SlideShare une entreprise Scribd logo
1  sur  9
Télécharger pour lire hors ligne
April 2014
CONTROLLING
HEALTH CARE EXPENDITURE IN
DECENTRALISED ENVIRONMENTS:
A MEXICAN CASE STUDY
BOGART MONTIEL
WWW.SALUD.GOB.MX
PARIS, FRANCE
CONTENT
Background
• The main Health Maintenance Organizations (HMOs) in Mexico.
• Decentralisation of health services in the Ministry of Health.
Challenges
• Redefine the calculation formula for financial transfers.
• Analyse of strategies (decentralisation and universal healthcare)
• Create of a single fund for all health care provision.
• Create of a new national agreement on decentralisation.
Achievements
• Administrative.
• Medical Services.
Some statistics
HEALTH SERVICES PROVISION IN MEXICO
Main Health Maintenance Organizations (HMOs) in
Mexico
IMSS private-sector employees
People with social
security
ISSSTE public-sector employees
PEMEX oil-sector employees
ISSSFAM national defense employees
Ministry of
Health
People without social
security
Background
1983 Constitutional Reform (Article 4): shared obligation
of health services provision between the central and local
governments
• First effort to decentralise some health services.
• Less than half of the Mexican states signed agreements.
• Spending decisions and the design of health policies and
regulations remain in the hands of the central government.
• Above all, an administrative decentralisation.
DECENTRALISATION OF HEALTH SERVICE IN MEXICO
Background
1996 National agreement for the
decentralisation of health services
• Local financial control was granted.
• A National Health Council was created to maintain
stewardship, improve quality, and set evaluation
procedures.
• The National Health Council is a permanent body
coordinating healthcare between the central
government and all states governments in Mexico.
DECENTRALISATION OF HEALTH SERVICE IN MEXICO
Background
1998 The Fiscal Coordination Act
• Branches were set up by the Act, one of which (FASSA) deals
with fund transfers from the central government to
governments at the state and municipal levels.
• A resource allocation formula was developed based solely on
the following points:
• health infrastructure inventory
• employee lists from each state
• the previous year’s operational and investment budgets
• other resources to promote the equalisation of healthcare
services.
DECENTRALISATION OF HEALTH SERVICE IN MEXICO
Challenges
DECENTRALISATION OF HEALTH SERVICE IN MEXICO
The Fiscal Coordination Act, however, did not take into account the
following essential considerations:
 What kind of diseases are there locally?
 How much would treatment of these disease be?
 How many hospitals or clinics are needed to attend to people?
 What kind of special services should these hospitals or clinics have?
 What staff is necessary to attend to local epidemiological needs?
 What resource allocation is needed to meet the above demands?
As a result, the Mexican government wants to redefine FASSA’s
resource allocation formula to respond to present epidemiological
profiles in order to eventually sign a new national agreement.
 Analyse the strategies (decentralisation / universal healthcare)
 Create an single fund for all healthcare provisions.
 Standardise quality and coverage of healthcare services in all HMOs.
Achievements
Administrative
• Design of local health acts and regulations
• Design of local health programmes
• Strengthening of the administrative structure
• Closer links between central and local governements
Medical Services
• Adoption of the services model
• General mortality reduction
• Infant mortality reduction
• Growth of the medical infraestructure
2003 Reform to the Ley General de Salud to establish Seguro
Popular, universal healthcare coverage.
DECENTRALISATION OF HEALTH SERVICE IN MEXICO
Some statistics
Ministry of Health Budget in 2014
• Branch 12 Health: 130,264.6 millions of pesos. 9,578 USD billions
• Branch 33 FASSA: 72,045.2 millions of pesos. 5,297 USD billions
202,310 millions of pesos. 14,875 USD billions
• 71% of the Branch 12 and 100% of the Brach 33 is transfer to local
governments (164,274.7 millions of pesos. 12,578 USD billions)
• So 81,2% of these branches is transfer by the central government.
• Total amount of the public budget, including all HMOs 485,228 millions
of pesos. 37,153.8 USD billions.
DECENTRALISATION OF HEALTH SERVICE IN MEXICO

Contenu connexe

Tendances

China+(health+reform)+state+council+plan
China+(health+reform)+state+council+planChina+(health+reform)+state+council+plan
China+(health+reform)+state+council+planelmoria
 
Health system of russia
Health system of russiaHealth system of russia
Health system of russiaRINSAVAHEED1
 
Uk health-system
Uk health-systemUk health-system
Uk health-systemHiwa Hiwa
 
Ethiopia Health Sector Financing Reform/HFG: End-of-Project Report
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportEthiopia Health Sector Financing Reform/HFG: End-of-Project Report
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportHFG Project
 
