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INSPCHSR
INSP - NATIONAL INSTITUTE OF PUBLIC HEALTH OF MEXICO
Center for Health Systems Research
Salud Migrante
Developing a Proposal through Binational Health Systems Integration
Planning Project
INSPCHSR 2/27
Outline
1. Social protection: progress in Mexico
2. Social protection & migration U.S.A. Mexico Development capacity for social protection
in health
3. Salud Migrante proposal
4. Conclusion
INSPCHSR 3/27
Family Affiliation to Seguro Popular
* Ley General de Salud projection
295.5
3,000
11,500*
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2002 2003 2004 2005 2006 2007 2008 2009 2010
Th
ou
san
ds
of
fam
ilie
s
5,000
Source: Ministry of Health of Mexico 2005
INSPCHSR 4/27
Seguro Popular Subscriber Outpatient Services
State-Level Analysis 2006 according to HDR
r=0.3584 (0.0440)Source: NHS (Ensanut) 2006 & HDR prepared by UNDP
Ags
BC
BCS
Camp
Coah
Col
Chis Chih
DF
Dgo
Gto
Gro
Hgo
Jal
Mex
Mich
Mor
Nay
NLOax
Pue Qro
QRoo
SLP
SinSon
Tab
Tamps
TlaxVer
YucZac
30
40
50
60
70
80
.7 .75 .8 .85 .9HDR
%
INSPCHSR 5/27
Seguro Popular impact on catastrophic expenditures according to source
Source: Galarraga O; Sosa-Rubí SG; Salinas A.; Sesma S. Impact of Universal Health Insurance on Catastrophic & Out-of-Pocket Health Expenditures in Mexico. Working Paper. 2008
02
46
810
12%
of
Cat
astr
op
hic
exp
end
itu
res
NIEHS (ENIGH) NHS (Ensanut) Impact Eval. SP
Not insured Insured with Seguro Popular
INSPCHSR 6/27
Tendency of the authorized budget from the Ministry of Health of Mexico
Year
Th
ou
san
ds o
f m
illion
s o
f p
esos
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006
Source: Ministry of Health of Mexico 2005
81.3
49.2
35.4
INSPCHSR 7/27
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1 2 3 4 5 6 7 8 9 10
1996 2002
Ministry of Health expenditure - distribution in deciles
2000
Decile of expenditureSource: John Scott, CIDE – Center for Economics Research &
Education
INSPCHSR 8/27
Toward a financial balance in health, 2000-2004
GDP in health from 5.7% to 6.3% Annual increase in health
expenditure Public for non-insured: 23% Out-of-pocket:13%
Reason for federal per capita expenditure according to insurance condition From 3.0 in 2000 to 2.1 for 2005
Source: Ministry of Health of Mexico 2005
INSPCHSR 9/27
Social protection and international migrationSituation in the U.S.
INSPCHSR 10/27
U.S. population without medical security, 2004
12.4 15.728.9
13.125.7
15.0
23.3
41.4
48.1 75.7 56.260.9
0%
20%
40%
60%
80%
100%
RecentMexican
immigrants
Longer-stayMexican
immigrants
MexicanAmerican
U.S.-BornWhites
U.S.-BornNon-Whites
Immigrantsfrom other
than Mexico
12.4 15.728.9
13.1 25.715.0
23.3
41.4
48.1 75.7 56.260.9
11.211.2 18.118.1 24.024.0
64.464.442.842.8
23.023.0
0%
20%
40%
60%
80%
100%
RecentMexican
immigrants
Longer-stayMexican
immigrants
MexicanAmerican
U.S.-BornWhites
U.S.-BornNon-Whites
Immigrantsfrom other
than Mexico
Public Not insured
Wallace 2007
Private
INSPCHSR 11/27
Dimension of the 11.8 million Mexican migrants in the U.S.
11% of the Mexican population 5.8% annual growth 56% without health insurance 60% without documents 21% with U.S. citizen status
DIAGNOSIS
INSPCHSR 12/27
Migrant contribution to the uninsured population in the U.S.
Migrants (of any nationality) and their U.S.-born children contribute as follows: 32% of the total population with no health
insurance (46 million) 86% of the growth of the population with
no health insurance
Mexican migrants contribute 13% of the total population with no health insurance in the U.S.
DIAGNOSIS
US
INSPCHSR 13/27
Health in the U.S., the most expensive in the world, + 14% of the GDP 5.6% of hospital expenses are not covered
¿Migrant responsibility? Represents 0.2% of the GDP
Relevance of health insurance for migrants in the U.S.
