Assessing a public health insurance scheme: Drawing evidence based global lessons from Mexico's seguro popular

<><>Background Social security insurance schemes are currently undergoing severe financial problems worldwide in account of population aging, rising health care costs, and a growing informal economy. Thus, voluntary health insurance programs are being developed to address both under coverage and the inefficient allocation of resources. The Mexican health insurance, Seguro Popular (SP), currently insures 7 million families. <>Aims Identify windows of opportunity to improve the implementation of SP started in 2002, as well as the challenges facing its consolidation in 2010. It also draws global policy lessons for implementation. <>Methods Qualitative assessment was conducted on April-November 2006, covering 13 Mexican states where nearly 60 percent of the total targeted population is affiliated to SP. In-depth interviews were applied to 321 decision-makers, 530 health care providers at 212 ambulatory units and 63 hospitals, and nearly 2000 beneficiaries. <>Results The first window of opportunity is speeding the flow of financial resources for timely allocation to health care providers. Second is strengthening the health care units accreditation to foster health care quality. The third is improving the supply of critical drugs for chronic diseases. The first challenge SPS faces is improving the efficiency of health care delivery to optimize the use of resources. Second, strengthening health care management will foster better performance. The third challenge is allocating more resources for prevention to ensure financial sustainability. <>Conclusions The Mexican experience provides valuable policy lessons for implementation. First, planning is essential for enhancing the feasibility of successful implementation. Second, creating a task force is highly recommended to ensure coordination between financial players, purchasers and providers of health care. Third, an integral information system should be built to provide reliable, consistent and complete data for decision-making, monitoring and evaluation. Finally, the assessment strategy was useful to conduct a comprehensive evaluation of SP implementation.