Health sector reforms
Health sector reformsHealth sector reforms
Health sector reformsVikash Keshri
 
HEALTH SYSTEMS IN NIGERIA
HEALTH SYSTEMS IN NIGERIAHEALTH SYSTEMS IN NIGERIA
HEALTH SYSTEMS IN NIGERIAWINRED AKPLAGAH
 
Performance & Transparency in the capital budget - Frederica Di Pilla, Italy
Performance & Transparency in the capital budget  - Frederica Di Pilla, ItalyPerformance & Transparency in the capital budget  - Frederica Di Pilla, Italy
Performance & Transparency in the capital budget - Frederica Di Pilla, ItalyOECD Governance
 
Essential Package of Health Services and Health Benefit Plans Mapping Brief
Essential Package of Health Services and Health Benefit Plans Mapping BriefEssential Package of Health Services and Health Benefit Plans Mapping Brief
Essential Package of Health Services and Health Benefit Plans Mapping BriefHFG Project
 
Primary Health Care Under One Roof - An Overview
Primary Health Care Under One Roof - An OverviewPrimary Health Care Under One Roof - An Overview
Primary Health Care Under One Roof - An OverviewHFG Project
 
Striving for UHC Nigeria's Cross River State Passes Health Insurance Bill
Striving for UHC Nigeria's Cross River State Passes Health Insurance BillStriving for UHC Nigeria's Cross River State Passes Health Insurance Bill
Striving for UHC Nigeria's Cross River State Passes Health Insurance BillHFG Project
 
Federal Ministry Of Health Presentation
Federal Ministry Of Health PresentationFederal Ministry Of Health Presentation
Federal Ministry Of Health PresentationTransformNG
 
Responding to Health System Failure on Tuberculosis in Southern Africa
Responding to Health System Failure on Tuberculosis in Southern AfricaResponding to Health System Failure on Tuberculosis in Southern Africa
Responding to Health System Failure on Tuberculosis in Southern AfricaHFG Project
 
Indra Linina: Joint External Evaluations (JEE) – Country experiences: Latvia
Indra Linina: Joint External Evaluations (JEE) – Country experiences: LatviaIndra Linina: Joint External Evaluations (JEE) – Country experiences: Latvia
Indra Linina: Joint External Evaluations (JEE) – Country experiences: LatviaTHL
 
Health Financing Profile: Ethiopia
Health Financing Profile: EthiopiaHealth Financing Profile: Ethiopia
Health Financing Profile: EthiopiaHFG Project
 
Fernandez nhi pppt
Fernandez nhi ppptFernandez nhi pppt
Fernandez nhi pppttessachloe
 
Healthcare system of germany
Healthcare system of germanyHealthcare system of germany
Healthcare system of germanylasha chkhikvadze
 
Policy framework for health care financing reform in Nigeria
Policy framework for health care financing reform in NigeriaPolicy framework for health care financing reform in Nigeria
Policy framework for health care financing reform in NigeriaHFG Project
 
Financing Healthcare (Part 1) Lecture B
Financing Healthcare (Part 1) Lecture BFinancing Healthcare (Part 1) Lecture B
Financing Healthcare (Part 1) Lecture BCMDLearning
 

Tendances (20)

China+(health+reform)+state+council+plan
China+(health+reform)+state+council+planChina+(health+reform)+state+council+plan
China+(health+reform)+state+council+plan
 
Health system of russia
Health system of russiaHealth system of russia
Health system of russia
 
Uk health-system
Uk health-systemUk health-system
Uk health-system
 
Ethiopia Health Sector Financing Reform/HFG: End-of-Project Report
Ethiopia Health Sector Financing Reform/HFG: End-of-Project ReportEthiopia Health Sector Financing Reform/HFG: End-of-Project Report
Ethiopia Health Sector Financing Reform/HFG: End-of-Project Report
 
Health sector reforms
Health sector reformsHealth sector reforms
Health sector reforms
 
HEALTH SYSTEMS IN NIGERIA
HEALTH SYSTEMS IN NIGERIAHEALTH SYSTEMS IN NIGERIA
HEALTH SYSTEMS IN NIGERIA
 
Performance & Transparency in the capital budget - Frederica Di Pilla, Italy
Performance & Transparency in the capital budget  - Frederica Di Pilla, ItalyPerformance & Transparency in the capital budget  - Frederica Di Pilla, Italy
Performance & Transparency in the capital budget - Frederica Di Pilla, Italy
 
