Public Private Interaction in Health: Three Mexican Examples

Thursday, August 10, 2006 10:30 AM to 12:00 PM

Speaker: Gustavo Nigenda: Director, Health Systems Innovations, National Institute of Public Health, Mexico
Moderator: Ruth Levine, Director of Programs and Senior Fellow, Center for Global Development


Gustavo Nigenda discussed the interactions between public and private agents in the Mexican Health System. Using three models of public/private interactions, he discussed the challenges of the public sector and the impact of private sector involvement in health on key development outcomes.

Mexico’s healthcare system is divided into three parts consisting of social security, public assistance, and the private system. The social security system was created in 1943 and entitled to contract private providers. The public assistance system was not entitled to contract private providers until the centralization of the health system in the 1980s. Centralized public entities work with the ministry of health to contract private providers. In the health care system in Mexico, the private sector is 55% of the health expenditure. 52% is out of pocket, and 3% is private insurance. The most recent data exists from 2001, showing the lack of transparency and accountability.

The first model of public/private interaction is the case of the Ministry of Health contracting a network of private providers in Jalisco. 70% of health care providers are women. The biggest problems are the lack of drugs and the lack of equipment. The model provides a narrow package of services and covers 30,000 families. The bonus of the model is its transparency.

The second case is the opening of private beds ward in the public hospital in Veracruz. A problem is that the doctors get moved to the private sector to service the patients as do their nurses, but only the doctors get a bonus pay. There is a complete lack of transparency in this model.

The third case involves the General Hospital of Mexico selling ambulatory services to the private sector. These are diagnostic services (such as chemotherapy). All doctors and nurses provide services. There are more resources for the public arena and effective utilization of their technological capacity, however there is no costing system.

by Rebecca Bonardi