICING AND REIMBURSEMENT IN MEXICO | NEWS | BLOGS | iPharmaCenter

OVERVIEW OF MEXICO HEALTHCARE SYSTEM

  • Article 4 of Mexico's constitution guarantees the right to health for all citizens.

  • Mexico has a mixed healthcare system.

  • Life expectancy at birth has increased significantly, currently 75 years at birth.

  • The leading causes of death are diabetes mellitus(81.13/1,000) and ischaemic heart disease (72.45/1,000).

HEALTH INSURANCE COVERAGE

Mexico has mixed health coverage programs, segmented between the public and private payers and providers. The Federal Ministry of Health coordinates the National Health System, which relates all the public and private providers to the Ministry of Health with different degrees of authority.

Public insurance is covered primarily by

  • The Mexican Social Insurance Institute (IMSS) - Provides insurance for private sector employees, which covers nearly 33% of the Mexican population.

  • The Institute for Social Security and Services for State Employees (ISSSTE) - Provides insurance coverage for federal government employees, which covers 7.4% of the Mexican population.

  • Seguro Popular (now INSABI) - Covers people not covered by IMSS and ISSSTE, unemployed people, and covers nearly 43.5% of the population. It provides a broad range of services and is replaced by the Institute for Health for Wellbeing (INSABI)

  • Other sector employees, like the military, navy, and Petróleos Mexicanos (PEMEX), provide insurance coverage to their employees.

Private insurance, which is opted for by high-income groups, covers 8% of the total population.

The out-of-pocket spending was 42%, which is still very high compared to the other OECD countries.

Nearly 50% of health care spending is on outpatient services, and one-third of the expenditure is on hospital services.


DELIVERY OF SERVICES

Mexico has 1.9 physicians per 1,000, much less than the OCED average of 3.3 per 1,000 individuals; 71% of the physicians are publicly employed. Nearly 30% of the hospitals are public and are usually significant bigger than private ones.

The Ministry of Health handles health promotion, disease prevention, education, and epidemiological surveillance.

Patient pathways are not officially regulated in Mexico. Pathways are primarily driven by socioeconomic status, health institutions, and enrolment.

Primary Healthcare

Primary healthcare services are provided through independent provider networks. Individuals can pay out of their pocket for physicians who are not covered in the provider networks. Primary healthcare providers act as gateways for specialized services with their networks.

Nearly 40% of outpatient services are provided by private institutions, making them one of the main entry points for healthcare services.

Specialized care:

Specialized care in Mexico is provided by Specialty Clinics (owned by ISSSTE and MoH), Ambulatory Care Medical Units (owned by IMSS), and private organizations. Among Mexico's specialty ambulatory care units, more than 60% are maintained by the public sector.

Hospital care

Public and private hospitals provide hospital care. Public hospitals are differentiated into general and specialty hospitals. Specialty hospitals often offer general services, including delivery care.


Private hospitals provide a varied range of services based on size and specialty.

REIMBURSEMENT AND PRICING OF PHARMACEUTICALS

The Mexican pharmaceutical industry is the second largest in Latin America, only next to Brazil. The public sector publishes the coverage list and does the consolidated purchasing.

Regulatory approval:

The Federal Commission for the Protection against Sanitary Risk (Comisión Federal para la Protección contra Riesgos Sanitarios, COFEPRIS) is involved in the approval based on the safety and efficacy.

Reimbursement:

The General Health Council (Consejo de Salubridad General, CSG) will determine if the drug has to be included in the positive public list. It primarily considers cost-effectiveness for decision-making.

After approval from CSG, companies must sell to public institutions, and getting approval from each institution is necessary.

The cost-effectiveness estimates submitted by the manufacturer to different institutions include prices that are used for selling to public health institutions.

Drug pricing:

IMSS, ISSSTE, Seguro Popular, and the Ministry of Health together constitute the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (Comisión Coordinadora para la Negociación de Precios de Medicamentos y otros Insumos para la Salud, CCPNM) that is involved in a single drug price negotiation between the manufacturer and public institutions.

The National Centre of Technological Excellence in Health (CENETEC) is responsible for the health technology assessment for all subsystems below MoH. It conducts economic evaluation, clinical guidelines, and telehealth.

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