The Report Company: During your time in the health sector, especially directing the Seguro Popular program, what has been your greatest achievement? How do you see the program affecting Mexico’s future?

Salomon Chertorivski Woldenburg: In the last century, Mexico opted for a Bismarckian welfare model, which provided social security through two institutions. One of these served public sector employees and the other served private sector employees. At that time, half of the population had no access to healthcare funding. In 1982, a vote was held to include it in the Constitution as an individual right and efforts began to provide healthcare services, rather than charity, to people without access to funding. In 2003 a social protection system, known as Seguro Popular, was created. This is a public funding policy which provides society-wide medical coverage. It has contributed to reducing inequality and poverty, improving the quality of life and wellbeing and increasing development opportunities.

From 2004 onwards, the financial structure was strengthened. This enabled the deployment of further resources to allow all Mexicans to join the Seguro Popular program, which led to more hospitals being built, more doctors being employed, and more treatments being carried out. This is financed by general taxes rather than payroll contributions. From that time until today more than 51 million Mexicans have joined the program. In December 2012, Mexico achieved universal healthcare coverage.

TRC: Can you give us an outline of the Seguro Popular program?

SCW: Seguro Popular covers 100% of primary care needs, including medical care and the associated medicines. This accounts for 95% of hospital admissions, in terms of frequency. It also covers a large part of high specialisation, including breast and testicular cancer treatment, as well as paediatric oncology, as well as adult bone marrow transplants, HIV, haemophilia and heart attacks, which together represent 80% of high specialisation treatments.

Everyone gets a priori funds – which was a part of the change in the model – to fund their future healthcare needs. In the five years of the Calderon administration the health sector’s installed capacity to provide services has increased by 20%. More than a thousand medical units have been built and more than two thousand have been remodelled.

In economic terms, this has meant almost 1.5 percentage points of GDP going to public investment. From 2007 to date, the public budget allocated to health has grown 80%. There have been studies about the effects of the measures, in reducing out-of-pocket expenses and catastrophic expenditure, but above all, in the far reaching material results in public health.

TRC: What was your role in defining and implementing this innovative, efficient model when you were directing the Seguro Popular?

SCW: In 2007 the system covered 15 million people and now it covers 51 million. The big challenge was to register people in this voluntary system and to raise awareness that with the membership, they would have the right to receive a service. My role during that time was to serve two main functions: first, to ensure that membership was accompanied by funding, and secondly, to safeguard and protect that right, demanding from providers the quality that is being paid for.

TRC: How do you want Mexican society to perceive the Secretariat?

SCW: As being in charge of maintaining the public health of all Mexicans, with all that that implies, such as the right to individual and community health, and protection against health risks in general; for example recently in the fight against H1N1 where Mexico reported effectively and transparently and followed the pandemic plan.

TRC: As Secretary and leader of the Mexican government health system, how do you want the sector to contribute to the Mexican brand?

SCW: I think it can be said that countries with financial mechanisms in place to cover the healthcare needs of all their citizens are in an exclusive club.

In Mexico, we have the saying “health comes first”, and I would love the world to know that during the mandate of President Calderon this saying has been fulfilled. The resources an administration has don’t cover everything and you have to prioritise, and during this sexenio, education and healthcare have been favoured overwhelmingly. We are setting an example for the whole world. There are countries who have approached us for advice, so I have visited the Philippines, India and Pakistan. China has asked about our catastrophic expenditure model to help it in planning a healthcare model in the same vein as the Seguro Popular to cover 300 million Chinese. We have worked with the WHO and the OECD to pass on the Mexican model, because after a serious, independent assessment, it has been found to be sustainable and effective. We can proudly say that Mexico is one of the few countries that can share and export a model that has demonstrable results.

TRC: Many countries with universal healthcare are gradually opening the door to public-private collaboration, which has led to complaints from citizens about the level of care they are receiving. What mechanisms do you have in place to look after this service?

SCW: Mexico’s advantage is that it can learn from countries that already have years of experience in universal healthcare service delivery, and we also have a very young population.

Currently, only 9% of our population is over 60 years old, but by 2050 one in three Mexicans will be over 60, a demographic curve that tells us that we will face financial and epidemiological challenges that are already being faced by many developed countries, but we have the opportunity to refer to the best models in the world. We already do this and we are changing from a curative to a preventative model. In Mexico we have 30 years to prevent many of the ailments and diseases that are currently contributing to the global financial crisis, but there has to be a balance between care and the quality of customer service with which it is provided, if we don’t focus on this we will have problems such as long waiting lists and a lack of quality.

Our main advantage is that we are very compassionate, and the Mexican nursing staff comprehensively meet this service requirement. This doesn’t mean we have to turn the health service into a luxury hotel, instead it means we have to implement quality assurance mechanisms in the medium term, when, as we age, the level of admissions and chronic non-contagious diseases increases. This will enable us to provide effective and compassionate care.

TRC: What role do private companies play in the healthcare sector and how open is the sector to international investment?

SCW: Since the Social Protection in Health law was established, we have modelled the sector on financing and not on procurement – i.e., the model is based on demand and not supply. We do fund more hospitals and equipment, and there are PPS practices which are similar to the English model, but the most important point of the Seguro Popular program since it was created has been that it provides the ability to buy services from the private sector and guarantees that those services will be paid for.

In this regard, we hope that with clear rules and over time, the publicly funded healthcare market will become a very attractive private market model in terms of care, not in terms of hospital construction. There are still few private hospitals in our country which offer services to the Seguro Popular program, but there are now some where things like cataract operations and bone marrow transplants are being done with our funding. I think the greatest strength in inviting private investment is that the payment of services can be made to any certified provider.

TRC: Are there opportunities for foreign investors in the Mexican health sector?

SCW: Yes, the healthcare model in Mexico will be worth more than the energy market in a few years, so there is plenty of room for private investment, in providing additional services or specific areas for very specialised issues such as eye hospitals.

TRC: What opportunities are there for medical tourism as a means of funding and what would make Mexico attractive to British medical tourists?

SCW: Mexico has great nurses, as well as the human resources to provide services to foreigners. Mexico has many advantages, including its climate. The country has 90 private hospitals which meet international standards and are open to providing services to foreigners. One important negotiation between the British government and the Mexican healthcare system could be to look at the possibility of financing British public services in Mexican private hospitals, as there would be savings and greater efficiency. We are totally open to looking at models of cooperation in this regard.