DIAGNOSIS
US
INSPCHSR 14/27
Situation en Mexico
INSPCHSR 15/27
Transnational population
45% of the Mexican migrants are recent Less than 10 years, 5.38 million of total figure
85% of the migrants send remittances to 1.3 million homes in Mexico
16% of married migrants have wives in Mexico
27.3% of migrants have at least one child in Mexico 18% have all of their children in Mexico
Constant migration flow 700,000 migrate annually 250,000 return
INSPCHSR 16/27
Remittances spent in health services in Mexico, 2002
percentage
Revision of Amuedo-Dorantes et al 2007, based on NIEHS (ENIGH) 2002
Head of the household
29.615.920.442.131.8TOTAL
2.71.31.44.22.5OTC drugs
0.50.22.17.64.5Pregnancy & birth
17.58.21220.915.9Hospitalization
8.96.24.99.48.9Primary healthcare
RuralUrbanALL
INSPCHSR 17/27
Reference population for binational insurance
11.8 million migrants 4.3 million migrant children born in U.S. 5.5 million dependents in Mexico*
21.6 million in transnational communities
DIAGNOSIS
INSPCHSR 18/27
Development capacity for social protection in health for migrants
INSPCHSR 19/27
Willingness to pay for binational health insurance
57% of migrants are willing to pay US$75 - $125 per month
Willing to cross the border Deprived of primary healthcare in the U.S. Public in Mexico
Cost represents 1/4 to 1/3 of insurance plans in the U.S. US$ 3,000 & US$ 4,500 per family per annum** Vs. US$ 12,000
*Vargas-Bustamante A, Ojeda G, Castañeda X. Willingness to pay for cross-border health insurance between the United States and Mexico. Health Affairs 27, no. 1 (2008): 169–178.
**Tim Waidmann & Saad Ahmad. Improving Access In a Binational Population. The Potential Role for Binational Health Insurance. Academy Health Research Meeting, Orlando, FL. 2007.
DIAGNOSIS
US
INSPCHSR 20/27
U.S. response capacity
DIAGNOSIS
Community healthcare centers in the U.S. 1,200 in total 6,300 points of service in all states 17 million persons attended 147 healthcare centers for migrants
800,000 clients Very interested in binational health insurance
Non-profit insurers Located strategically for providing binational health
insurance Hometown clubs
Broad experience in health Not always available Problematic relation with Mexico
INSPCHSR 21/27
Mexico response capacity
Ministry of Health services in high- migrant locations
State-level governments very interested in supporting migrants
Seguro Popular Program Interest & capacity to focus on migrants Need for new affiliation mechanisms
DIAGNOSIS
INSPCHSR 22/27
SALUD MIGRANTE
PROPOSAL
INSPCHSR 23/27
Salud Migrante Components
Doctrine Policy Articulating agency Insurance agencies Service networks Community-level support
PROPOSAL
INSPCHSR 24/27
Salud Migrante doctrine
Migrants are entitled to health protection in the U.S.
Temporary residence abroad should not restrict Mexicans’ constitutional right to health in Mexico.
Constitutional obligation to guarantee migrants access to health services, wherever he may reside temporarily.
PROPOSAL
INSPCHSR 25/27
Healthcare centers in the
U.S.
Contract
Providers Mexico
Pay-ment
Salud en el Norte Primary healthcare in the U.S.
Seguro Popular Affiliation in the U.S.
Salud Migrante policy
Insurance Departments
Regulation
Sale
Salud Migrante Agency
Decree/Agreement
Migrants
Affiliation
Service networks Guarantee
Community agenciesPromotion
Transportation
Seguro Popular
Cap. Constr. Non-profit insurers Concession
Diffusion of the Salud Migrante doctrine in Mexico & the U.S. Capacity building & development: “Servicios de Salud Amigos
del Migrante” (“Migrants’ Friends” Health Services) Insurers & Seguro Popular Binational health service networks Civil society organizations
Salud en el Norte insurance Sale of policies to migrants Dealer / franchiser for insurance agencies
INSPCHSR 26/27
CONCLUSIONS & NEXT STEPS
INSPCHSR 27/27
Conclusions
Migration requires far-reaching government policies
with a broad vision.
Mexico can lead a binational health insurance
program.
Key actors from both countries have the capacity &
are interested to collaborate in this regard.
Model can be partially adapted to migrants from other
countries.
INSPCHSR 28/27
Possible next steps
Development of a model for workers with H2A visas
Promotion of services already guaranteed for migrants in the U.S.
Establishment of the Salud Migrante agency at state level
