Ministry of Health Mexicos experience with using NHA

Ministry of Health, Mexico´s experience with using NHA data in the Policy-making Process Reform of the General Health Law October 2003 OECD, Paris SICUENTAS

Ministry of Health, Mexico Outline ØBackground on the use of NHA in Mexico ØSetting the scene – providing evidence ØObjectives of the Reform Ø SICUENTAS and the Reform ØConclusions SICUENTAS

Ministry of Health, Mexico Background FUNSALUD conducted the first NHA analysis in Mexico (1992 – 1998) Public and private expenditure as percentage of GDP, Mexico 1992 -1998 7 6 5 4 3 2 1 0 1992 1993 1994 Public expenditure SICUENTAS 1995 1996 1997 Private expenditure 1998

Ministry of Health, Mexico Evidence provided was used in prospective policy formulation National Health Program 2001 – 2006 identified three challenges of the health system: 1. Equity 2. Quality 3. Financial protection SICUENTAS

Ministry of Health, Mexico National Health Program 2001 – 2006 Strengthen the stewardship function of MOH System of National and State Health Accounts (SICUENTAS) General Direction for Information and Health System Performance Asssessment (National Health Information System) SICUENTAS

Ministry of Health, Mexico Setting the scene Providing evidence FINANCIAL IMBALANCES • Level Insufficient investment 5. 8% of GDP • Origin of expenditure Out-of-pocket expenditure (55%) • Distribution Between institutions: one and half times between • State effort A difference of 119 to 1 between highest and lowest SICUENTAS insured and uninsured population Between States: 11 to 1 between highest and lowest

Ministry of Health, Mexico Objectives of the reform § Order the current allocation of resources § Correct the financial imbalances and historic inercia § Move towards a framework of public insurance to finance medical care § Establish co-responsibility between different levels of government and the population § Provide effective content to the full exercise of social rights as part of the reform of the State SICUENTAS

Ministry of Health, Mexico Proposal – towards a new financial architecture of the health system Public Insurance Schemes IMSS – Medical insurance ISSSTE – Medical insurance Popular Health Insurance SICUENTAS Contributors Employee Employer Employee Federal Government Family Nation State Gov. Federal Gov.

Ministry of Health, Mexico SICUENTAS and the Reform Classification of health services Public Goods Health Goods Individual health services (medical care) SICUENTAS • Stewardship • Information and research • Community health services • • Prevention Diagnosis Treatment Rehabilitation • Epi surveillance • Environmental health • Collective services • Disaster management

Ministry of Health, Mexico Public Health Expenditure by Function and Source of Funds, Mexico 2002 SICUENTAS

Ministry of Health, Mexico Examples of modifications National Health Accounts Ministry of Health Classification Health Related Expenditures • To train personnel • HC. R. 2 Education formation of health care provider institutions • To conduct scientific and technologic research • HC. R. 3 Research and development in health • To conduct sanitary regulation • HC. R. 4 Food, hygiene and drinking water control TOTAL HEALTH EXPENDITURE SICUENTAS

Ministry of Health, Mexico • Stewardship has been added to the list of functions of the health system, AS A DIFFERENT FUNCTION FROM ADMINISTRATION • MOF has agreed to a health expenditure reporting format that is more closely related to the functions of the health system, including stewardship • Health related functions are included as part of the total health expenditure • Improve quality of reporting on pharmaceuticals • Include information from municipalitites • Manual for the Mexican SICUENTAS • Informatio to be produced every three months SICUENTAS

Ministry of Health, Mexico SICUENTAS, as part of the National Information System, is an important tool providing evidence for policy formulation, accountability, resource allocation INFORMATION THAT IS NOT USEFUL IS NOT USED SICUENTAS

Ministry of Health, Mexico SICUENTAS