The Role of Evidence on Financial Protection in the Mexican Health Reform of 2003

Abstract

Evidence from research can be applied to policy makng in many different ways: consensus building, policy design, diagnosing the problem, projecting the impact of the policy, benchmarking progress, applying incentives and budgetary guidelines, evaluating impact and disseminating results. The Mexican health reform of 2003 constitutes an example of a successful process of combining relevance and excellence (Frenk, 1992) in research and applying the evidence from research to the development, design, advocacy and implementation phases of policy making. The use of evidence for health reform has simultaneously lead to the production, reproduction and utilization of knowledge for decision making and for the further advancement of research (Frenk, Knaul and Gómez Dantés, 2004). Evidence will continue to play an important role in all future stages for innovation, monitoring, advocacy, and quality control. This experience using research – both national and international -- and translating it into policy and practice has, however, not been fully analyzed or written-up for dissemination and publication. This is the main objective of this paper and its companion policy note. These documents seek to analyze the Mexican experience in applying evidence to policy, and in particular research on financial protection, in the context of health reform thus making information on this experience accessible to other countries, policy makers and researchers.

The work summarized in this paper (and the policy note) focuses on the use of data on financial protection. While this is only one of many types of evidence that have been incorporated into the reform process, it was one of the most important. Another reason for the focus on evidence on financial protection is that it facilitates the analysis of how international evidence was incorporated into the reform process. Much of the international evidence used in the reform originated from the international literature on health finance and health equity, including international rankings. Specifically, this evidence drew on the WHO (2000) international ranking of health system performance – particularly the information on financial protection - and this document also analyzes the ways in which this international framework has been applied in Mexico. Thus, this document also contributes to the ongoing debates on the usefulness of international rankings and frameworks for policy making, particularly in the health sector (Murray and Frenk, 2000a, 2000b and 2001; McPake and Mills, 2000; Almeida, Braveman, Gold, et al., 2000; Ginter, 2000; Wibulpolprasert and 4 Tangcharoensathien, 2001; Wagstaff, 2002; Hyder, 2003; Musgrove, 2003; and Brundtland, Frenk and Murray, 2003).

The paper begins with background information on the Mexican health system and continues with a summary of the reform. Section four reviews the history and content of the reform in relation to the use of local and international research. The paper concludes by analyzing some of the reasons why evidence, and particularly data on financial protection, was usefully incorporated into the policy making process in Mexico. These results, summarized in the concluding section, suggest strategies that can increase the likelihood of successfully incorporating evidence into policy-making to improve health systems, as well as more generally in policy formulation in other sectors and particularly in other areas of human and social development. The strategies are: building local research capacity; collecting data and guaranteeing that they are comparable over time; investing in research and participating in international research activities; translating research into policy messages; integrating international frameworks and evidence produced by international agencies; and, linking health to economic research and policy making.

Keywords: Mexican health reform of 2003