Comparative Analysis of the Health Care Systems Offered in the United States and Mexico
Comparative Analysis of the Health Care Systems Offered in the United States and Mexico
Healthcare Comparison of United States and Mexico
The objective of this report is to give a comparative analysis between the United States healthcare system and Mexico's. Its key focal point will be centered on the countries policies, how their various systems are financed, who provides healthcare, the costs of the programs and availability of access. While some factors of these two countries are similar there are varying differences among them, especially cost and access. All of the components of the two countries healthcare systems will be discussed in depth in a non-biased manner, it is our goal to simply establish how they are similar and what differences there are among them. For starters a comparison of the overall health of the people of the two countries will form a baseline as to the quality of care being provided in each of the countries and give us an insight into the effectiveness of its preventative services. The mortality rate of citizens of Mexico is 4.86 per 1,000, whereas the U.S. has 8.38 per 1,000(CIA, 2001) This is due in large part to the number of citizens the U.S. has over 65 years of age, 13.1% of the U.S. population is over 65, Mexico's is half that with 6.6%. While the baby boomer generation is a large reason why this number is high, a correlation between the quality of care given to this age group can be made about U.S. citizens compared to that of Mexico's, generally speaking countries with high percentages of citizens over age 65 invest more in the health care sector than that of other countries.
The health policies in Mexico and the United States are similar in that the healthcare system in both countries is a mix of public and private insurance, with an estimated 50 million Americans being uninsured. The majority of healthcare coverage in the United States is employer sponsored private insurance where the employer pays a portion of the premium and the employee pays the other portion. The public Medicare program is a Federal program that covers those residents who are age 65 or older as well as those who have qualifying disabilities. The public Medicaid program is Federal law, but run mostly by the individual States, that provides coverage for low income individuals, families, and the disabled. The State Children’s Health Insurance Program (SCHIP) is a public insurer that covers those children whose family’s income is too high for the whole family to qualify for Medicaid (Miller, 2009). The public programs in the U.S. are funded through taxes. The majority of healthcare coverage in Mexico is public insurance. Private insurance is available only to those who are wealthy enough to afford the premiums, employees of the bank and corporate executives (Massachusetts Mexico Office, n.d.). More than 50 million Mexicans have public insurance that is partially paid by the employer and partially paid by the employee, based on their salary, through the Mexican Institute of Social Security (IMSS) that provides coverage for salaried formal employees (Frenk & Knaul, 2005). Prior to healthcare reform in Mexico, the Ministry of Health or MoH, decentralized care for those without coverage to the individual states and patients were restricted to receiving care through those facilities if they could not afford to pay out of pocket for their care (Directorate for Employment, 2006). The 50 million Mexico residents that were previously uninsured are now able to obtain healthcare coverage through a new program called Seguro Popular or Popular Health Insurance (Frenk, Gomez-Dantes, Knaul & Sepulveda, 2003).
The United States began their first step healthcare reform in 2010 with the enactment of the Patient Protection and Affordable Care Act. This reform process is expected to be fully complete by 2018 and is expected to provide healthcare coverage to an estimated 32 million citizens that are currently without healthcare coverage, but will still leave an estimated 20 million people without health insurance (Jonas * Kovner, 2011). The U.S. is slightly behind Mexico when it comes to passing legislation that provides financial protection due to healthcare expenses and allowing healthcare to be a constitutional right. Mexico took their first step in major healthcare reform with the enactment of the System for Social Protection in Health (SSPH) in 2003; and was expected to insure all Mexicans by 2010 (Frenk & Knaul, 2005). The National Health Program (NHP or Programma Nacional de Salud) started the Popular Health Insurance (Seguro Popular) program in January 2004 with the purpose of offering voluntary basic and catastrophic healthcare coverage to all Mexicans, especially to those 50 million people that are uninsured (Frenk et al., 2003). This number of uninsured represents those that are self-employed, unemployed, work in the informal sector, or are no longer working for various reasons (Frenk, et al., 2003). Premiums for this voluntary universal health coverage are paid for in part by the Federal government, in part by the State and in part by the individual or family based on their disposable income, while the poorest of the population pay nothing (Miller, 2009). Currently, the Popular Health Insurance (PHI) program provides coverage for the previously uninsured, the Mexican Institute of Social Security (IMSS) provides coverage for those who work in the private sector and their families, and the Institute of Social Services and Security for Civil Servants (ISSSTE) provides coverage for those who work in the public sector and their families (Frenk & Knaul, 2005).