Essential Package of Health Services and Health Benefit Plans Mapping Brief
Essential Package of Health Services and Health Benefit Plans Mapping BriefEssential Package of Health Services and Health Benefit Plans Mapping Brief
Essential Package of Health Services and Health Benefit Plans Mapping Brief
 
Primary Health Care Under One Roof - An Overview
Primary Health Care Under One Roof - An OverviewPrimary Health Care Under One Roof - An Overview
Primary Health Care Under One Roof - An Overview
 
Striving for UHC Nigeria's Cross River State Passes Health Insurance Bill
Striving for UHC Nigeria's Cross River State Passes Health Insurance BillStriving for UHC Nigeria's Cross River State Passes Health Insurance Bill
Striving for UHC Nigeria's Cross River State Passes Health Insurance Bill
 
Federal Ministry Of Health Presentation
Federal Ministry Of Health PresentationFederal Ministry Of Health Presentation
Federal Ministry Of Health Presentation
 
Responding to Health System Failure on Tuberculosis in Southern Africa
Responding to Health System Failure on Tuberculosis in Southern AfricaResponding to Health System Failure on Tuberculosis in Southern Africa
Responding to Health System Failure on Tuberculosis in Southern Africa
 
Indra Linina: Joint External Evaluations (JEE) – Country experiences: Latvia
Indra Linina: Joint External Evaluations (JEE) – Country experiences: LatviaIndra Linina: Joint External Evaluations (JEE) – Country experiences: Latvia
Indra Linina: Joint External Evaluations (JEE) – Country experiences: Latvia
 
Health Financing Profile: Ethiopia
Health Financing Profile: EthiopiaHealth Financing Profile: Ethiopia
Health Financing Profile: Ethiopia
 
Fernandez nhi pppt
Fernandez nhi ppptFernandez nhi pppt
Fernandez nhi pppt
 
Insurance - Germany
Insurance  - GermanyInsurance  - Germany
Insurance - Germany
 
Healthcare system of germany
Healthcare system of germanyHealthcare system of germany
Healthcare system of germany
 
Policy framework for health care financing reform in Nigeria
Policy framework for health care financing reform in NigeriaPolicy framework for health care financing reform in Nigeria
Policy framework for health care financing reform in Nigeria
 
Financing Healthcare (Part 1) Lecture B
Financing Healthcare (Part 1) Lecture BFinancing Healthcare (Part 1) Lecture B
Financing Healthcare (Part 1) Lecture B
 
5.social health insurance nrs
5.social health insurance nrs5.social health insurance nrs
5.social health insurance nrs
 

En vedette

DELSA/GOV 3rd Health meeting - Mark BLECHER
DELSA/GOV 3rd Health meeting - Mark BLECHERDELSA/GOV 3rd Health meeting - Mark BLECHER
DELSA/GOV 3rd Health meeting - Mark BLECHEROECD Governance
 
DELSA/GOV 3rd Health meeting - Christian KASTROP
DELSA/GOV 3rd Health meeting - Christian KASTROPDELSA/GOV 3rd Health meeting - Christian KASTROP
DELSA/GOV 3rd Health meeting - Christian KASTROPOECD Governance
 
DELSA/GOV 3rd Health meeting - Ankit KUMAR
DELSA/GOV 3rd Health meeting - Ankit KUMARDELSA/GOV 3rd Health meeting - Ankit KUMAR
DELSA/GOV 3rd Health meeting - Ankit KUMAROECD Governance
 
DELSA/GOV 3rd Health meeting - Tamas EVETOVITS
DELSA/GOV 3rd Health meeting - Tamas EVETOVITSDELSA/GOV 3rd Health meeting - Tamas EVETOVITS
DELSA/GOV 3rd Health meeting - Tamas EVETOVITSOECD Governance
 
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERTDELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERTOECD Governance
 
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANN
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANNDELSA/GOV 3rd Health meeting - Mads Bager HOFFMANN
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANNOECD Governance
 
DELSA/GOV 3rd Health meeting - Sarah THOMSON
DELSA/GOV 3rd Health meeting - Sarah THOMSONDELSA/GOV 3rd Health meeting - Sarah THOMSON
DELSA/GOV 3rd Health meeting - Sarah THOMSONOECD Governance
 
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN OECD Governance
 
DELSA/GOV 3rd Health meeting - Barbara UBALDI
DELSA/GOV 3rd Health meeting - Barbara UBALDIDELSA/GOV 3rd Health meeting - Barbara UBALDI
DELSA/GOV 3rd Health meeting - Barbara UBALDIOECD Governance
 
