Table 1 Key features describing the Mexican healthcare system –current and proposed modifications for the intended health reform during the Peña-Nieto’s Mexican administration (2012–2018)

Universality

Various types of access to health services, according to the employer/employee relationship, i.e. state employees (federal level) are covered by ISSSSTE; those who work in any of the 32 Mexican states have local-state health services (e.g. for Chiapas Mexican state employees are attended by ISSTECH); Ministry of National Defense (Mexican Army, Mexican Air Force) and Ministry of Navy employees are attended by their own health services; PEMEX (Mexican Petroleum) employees are attended by their internal medical services. Senior Mexican government employees (e.g. ministers, congressmen, judges), all have major private medical insurance paid by the state.

People formally employed in the private sector are attended by IMSS medical services; some private companies (such as banks) offer employees insurance for major medical expenses. Similarly, people who can afford to pay may arrange private insurance. Finally, the general population with no formal employment, e.g. employed by outsourcing, or unemployed people are not eligible for any of the medical benefits described above. However, “Popular Insurance” (“Seguro Popular”), represents an option for these people. This insurance allows people to be eligible for a “Unique Catalog for Health Services”), that includes around 384 medical surgeries. An important proportion (33.2%) of the Mexican population are not eligible to any of the above medical schemes; instead they are being offered health services through health programs of the Secretary of Health (SSA) or IMSS-‘Prospera’ or ‘Popular Insurance’ (CONEVAL, 2010).

For both SSA and IMSS, medical attention is structured in three levels of care: first level (via health centres or family medicine units), second level (via general hospitals, which provide internal medicine, gynaecology obstetrics, paediatrics and general surgery) and third level services (special care by SSA is offered via national institutes of health -cardiology, nutrition, and orthopaedics, among others). In the case of IMSS hospitals, 21 Century National Medical Centre Hospital, “The Race”, Orthopaedics Hospital and Trauma Hospital.

Moreover, it is becoming popular to be attended by practitioners employed at pharmacy stores (e.g. “Farmacias del Ahorro” and “Similares”), which provide basic medical consultation at relatively affordable cost. Also, in rural areas, indigenous population frequently use traditional medicine.

Introduction of Universal Health Insurance (purchased by individuals with financial support from taxation by consumers) to finance some services; general taxation to remain as the core financing mechanism. Multiple competing private insurers for financed services. Money follows the patient for financed hospital services. It includes the possibility of public-private partnerships to stimulate investments that allow expanding the provision of health services

Basic packages

Health services provided by government institutions such as IMSS, ISSSTE, SEDENA, Semar, and Pemex, cover all kind of diseases and health problems of their beneficiaries. Health services provided by government institutions such as SSA (Ministry of Health) and IMSS-Prospera, and the 32 State Systems of Health (Sistemas Estatales de Salud, SESA), provide first, second and third level services of care (most of the time directly and sometimes, through subrogated contracts), mainly via “Seguro Popular” (Popular Insurance). They include a provision of basic programs established in the so-called “Primary Health Care”, in which 12 preventive programs include immunizations, baby setters, and prenatal care.

Creation of a “single standard that impacts on the efficiency of money-spending and on saving resources”. Degrading the “right” to health. Standardizing treatment protocols and various institutions to apply rates that “explicitly” refer to a basic package. Increasing a rationalized list of interventions as “explicit” basic packages (“Universal Catalogue of Health Services” and Catastrophic Fund). Creating an “office” to oversee and check the “enforceable” condition of the “explicit” minimum packages.

Outsourcing

In recent years, this type of contract in the country has become more frequent. The labour reform promoted by the Mexican government aims to regularize this type of recruitment scheme, although under the current legislation. It fails to incorporate disease working tables or valuation of permanent disabilities. It increases the intensity of working day hours with fewer rights and salaries; minimum social protection, pensions and low health services are also increasingly compacted.

Increasing the intensity of working day hours with fewer rights and salaries, minimum social protection, pensions and low health services increasingly compacted, resulting in a precarious quality of jobs.