Why expanding public health insurance coverage is not enough to provide effective ambulatory care: policy lessons from Mexico, 2000-2022

Abstract

Despite expanding public insurance coverage and investment in public healthcare supply, the Mexican population not covered by social security has increasingly used private-sector outpatient health services over the past two decades. This is a public health policy problem because Mexico is committed to a constitutional right to health protection, which means unmet ambulatory needs must be fulfilled. This brief aims to measure the magnitude of unmet ambulatory health care needs, analyze factors that led to their growth, and formulate policy options to address them. Private services' share of total ambulatory care grew from 38 percent in 2006 to 66 percent in 2022, despite two national policy efforts to increase public coverage to nearly 50 million people. Neither policy provided adequate ambulatory coverage for its targeted population, leading to care seeking through private outpatient providers. We recommend strengthening public ambulatory care by increasing financial resources for public primary care and implementing more effective allocation to improve timeliness and quality of care.

Keywords: Mexico; Outpatient health care; Policy lessons; Private use; Public health insurance.

Fig. 1

The trends in key characteristics: Panel (a) the use of private ambulatory care in 2006–2022 [5, 6, 7, 8, 9]; Panel (b) out-of-pocket and catastrophic health expenditures in 2001–2024 [10]; Panel (c) the vaccination coverage in 2000–2021 [11]