DELSA/GOV 3rd Health meeting - Franck VON LENNEP
DELSA/GOV 3rd Health meeting - Franck VON LENNEPDELSA/GOV 3rd Health meeting - Franck VON LENNEP
DELSA/GOV 3rd Health meeting - Franck VON LENNEPOECD Governance
 

En vedette (10)

DELSA/GOV 3rd Health meeting - Mark BLECHER
DELSA/GOV 3rd Health meeting - Mark BLECHERDELSA/GOV 3rd Health meeting - Mark BLECHER
DELSA/GOV 3rd Health meeting - Mark BLECHER
 
DELSA/GOV 3rd Health meeting - Christian KASTROP
DELSA/GOV 3rd Health meeting - Christian KASTROPDELSA/GOV 3rd Health meeting - Christian KASTROP
DELSA/GOV 3rd Health meeting - Christian KASTROP
 
DELSA/GOV 3rd Health meeting - Ankit KUMAR
DELSA/GOV 3rd Health meeting - Ankit KUMARDELSA/GOV 3rd Health meeting - Ankit KUMAR
DELSA/GOV 3rd Health meeting - Ankit KUMAR
 
DELSA/GOV 3rd Health meeting - Tamas EVETOVITS
DELSA/GOV 3rd Health meeting - Tamas EVETOVITSDELSA/GOV 3rd Health meeting - Tamas EVETOVITS
DELSA/GOV 3rd Health meeting - Tamas EVETOVITS
 
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERTDELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT
DELSA/GOV 3rd Health meeting - Camila VAMMALLE and Claudia HULBERT
 
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANN
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANNDELSA/GOV 3rd Health meeting - Mads Bager HOFFMANN
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANN
 
DELSA/GOV 3rd Health meeting - Sarah THOMSON
DELSA/GOV 3rd Health meeting - Sarah THOMSONDELSA/GOV 3rd Health meeting - Sarah THOMSON
DELSA/GOV 3rd Health meeting - Sarah THOMSON
 
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN
DELSA/GOV 3rd Health meeting - Akiko MAEDA, Cheryl CASHIN
 
DELSA/GOV 3rd Health meeting - Barbara UBALDI
DELSA/GOV 3rd Health meeting - Barbara UBALDIDELSA/GOV 3rd Health meeting - Barbara UBALDI
DELSA/GOV 3rd Health meeting - Barbara UBALDI
 
DELSA/GOV 3rd Health meeting - Franck VON LENNEP
DELSA/GOV 3rd Health meeting - Franck VON LENNEPDELSA/GOV 3rd Health meeting - Franck VON LENNEP
DELSA/GOV 3rd Health meeting - Franck VON LENNEP
 

Similaire à DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA

National health policy, population policy, ayush
National health policy, population policy, ayushNational health policy, population policy, ayush
National health policy, population policy, ayushKailash Nagar
 
Autralian Health Care.pptx
Autralian Health Care.pptxAutralian Health Care.pptx
Autralian Health Care.pptxIram72585
 
Oc & d in hospital sectors
Oc & d in hospital sectorsOc & d in hospital sectors
Oc & d in hospital sectorsathul cs
 
Incoherent policies pachanee and wibulpolprasert
Incoherent policies  pachanee and wibulpolprasertIncoherent policies  pachanee and wibulpolprasert
Incoherent policies pachanee and wibulpolprasertNithimar Or
 
National health policy.pptx
National health policy.pptxNational health policy.pptx
National health policy.pptxVipinBaloni3
 
Cuba Healthcare system
Cuba Healthcare systemCuba Healthcare system
Cuba Healthcare systemkookoronald
 
National health policy 2002
National health policy 2002National health policy 2002
National health policy 2002Md Yusuf Ali
 
The Italian Healthcare System. Time for a check-up
The Italian Healthcare System. Time for a check-upThe Italian Healthcare System. Time for a check-up
The Italian Healthcare System. Time for a check-uptelosaes
 
Healthcare Delivery System in Federal Context of Nepal
Healthcare Delivery System in Federal Context of NepalHealthcare Delivery System in Federal Context of Nepal
Healthcare Delivery System in Federal Context of NepalSonali Shah
 
Week 2 - Ontario's Health System
Week 2 - Ontario's Health SystemWeek 2 - Ontario's Health System
Week 2 - Ontario's Health SystemAlexandre Mayer
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverageVineetha K
 
National health policy (1983-2002)
National health policy (1983-2002)National health policy (1983-2002)
National health policy (1983-2002)SraddhaPandey
 
