Alongside security, health is the other area where López Obrador acknowledged his administration has not made significant progress in delivering the improvements promised during his campaign: universal coverage, improvement of infrastructure and services, more staff, and free medicines.
His assessment of the problems that most affect the health sector has been accurate, as it suffers from fragmentation, underfunding, and limited coverage. Inequality in accessing health care across the country, as well as quality of services, is also significant. Figures from the National Council for the Evaluation of Social Development Policy (Coneval) show that some 9m people in rural areas have very limited or no access at all to health services. In contrast, around 86 million people in urban areas can easily access health care.
In order to achieve its goals regarding health, soon after López Obrador took office in December 2018, the government launched its ‘federalisation of public health services’ which brought together the main health providers – the Ministry of Health (SS), the Mexican Social Security Institute (IMSS), and the Institute for Social Security and Services for State Workers (ISSSTE) – into a single system. Thus, this process in practice entailed a centralisation of responsibilities away from state governments towards the national government. This process was launched in eight states within the south-eastern region of the country, where limited access to health is more severe, and the rest will follow gradually.
The reform to the sector under the current government also includes the centralisation of medicine supplies at the national level and the regularisation of more than 80,000 temporary employees. It also sees the federal government taking over responsibilities that were previously the remit of state-level authorities, in particular the so-called ‘popular insurance’ (SP), which was introduced in 2003 to cover non-salaried workers – self-employed, under-employed, or jobless – who are uninsured and comprise the poorest sections of the population. On 12 July, López Obrador announced that the SP would be eliminated and instead an institute of health for wellbeing would be set up to cover the uninsured population. This sparked some controversy as despite its shortcomings – beneficiaries often missed their necessary treatments due to lack of personnel, equipment, or medicines – the SP was considered a success as it reduced the size of the uninsured population from around half to15%, as of November 2018. At the same time, specialists have welcomed the opportunity to reform the health sector given the increased pressures it faces due to Mexico’s aging population with chronic conditions such as heart disease and diabetes – though critics have voiced concerns about the lack of strategies for prevention, particularly regarding obesity.
However, as ever, the success of López Obrador’s plans will depend on implementation. Crucially, the 2020 budget sees resources for the sector increase by only 2.1% relative to 2019, with the IMSS and the ISSSTE receiving 3.6% and 3.4% more resources, respectively. According to the Centre of Economic and Budgetary Research (CIEP), a local think tank, providing health coverage to all the population that is non-salaried would require an increase of 66% in resources for this sector, so no significant improvement in this area is likely in the short-term.