Health care quality improvement in Mexico: challenges, opportunities, and progress

Enrique Ruelas, MD

From the Undersecretary of Health, Mexico City, Mexico.

Corresponding author: Enrique Ruelas, MD, Undersecretary for Innovation and Quality, Secretary of Health of Mexico, Lieja 7, 1er. piso, Col. Juarez 06696, Mexico D.F.

The health care quality improvement effort is international: all nations seek to apply new knowledge and new technology for the health of their populations. However, the environment within which this effort takes place differs remarkably. In Mexico, for example, total expenditure on health care is only 5.6% of the gross national product—compared with about 15% in the USA, 11% or 12% in Canada, and an average of 6.1% in the Latin American countries. Further, 52% of Mexican health care expenditures are out of pocket in a country where poverty is prevalent and many people postpone care.

Structurally, the health care system in Mexico is public and private. Mexico has 4000 hospitals. The 1000 public hospitals have 75% of the beds; 90% of the 3000 private hospitals have <=20 beds, often as few as <=5 beds. In fact, some “private hospitals” can hardly be considered hospitals at all, since they have no laboratories, radiography equipment, or even nurses. The system also includes 20,000 primary care facilities.

As soon as President Vicente Fox began his administration in December 2000, government leaders began working on a national strategy for improving health care. In this article, I discuss the health care challenges, the objectives of this particular strategy, and the progress made to date. (BUMC Proceedings 2002;15:319-322)