Health Aspect of 12th five year plan in India
Health Aspect of 12th five year plan in IndiaHealth Aspect of 12th five year plan in India
Health Aspect of 12th five year plan in IndiaVikash Keshri
 

Similaire à DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA (20)

APO People's Republic of China Health System Review (Health in Transition)
APO People's Republic of China Health System Review (Health in Transition)APO People's Republic of China Health System Review (Health in Transition)
APO People's Republic of China Health System Review (Health in Transition)
 
National health policy, population policy, ayush
National health policy, population policy, ayushNational health policy, population policy, ayush
National health policy, population policy, ayush
 
Autralian Health Care.pptx
Autralian Health Care.pptxAutralian Health Care.pptx
Autralian Health Care.pptx
 
Oc & d in hospital sectors
Oc & d in hospital sectorsOc & d in hospital sectors
Oc & d in hospital sectors
 
Incoherent policies pachanee and wibulpolprasert
Incoherent policies  pachanee and wibulpolprasertIncoherent policies  pachanee and wibulpolprasert
Incoherent policies pachanee and wibulpolprasert
 
ppt nhp.pptx
ppt nhp.pptxppt nhp.pptx
ppt nhp.pptx
 
National health policy.pptx
National health policy.pptxNational health policy.pptx
National health policy.pptx
 
Cuba Healthcare system
Cuba Healthcare systemCuba Healthcare system
Cuba Healthcare system
 
National health policy 2002
National health policy 2002National health policy 2002
National health policy 2002
 
The Italian Healthcare System. Time for a check-up
The Italian Healthcare System. Time for a check-upThe Italian Healthcare System. Time for a check-up
The Italian Healthcare System. Time for a check-up
 
Health Care in Denmark
Health Care in DenmarkHealth Care in Denmark
Health Care in Denmark
 
Health financing in ghana
Health financing in ghanaHealth financing in ghana
Health financing in ghana
 
NAPH presentation chicago
NAPH presentation chicagoNAPH presentation chicago
NAPH presentation chicago
 
Healthcare Delivery System in Federal Context of Nepal
Healthcare Delivery System in Federal Context of NepalHealthcare Delivery System in Federal Context of Nepal
Healthcare Delivery System in Federal Context of Nepal
 
Week 2 - Ontario's Health System
Week 2 - Ontario's Health SystemWeek 2 - Ontario's Health System
Week 2 - Ontario's Health System
 
815 039 aco summit mw v4final
815 039 aco summit mw v4final815 039 aco summit mw v4final
815 039 aco summit mw v4final
 
Universal health coverage
Universal health coverageUniversal health coverage
Universal health coverage
 
Martin aafp state affairs
Martin aafp state affairsMartin aafp state affairs
Martin aafp state affairs
 
National health policy (1983-2002)
National health policy (1983-2002)National health policy (1983-2002)
National health policy (1983-2002)
 
Health Aspect of 12th five year plan in India
Health Aspect of 12th five year plan in IndiaHealth Aspect of 12th five year plan in India
Health Aspect of 12th five year plan in India
 

Plus de OECD Governance

Public Integrity Indicators Slides
Public Integrity Indicators SlidesPublic Integrity Indicators Slides
Public Integrity Indicators SlidesOECD Governance
 
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...Summary of the OECD expert meeting: Construction Risk Management in Infrastru...
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...OECD Governance
 
Using AI led assurance to deliver projects on time and on budget - D. Amratia...
Using AI led assurance to deliver projects on time and on budget - D. Amratia...Using AI led assurance to deliver projects on time and on budget - D. Amratia...
Using AI led assurance to deliver projects on time and on budget - D. Amratia...OECD Governance
 
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)
 ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE) ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)OECD Governance
 
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...OECD Governance
 
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...OECD Governance
 
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...OECD Governance
 
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...OECD Governance
 
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, StockholmECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, StockholmOECD Governance
 
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...EPEC's perception of market developments - E. Farquharson, Principal Adviser,...
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...OECD Governance
 
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...OECD Governance
 
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...OECD Governance
 
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...Executive Agency of the Dutch Ministry of Infrastructure and Water Management...
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...OECD Governance
 
Presentation of OECD Government at a Glance 2023
Presentation of OECD Government at a Glance 2023Presentation of OECD Government at a Glance 2023
Presentation of OECD Government at a Glance 2023OECD Governance
 
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...The Protection and Promotion of Civic Space: Strengthening Alignment with Int...
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...OECD Governance
 