The delivery of health care in Mexico is similar to how it is delivered in the United States. However, the economics behind how the health care is paid for in Mexico is quite different than how it is paid for in the United States of America. The biggest difference is that in the United States of America most of the healthcare is privatized with the exception of Medicare and Medicaid which are state and government funded programs for the elderly, unemployed, and disabled. In Mexico almost the entire health care system is primarily funded by the government. The United States is the only major industrialized country that does not have a universal health care system. In the United States, health insurance is a fundamental necessity due to the lack of government subsidy and the extremely high costs of medical services. Due to the National Health Service in Mexico, very few Mexican citizens have private health insurance. Mexico splits its health care system into two distinct systems; there is a public and a private system. The public section is subsidized by the government and open to all citizens through various government programs. The other section is the private healthcare system. This privatized sector of the health care system in Mexico is a free enterprise system which opposes governmental regulation, operates almost completely free from government intervention, and has little to no price controls. This private health care system is comprised of many different hospitals and service providers who are unaffiliated with one another and each provide for their own billing and own medical services. These private facilities only admit individuals or provide services to those who are able to pay cash or have their own private health insurance. This privatized system in Mexico is often criticized for being expensive compared to the average income of a Mexican citizen. Consequently, many Mexican citizens cannot afford private care in Mexico. Therefore, the privatized healthcare services in Mexico are available only to those who are able to pay for them. As a result, many Mexican citizens claim that the national health insurance program makes private hospitals a luxury rather than a necessity.
The hospitals in Mexico are funded by two primary sources, the Mexican federal government and out of pocket payments. Most of the hospital beds in Mexico are found within public hospitals. These hospitals are large complexes that are usually affiliated with a University rather than a corporate enterprise as found in the United States. These public hospitals are usually well outfitted with lots of medical equipment. They will usually contain expensive laboratories and diagnostic equipment. These diagnostic tools and labs are what separate the government funded providers from most of the private providers, except for some of the largest private facilities. (King, et al., 2009) The Mexican federal government guarantees health care to all citizens in its constitution. The Mexican government does this by subsidizing the public health care based on the employment status of the individual. All Mexican citizens are able to use this subsidized care to some extent. As for the unemployed and the elderly in Mexico, the federal government operates a number of universal hospitals in addition to a series of hospitals run by the Mexican Social Security Administration. The state governments in Mexico also contribute to health care financing, with several states kicking in additional funding in order to give free healthcare to every citizen. Finally, many foreigners contribute cash payments to the Mexican health care system by seeking medical treatment in Mexico or buying drugs there. While foreigners do not qualify for subsidized health care, they still find that the health costs are cheap enough in Mexico to justify spending money there. Additionally, many uninsured Americans cross the border for health procedures, creating a net influx of cash into border hospitals. (Macias & Morales, 2001)
The cost of health care in Mexico is very affordable for both Mexican citizens and for the estimated 200,000 nationals who seek treatment in Mexico each year. Overall, the cost of medical services in Mexico are about 25-40% less than what they would cost in the United States, with the quality of service (as measured by complications and mortality) being roughly equal. However, the cost of private hospitals in Mexico tends to be much higher, but the vast majority of Mexican citizens use public hospitals which keeps the average costs down. In every major Mexican city you will find at least one hospital with international accreditation. These hospitals often have many specialists who perform procedures covered under the public health insurance.
A major problem for some Mexicans who want to get treatment in Mexico is the inability for migrants to the United States to get health care coverage in Mexico. According to one study, only about 45% of all temporary migrants to the United States are able to get American health insurance. This means that many Mexican immigrants are forced to travel back to Mexico for health treatment. However, if they are employed within the United States it is very difficult for these immigrants to get subsidized treatment on their return to Mexico. (Gonzalez-Block & A de la Sierra-de la Vega, 2011)
For the most part, the health care system in Mexico is essentially a universal coverage program. There is a program that was put in place in 2003 which has been gradually increasing the healthcare expenditures by 1% of GDP each year to get more and more people fully subsidized and covered in Mexico. However, there are a few non-communicable conditions which are very costly to treat that are not covered under the Mexican universal health care program. Currently, the Mexican government is trying to find other sources of public funding to help meet the financial needs of those patients.
