On August 16 this year, the reputed medical journal Lancet published a report on the 10-year experience of Mexico’s journey towards universal health coverage (UHC). This year, Mexico achieved UHC for all of its 100 million citizens, with Seguro Popular, a national health insurance programme introduced in 2001, extending protection to 52 million previously uninsured citizens. This month, the Planning Commission of India has proposed to extend and expand the Rashtriya Swasthya Bima Yojana (RSBY) in the 12th Plan. What are the similarities and differences between these two programmes?
UHC in Mexico is synonymous with social protection of health. In the words of an accompanying Lancet editorial, “health insurance is no longer seen as an employment benefit but as a right of citizenship”. The report describes the three stages of UHC: (1) universal enrolment, with benefits extending from a publicly organised insurance; (2) regular access to a comprehensive package of services with financial protection for all; and (3) universal effective coverage guarantees for specialised high-cost services to prevent financial shocks.
A Fund for Community Health Services covers health promotion, immunisation campaigns, primary prevention, early detection, epidemiological surveillance and risk protection. Personal clinical services which are not highly specialised are funded through Seguro Popular, which draws on pre-paid contributions (according to the capacity to pay) and public funding from general taxation (which pays for most services). There is a special fund for children and new-borns (Medical Insurance For A New Generation) and a Fund For Protection Against Catastrophic Health Expenditures (FPCHE) which provides for high cost, specialised interventions. As of 2008, states are required to invest 20% of all Seguro Popular funds on prevention, in addition to the federally-run community health fund. In contrast, only 8% of the resources allocated to Seguro Popular flow into the high-cost FPCHE, though this can be supplemented by earmarked contributions. Mexico is now moving towards a single insurance fund, mostly tax-financed, to provide universal access to a common package of essential and high-speciality interventions.
Since its introduction in 2007, the RSBY has grown rapidly to cover about 150 million persons through 32.2 million family cards in 26 states. The central government pays 75% of the cost and the states pay 25%, with the maximum premium per family set by the government at R750. The beneficiary pays R30 for the card and obtains annual family coverage of health expenses up to R30,000. The programme originally targeted BPL families, though