Digital Government Review Türkiye - Assessment and Recommendations
Digital Government Review Türkiye - Assessment and RecommendationsDigital Government Review Türkiye - Assessment and Recommendations
Digital Government Review Türkiye - Assessment and RecommendationsOECD Governance
 
Buliding-Financial-Resilience-to climate-Impacts.pdf
Buliding-Financial-Resilience-to climate-Impacts.pdfBuliding-Financial-Resilience-to climate-Impacts.pdf
Buliding-Financial-Resilience-to climate-Impacts.pdfOECD Governance
 
Session-7-OECD-Strengthening-climate.pptx
Session-7-OECD-Strengthening-climate.pptxSession-7-OECD-Strengthening-climate.pptx
Session-7-OECD-Strengthening-climate.pptxOECD Governance
 
Session-6-Building-Financial-Resilience.pptx
Session-6-Building-Financial-Resilience.pptxSession-6-Building-Financial-Resilience.pptx
Session-6-Building-Financial-Resilience.pptxOECD Governance
 
Session-5-Assurance-on-sustainability-Peter-Welch.pptx
Session-5-Assurance-on-sustainability-Peter-Welch.pptxSession-5-Assurance-on-sustainability-Peter-Welch.pptx
Session-5-Assurance-on-sustainability-Peter-Welch.pptxOECD Governance
 

Plus de OECD Governance (20)

Public Integrity Indicators Slides
Public Integrity Indicators SlidesPublic Integrity Indicators Slides
Public Integrity Indicators Slides
 
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...Summary of the OECD expert meeting: Construction Risk Management in Infrastru...
Summary of the OECD expert meeting: Construction Risk Management in Infrastru...
 
Using AI led assurance to deliver projects on time and on budget - D. Amratia...
Using AI led assurance to deliver projects on time and on budget - D. Amratia...Using AI led assurance to deliver projects on time and on budget - D. Amratia...
Using AI led assurance to deliver projects on time and on budget - D. Amratia...
 
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)
 ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE) ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm (SE)
 
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...
Building Client Capability to Deliver Megaprojects - J. Denicol, professor at...
 
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...
Procurement strategy in major infrastructure: The AS-IS and STEPS - D. Makovš...
 
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...
Procurement of major infrastructure projects 2017-22 - B. Hasselgren, Senior ...
 
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...
ECI Dutch Experience - A. Chao, Partner, Bird&Bird & J. de Koning, Head of Co...
 
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, StockholmECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm
ECI in Sweden - A. Kadefors, KTH Royal Institute of Technology, Stockholm
 
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...EPEC's perception of market developments - E. Farquharson, Principal Adviser,...
EPEC's perception of market developments - E. Farquharson, Principal Adviser,...
 
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...
Geographical scope of the lines in Design and Build - B.Dupuis, Executive Dir...
 
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...
New Jersey Wind Port - J. Kennedy, New Jersey Economic Development Authority ...
 
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...Executive Agency of the Dutch Ministry of Infrastructure and Water Management...
Executive Agency of the Dutch Ministry of Infrastructure and Water Management...
 
Presentation of OECD Government at a Glance 2023
Presentation of OECD Government at a Glance 2023Presentation of OECD Government at a Glance 2023
Presentation of OECD Government at a Glance 2023
 
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...The Protection and Promotion of Civic Space: Strengthening Alignment with Int...
The Protection and Promotion of Civic Space: Strengthening Alignment with Int...
 
Digital Government Review Türkiye - Assessment and Recommendations
Digital Government Review Türkiye - Assessment and RecommendationsDigital Government Review Türkiye - Assessment and Recommendations
Digital Government Review Türkiye - Assessment and Recommendations
 
Buliding-Financial-Resilience-to climate-Impacts.pdf
Buliding-Financial-Resilience-to climate-Impacts.pdfBuliding-Financial-Resilience-to climate-Impacts.pdf
Buliding-Financial-Resilience-to climate-Impacts.pdf
 
Session-7-OECD-Strengthening-climate.pptx
Session-7-OECD-Strengthening-climate.pptxSession-7-OECD-Strengthening-climate.pptx
Session-7-OECD-Strengthening-climate.pptx
 
Session-6-Building-Financial-Resilience.pptx
Session-6-Building-Financial-Resilience.pptxSession-6-Building-Financial-Resilience.pptx
Session-6-Building-Financial-Resilience.pptx
 
Session-5-Assurance-on-sustainability-Peter-Welch.pptx
Session-5-Assurance-on-sustainability-Peter-Welch.pptxSession-5-Assurance-on-sustainability-Peter-Welch.pptx
Session-5-Assurance-on-sustainability-Peter-Welch.pptx
 