Because the Mexican government is the main provider of public health care in Mexico, it is able to control costs within its own system. The costs within the private healthcare sector of Mexico are controlled only by the free market, although intense competition (as well as an influx of foreigners looking for cheaper health care) has served to keep health care prices in Mexico under control. (Frenk, Gomez-Dantes & Knaul, 2009)
An interesting fact to consider when comparing the two countries delivery of health care is that Mexico has a slightly higher number of people uninsured than the U.S, about 50 million are without coverage compared to 46 million in the U.S., however the us population is also 3 times that of Mexico, therefore availability and access to medical programs is more prevalent in the U.S. then Mexico. The various types of programs made to citizens of these countries will be discussed in further detail and provide a clearer picture as to why this is the case later. We will also go into detail about the economic structure of each countries health care systems and discuss the ways health services are financed by both the government and private insurers as well as what measures they are each taking to administer preventative health programs. A number of health prevention programs are being put in place by both the U.S and Mexico targeting issues such as alcohol and tobacco use, teen pregnancy, and obesity just to name a few. There are three levels of health prevention that take place regardless of where an individual lives; first is the act of primary prevention, this encourages patients to maintain a healthy weight, be physically active and not smoke. Then there is Secondary Prevention, this includes regular checkups for high blood pressure, elevated cholesterol and other risk factors. The third level of prevention practices is Tertiary; this aspect involves treating a problem after it has occurred to keep it from getting worse, such as treatment to save a heart muscle after a heart attack or to prevent complications from stroke. These levels of preventative care all take place at the individual medical care level, but there is still yet another aspect of health prevention which is the public health side. A public health action in the primary prevention setting would be public works projects to establish bike and walking paths to promote healthy activities and maintain weight, offer smoker cessation helplines and advocate for smoke free public spaces and provide prevention guidelines to medical care providers. In the secondary level, campaigns to promote the importance of controlling blood pressure and understanding what a healthy cholesterol level should be, as well as once again providing health guidelines to medical care givers. At the tertiary level an awareness of the symptoms of a heart attack and stroke to emphasize the importance of getting help quickly, providing CPR training and automated defibrillators in public places and worksites(Leviton, Rhodes, Chang, 2011). Now that we have established the different levels of preventive services and what role each has established for public health officials we will now look at what each of the two countries in question are doing to meet the goals of these preventive services and what impact they are having on the healthcare system.
Both the U.S. and Mexico provide a substantial number of preventive programs to both raise awareness and promote healthier lifestyles for their communities ranging from childhood obesity, tobacco and alcohol use to programs for the elderly. A comparison of what steps are taken to administer these various services will be the focus of this next section. One of the prevention programs being put to use in Mexico is the Diabetes Prevention and Control Project. The goal of this program is to prevent diabetes complications by controlling diabetes among people who have type 2 diabetes. This project is a collaborative effort involving the Pan American Health Organization (PAHO) and various other federal, state, academic and nonprofit organizations. The project consists of two phases. Phase 1 is to focus on the activities to determine the prevalence of diabetes and its risk factors. Phase 2 focuses on activities with community health workers, health care professionals, researchers and policy makers. This will include training for health care providers, creating diabetes forums, publications and policy briefs. Phase 1 of this project discovered that roughly 1.11 million inhabitants living in the U.S. Mexico border region had diabetes, of that number 40% did not know they had diabetes. An examination of its inhabitants also concluded that 27% of the total population of the area was overweight or obese.(CDC, 2011) The implementation process of Phase 1 involved multiple stages. Stage 1 was to determine the prevalence of diabetes using the current American Diabetes Association recommendations based on the FPG test. Stage 2 was to determine the behavioral risk factors and barriers to diabetes care. Stage 3 assessed associated risk factors for diabetes. Stage 4 conducted a quantitative analysis of the study data as well as a qualitative analysis. Lastly, stage 5 was to develop reports for reference and recommendations based on study findings. Phase 2 of the prevention program focused on implementing the following activities, training for health care providers, diabetes fora, publications, policy briefs, and developing a network of researcher in the border region. CHWs are being trained using Road to Health Toolkit, a toolkit on primary prevention of type 2 diabetes based on the Diabetes Prevention Program Study. This toolkit was developed by National Diabetes Education Program, a collaboration between the U.S. Department of Health and Human Services’ National Institutes of Health and the CDC. Health professionals will be trained using the International Curriculum for Diabetes Health Professional Education of the International Diabetes Federation. Fora are intended to educate the participants about the needs of the border population with diabetes with the expectation of informing policy makers to act and possibly influence border related policies. The purpose of the publications will be to share the findings of the project with the community and partners at large. Scientific articles will cover the following health themes: burden of type 2 diabetes, risk factors and Border social determinants of health. The U.S.-Mexico Border Diabetes Prevention and Control Project First Report of Results publication is available from the PAHO/WHO United States-Mexico Border Offices or can be accessed from their Web site. Training and technical support for up-and-coming local researchers will be provided, to increase their awareness and access to prevalence data collected during phase 1 of the project. This prevention program is a prime example of just one of Mexico’s prevention programs being instituted around the country. It takes into account the many facets a prevention program must encompass to be successful.
