HEALTH CARE DECISION MAKING IN MEXICO: THE ROLE OF HEALTH TECHNOLOGY ASSESSMENT AND ECONOMIC EVALUATION

Purpose: To describe the historical path and current role of health technology assessment (HTA) and economic evaluation (EE) in health care decision-making in Mexico.

Method: We reviewed historical documents and peer-reviewed articles related to HTA and EE from Mexican Ministry of Health (MH) and Social Security Institutions (SSI). We identified changes in the country’s health care decision-making and their impact in acquisition of medicines and health devices in public health services. 

Result: Mexico is classified as an upper middle-income country assigning approximately 6% of its GDP to health (32% less than OECD average). The Mexican Health System is fragmented into main three health providers: MH, SSI and Private Services (PS). The MH provides approximately 49% of the health care coverage, while the SSI covers 50% and the Private sector covers 1%. The out-of-pocket (OOP) health expenditure as a percentage of total health expenditure is 49% which is 2.5 times the percentage of OECD average. To provide health services with better quality, the access of treatment and diagnosis has to be efficient and cost-effective for the government, therefore the creation of the Positive List in 1983 marked a starting point in the timeline of HTA in Mexico. From 2002 no public institution can use any health supply that is not in the Positive List. To be included into the Positive List, health supplies have to be endorsed by proofs of safety, efficacy and cost-effectiveness. These endorsements must follow the EE and Evaluation of Health Inputs guidelines, which were developed as part of the National Health Program between 2008-2011. The Federal Commission for the Protection against Sanitary Risk and the Inter-institutional Commission are the bodies in charge of reviewing the endorsements. The latter is coordinated by the General Health Council and integrated by the Health Institutions. Subsequently, the Commission of Price Negotiation regulates the acquisition prices, and each institution manages the access of the health supplies into specific population groups.

Conclusion: HTA and EE play a fundamental role in the acquisition of new health supplies into the country’s health system. Improvements in the process of inclusion of new health supplies have allowed selecting cost effective alternatives, however, the rules of decision have to be strengthened to avoid a budgetary imbalance in the Mexican Health System.