Dernier

What Teenagers Have to Say about the Grandparents
What Teenagers Have to Say about the GrandparentsWhat Teenagers Have to Say about the Grandparents
What Teenagers Have to Say about the GrandparentsSERUDS INDIA
 
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...Congressional Budget Office
 
Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.ahcitycouncil
 
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxDB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxNAP Global Network
 
World Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportWorld Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportEnergy for One World
 
Parents give a charity ideas for children
Parents give a charity ideas for childrenParents give a charity ideas for children
Parents give a charity ideas for childrenSERUDS INDIA
 
My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54mmazurak
 
CBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCongressional Budget Office
 
PPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements PowerpointPPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements Powerpointahcitycouncil
 
Best charity ideas parents give their children’s
Best charity ideas parents give their children’sBest charity ideas parents give their children’s
Best charity ideas parents give their children’sSERUDS INDIA
 
National Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonNational Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonAryaCapale
 
War in Ukraine and problematics of the Ukrainian refugees in USA
War in Ukraine and problematics of the Ukrainian refugees in USAWar in Ukraine and problematics of the Ukrainian refugees in USA
War in Ukraine and problematics of the Ukrainian refugees in USAival6
 
Yes!? We can end TB - World Tuberculosis Day 2024.
Yes!? We can end TB - World Tuberculosis Day 2024.Yes!? We can end TB - World Tuberculosis Day 2024.
Yes!? We can end TB - World Tuberculosis Day 2024.Christina Parmionova
 
Children who live with Grandparents are really lucky
Children who live with Grandparents are really luckyChildren who live with Grandparents are really lucky
Children who live with Grandparents are really luckySERUDS INDIA
 
Hub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationHub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationStephen Abram
 
Water can create peace or spark conflict.
Water can create peace or spark conflict.Water can create peace or spark conflict.
Water can create peace or spark conflict.Christina Parmionova
 
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...OECDregions
 
Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...ResolutionFoundation
 
india sanitation coalition Swachata Abhiyan ​.pdf
india sanitation coalition Swachata Abhiyan ​.pdfindia sanitation coalition Swachata Abhiyan ​.pdf
india sanitation coalition Swachata Abhiyan ​.pdfcoalitionindiasanita
 

Dernier (20)

What Teenagers Have to Say about the Grandparents
What Teenagers Have to Say about the GrandparentsWhat Teenagers Have to Say about the Grandparents
What Teenagers Have to Say about the Grandparents
 
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
The Federal Perspective on Coverage of Medications to Treat Obesity: Consider...
 
Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.Item # 5&6 - 218 Canyon Drive replat prop.
Item # 5&6 - 218 Canyon Drive replat prop.
 
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptxDB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
DB9_BTR_Webinar_Slidedeck_20230320 (1).pptx
 
World Happiness Report 2024- Full Report
World Happiness Report 2024- Full ReportWorld Happiness Report 2024- Full Report
World Happiness Report 2024- Full Report
 
Parents give a charity ideas for children
Parents give a charity ideas for childrenParents give a charity ideas for children
Parents give a charity ideas for children
 
My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54My Burning Issue: "War in Ukraine" Cycle 54
My Burning Issue: "War in Ukraine" Cycle 54
 
How to Save a Place: Become an Advocate.
How to Save a Place: Become an Advocate.How to Save a Place: Become an Advocate.
How to Save a Place: Become an Advocate.
 
CBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New ResearchCBO’s Work on Health Care and a Call for New Research
CBO’s Work on Health Care and a Call for New Research
 
PPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements PowerpointPPT Item # 2 -- Announcements Powerpoint
PPT Item # 2 -- Announcements Powerpoint
 
Best charity ideas parents give their children’s
Best charity ideas parents give their children’sBest charity ideas parents give their children’s
Best charity ideas parents give their children’s
 
National Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO QuezonNational Women's Month Celebration for PENRO Quezon
National Women's Month Celebration for PENRO Quezon
 
War in Ukraine and problematics of the Ukrainian refugees in USA
War in Ukraine and problematics of the Ukrainian refugees in USAWar in Ukraine and problematics of the Ukrainian refugees in USA
War in Ukraine and problematics of the Ukrainian refugees in USA
 
Yes!? We can end TB - World Tuberculosis Day 2024.
Yes!? We can end TB - World Tuberculosis Day 2024.Yes!? We can end TB - World Tuberculosis Day 2024.
Yes!? We can end TB - World Tuberculosis Day 2024.
 
