The U.S. can learn from Mexico's recent efforts at health reform, especially as it relates to transferring care from specialists back to primary care physicians, researchers said.
Mexico created its national health insurance program, called the Seguro Popular in 2003, and achieved universal coverage for its 100 million citizens earlier this year, Felicia Knaul, PhD, of Harvard Medical School and colleagues wrote in the Aug. 16 edition of The Lancet.
The program now provides coverage to 52 million previously uninsured Mexicans, they noted.
Its list of essential covered services grew from 91 in 2004 to 284 in 2012 -- covering treatment for more than 95% of conditions in ambulatory units and hospitals, Knaul and colleagues wrote.
Meanwhile, Mexico also built 15 high-specialty centers, more than 200 hospitals, and almost 2,000 ambulatory clinics.
As the country slowly expanded coverage, its state-run specialty care centers became overcrowded with patients. To avoid facing a similar problem, the U.S. could learn to strengthen primary care's ability to provide follow-up treatment to patients recovering from catastrophic illnesses such as cancer, Knaul said in an interview with MedPage Today.
"That's not what primary care has been able to do well," she said.
The real challenge for the medical community will be how to train primary care doctors to handle that, Knaul said. It's not good for patients to continue to seek treatment at the specialty level, but it can be complex to link that follow-up care back to primary care doctors.
Regardless of how that's done, Mexican reform has shown it's possible to build financially responsible ways to treat chronic diseases alongside prevention, Knaul and colleagues wrote.
"Part of the global community has been convinced that middle-income and especially low-income countries should limit their activities to prevention in the case of chronic and noncommunicable diseases," the paper stated. That line of thinking is wrong and would conflict with the point of health reform, which is to provide affordable healthcare to all citizens, Knaul said.
For example, although treating a chronic illness like childhood asthma isn't expensive from month to month, Knaul pointed out that it adds up over time and can be financially burdensome.
Knaul knows of Mexican families living in the U.S. that have developed serious medical conditions, lost their jobs and their work visas as a result, and have returned to Mexico because they can be treated there. "Hopefully, this will change as a result of reform in the United States," she said.
Another key principle transferable to other countries is the importance of monitoring and assessment. "Several countries and most notably China, have similarly included a strong measurement and assessment component in their reforms," the paper noted.
The U.S. has more data than most countries, Knaul said.
It's also important to share data with stakeholders and policymakers to improve performance and make metrics uniform and applicable to all states to make comparisons easier, Knaul and colleagues noted.
"Another lesson is the importance of long-term investment in the development of research and educational institutions that generate evidence for policy design and implementation," the authors wrote. The institutions train leaders and policymakers at local and federal levels to implement reforms.
Health reform in Mexico has spurred economic growth while improving health, Knaul noted. The infant mortality rate dropped from from 18.2 to 14.1 per 1,000 live births from 2000 to 2010. The percentage of deaths from communicable diseases also fell -- from 15.4% to 10.8% -- during the same period.
Meanwhile, the gross domestic product per capita increased from $11,852.70 in 2000 to $12,440.90 in 2010.