Mexico´s experience with using NHA data in the Policy-making Process

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

2. Outline • Background on the use of NHA in Mexico • Setting the scene – providing evidence • Objectives of the Reform • SICUENTAS and the Reform • Conclusions

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

4. Evidence provided was used in prospective policy formulation National Health Program 2001 – 2006 identified three challenges of the health system: • Equity • Quality • Financial protection

5. 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)

6. 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 insured and uninsured population Between States: 11 to 1 between highest and lowest • State effort A difference of 119 to 1 between highest and lowest

7. 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

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

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

10. Public Health Expenditure by Function and Source of Funds, Mexico 2002

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

12. 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

13. 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