Children who live with Grandparents are really lucky
Children who live with Grandparents are really luckyChildren who live with Grandparents are really lucky
Children who live with Grandparents are really lucky
 
Hub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspirationHub Design Inspiration Graphics for inspiration
Hub Design Inspiration Graphics for inspiration
 
Water can create peace or spark conflict.
Water can create peace or spark conflict.Water can create peace or spark conflict.
Water can create peace or spark conflict.
 
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...
OECD Webinar - ESG to deliver well-being in resource-rich regions: the role o...
 
Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...Living life to the full: How can we make our longer lives healthier, happier ...
Living life to the full: How can we make our longer lives healthier, happier ...
 
india sanitation coalition Swachata Abhiyan ​.pdf
india sanitation coalition Swachata Abhiyan ​.pdfindia sanitation coalition Swachata Abhiyan ​.pdf
india sanitation coalition Swachata Abhiyan ​.pdf
 

DELSA/GOV 3rd Health meeting - Bogart MONTIEL REYNA

  • 1. April 2014 CONTROLLING HEALTH CARE EXPENDITURE IN DECENTRALISED ENVIRONMENTS: A MEXICAN CASE STUDY BOGART MONTIEL WWW.SALUD.GOB.MX PARIS, FRANCE
  • 2. CONTENT Background • The main Health Maintenance Organizations (HMOs) in Mexico. • Decentralisation of health services in the Ministry of Health. Challenges • Redefine the calculation formula for financial transfers. • Analyse of strategies (decentralisation and universal healthcare) • Create of a single fund for all health care provision. • Create of a new national agreement on decentralisation. Achievements • Administrative. • Medical Services. Some statistics
  • 3. HEALTH SERVICES PROVISION IN MEXICO Main Health Maintenance Organizations (HMOs) in Mexico IMSS private-sector employees People with social security ISSSTE public-sector employees PEMEX oil-sector employees ISSSFAM national defense employees Ministry of Health People without social security
  • 4. Background 1983 Constitutional Reform (Article 4): shared obligation of health services provision between the central and local governments • First effort to decentralise some health services. • Less than half of the Mexican states signed agreements. • Spending decisions and the design of health policies and regulations remain in the hands of the central government. • Above all, an administrative decentralisation. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 5. Background 1996 National agreement for the decentralisation of health services • Local financial control was granted. • A National Health Council was created to maintain stewardship, improve quality, and set evaluation procedures. • The National Health Council is a permanent body coordinating healthcare between the central government and all states governments in Mexico. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 6. Background 1998 The Fiscal Coordination Act • Branches were set up by the Act, one of which (FASSA) deals with fund transfers from the central government to governments at the state and municipal levels. • A resource allocation formula was developed based solely on the following points: • health infrastructure inventory • employee lists from each state • the previous year’s operational and investment budgets • other resources to promote the equalisation of healthcare services. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 7. Challenges DECENTRALISATION OF HEALTH SERVICE IN MEXICO The Fiscal Coordination Act, however, did not take into account the following essential considerations:  What kind of diseases are there locally?  How much would treatment of these disease be?  How many hospitals or clinics are needed to attend to people?  What kind of special services should these hospitals or clinics have?  What staff is necessary to attend to local epidemiological needs?  What resource allocation is needed to meet the above demands? As a result, the Mexican government wants to redefine FASSA’s resource allocation formula to respond to present epidemiological profiles in order to eventually sign a new national agreement.  Analyse the strategies (decentralisation / universal healthcare)  Create an single fund for all healthcare provisions.  Standardise quality and coverage of healthcare services in all HMOs.
  • 8. Achievements Administrative • Design of local health acts and regulations • Design of local health programmes • Strengthening of the administrative structure • Closer links between central and local governements Medical Services • Adoption of the services model • General mortality reduction • Infant mortality reduction • Growth of the medical infraestructure 2003 Reform to the Ley General de Salud to establish Seguro Popular, universal healthcare coverage. DECENTRALISATION OF HEALTH SERVICE IN MEXICO
  • 9. Some statistics Ministry of Health Budget in 2014 • Branch 12 Health: 130,264.6 millions of pesos. 9,578 USD billions • Branch 33 FASSA: 72,045.2 millions of pesos. 5,297 USD billions 202,310 millions of pesos. 14,875 USD billions • 71% of the Branch 12 and 100% of the Brach 33 is transfer to local governments (164,274.7 millions of pesos. 12,578 USD billions) • So 81,2% of these branches is transfer by the central government. • Total amount of the public budget, including all HMOs 485,228 millions of pesos. 37,153.8 USD billions. DECENTRALISATION OF HEALTH SERVICE IN MEXICO