Now let’s take a look at how the U.S is implementing a similar prevention program that targets diabetes. One of the U.S.’s plans of action for preventing the onset of diabetes and managing those individuals who are already diabetic are similar to that of Mexico’s. The creators of the program have established a set of guidelines to administer the proper tools and provide health care givers with the necessary information to coordinate the program to meet its goals set forth by the Diabetes Advisory Council. This advisory board was established with the goal in mind to decrease the percentage of Americans living with diabetes and works with several other organizations in the fight against this disease. The number of Americans living with diabetes is currently 25.8 million which is about 8.3%, with an increase of 1.8 million since last year(ADA). It is one of many health behaviors that can be modified and prevented, with prevention plans being introduced around the country an in depth look into how they are being administered will give insight into how the U.S. approaches designing and implementing health prevention programs.
Their plan of action is stated as such. Plan and implement a prevention program in at risk states. The goal of the project is to increase consumer awareness of their diabetes risk and encourage at-risk individuals to seek screening. Secondary goals are to mobilize alliance members in the community to oversee the project. The primary prevention committee will keep detailed records of successes and lessons learned. If successful, the committee will consider scaling the project throughout the country. It is the intention of the program to locate local health care providers, pharmacies, grassroots organizations, churches, supermarkets, etc. who can display and distribute ADA risk factor brochures. It will also use local providers who will provide free/low-cost screening and make appropriate referrals then develop an evaluation plan for them to follow. The goal is to increase the number of individuals who participate in diabetes self-management education by 3% by 2013(DAC). The importance of increasing participation in DSME is to prevent or delay complications of diabetes in people who have the disease. The data will demonstrate that getting diabetes self-management education is the single consistent factor in predicting whether a person with diabetes achieves other disease management goals such as obtaining annual eye and foot exams, A1c tests, and flu shots. Another objective of the program is to install two non-health school professional staff at each school. The purpose of this is to improve the lives of children with diabetes by allowing them to stay in their neighborhood schools and receive appropriate care. In the future, an action step may be added that addresses children transitioning into college. With these objectives in mind the organizations involved in the operations of the program will hopefully achieve the success rate of which the program has set as a benchmark for.
In conclusion a comparison of the health care systems between the U.S. and Mexico has showed that we are similar in certain respects. Bothe offer public and private health insurance programs and both have problems with finding ways of providing insurance to those who are uninsured. Due to Mexico’s high poverty level, private insurance is simply out of range and not an option for many of this lower income demographic. The Mexican government realizing this was an ever growing issue created the Seguro Popular (Frenk, Gomez-Dantes, Knaul & Sepulveda, 2003) which will allow its citizens to obtain coverage. The U.S. also created a way of offering insurance to its lower income population through the Medicaid program and has been mostly successful; however 50 million Americans are still uninsured. As discussed earlier one of the biggest differences between the two countries is how the delivery of the system is financed. Where most of Americas health care is privately financed almost all of Mexico’s is entirely financed by the government. Another keynote to take into account is the large number of nationals who cross the border to seek medical treatment and prescriptions in Mexico due to their low cost, usually between 25-40% less than they would be in the U.S., thus creating an increase in cash being pumped into the border hospitals(Macias & Morales, 2001). While both countries systems are not perfect they are both showing signs of moving in the direction of providing coverage for all their citizens, as well as creating preventative programs instead of focusing solely on curative medicine. Steps in these directions is a promising sign for all parties involved and will continue to be areas of interest and debate among policy makers and health care providers.
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