Health System Reform in Mexico 5 Assessing the eff ect of the 2001–06 Mexican health reform:

Since 2001, Mexico has been designing, legislating, and implementing a major health-system reform. A key component was the creation of Seguro Popular, which is intended to expand insurance coverage over 7 years to uninsured people, nearly half the total population at the start of 2001. The reform included fi ve actions: legislation of entitlement per family affi liated which, with full implementation, will increase public spending on health by 0·8–1·0 % of gross domestic product; creation of explicit benefi ts packages; allocation of monies to decentralised state ministries of health in proportion to number of families affi liated; division of federal resources fl owing to states into separate funds for personal and non-personal health services; and creation of a fund to protect families against catastrophic health expenditures. Using the WHO health-systems framework, we used a wide range of datasets to assess the eff ect of this reform on diff erent dimensions of the health system. Key fi ndings include: affi liation is preferentially reaching the poor and the marginalised communities; federal non-social security expenditure in real per-head terms increased by 38 % from 2000 to 2005; equity of public-health expenditure across states improved; Seguro Popular affi liates used more inpatient and outpatient services than uninsured people; eff ective coverage of 11 interventions has improved between 2000 and 2005–06; inequalities in eff ective coverage across states and wealth deciles has decreased over this period; catastrophic expenditures for Seguro Popular affi liates are lower than for uninsured people even though use of services has increased. We present some lessons for Mexico based on thi