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

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

3. Ministry of Health, Mexico SICUENTAS Background FUNSALUD conducted the first NHA analysis in Mexico (1992 – 1998) Public and private expenditure as percentage of GDP, Mexico 1992-1998 0 1 2 3 4 5 6 7 1992199319941995199619971998 Public expenditurePrivate expenditure

4. Ministry of Health, Mexico SICUENTAS 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

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

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

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

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

11. Ministry of Health, Mexico SICUENTAS To train personnel To conduct scientific and technologic research To conduct sanitary regulation 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 Examples of modifications National Health Accounts Ministry of Health Classification TOTAL HEALTH EXPENDITURE

12. Ministry of Health, Mexico SICUENTAS 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. Ministry of Health, Mexico SICUENTAS 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

14. Ministry of Health, Mexico SICUENTAS