Important note: Information in this article was accurate in 2004. The state of the art may have changed since the publication date.

Reuters NewMedia - December 10, 2004
Lorraine Orlandi

Hours later, Ana Elvia stopped breathing and died. A hospital worker then approached Trasvina demanding payment for his daughter's care.

In Coahuila state, a man went to a public hospital last year for a circumcision and ended up in a coma. So did a woman during a gall bladder operation in Guadalajara.

These are tales from a health system with one foot in the third world and another in the first.

Mexico has led developing nations in advances like mass immunization that have slashed infant mortality and nearly doubled life expectancy, though gaps remain for the poor.

But as Mexicans live longer, they suffer from more modern diseases, creating a new burden for the largely outdated health system, one it is struggling to handle.

Experts say a cash infusion and reforms are needed to make the system more responsive to changing health needs in an aging society and to fix flawed basic services like maternal care.

"We're victims of our own success," said Health Minister Julio Frenk. "You prevent the death of a child, that child grows to be an adult who is now exposed to the risk of much more complex and difficult-to-prevent diseases."

"So our success in reducing child mortality has created in and of itself the pressure for diabetes care, for cancer, for mental health," he said.

With resources stretched, hospitals can make fatal mistakes. While accidents may not always result from systemic shortcomings, many Mexicans including health care professionals say they often reflect an overtaxed system struggling to adjust its changing mandate.

Human rights ombudsman Luis Soberanes calls health one of Mexico's most serious challenges, saying the system faces a "lack of medicine, insufficient equipment and personnel, negligence and, in general, inadequate services."

In the face of these challenges, patients contend many medical staff are so overwhelmed they have stopped caring.

Raul Organista complains doctors kept him in the dark when his 30-year-old pregnant wife and their unborn child died in a public hospital. The baby died and Organista's wife fell into a coma as doctors tried to remove the fetus.

"They kept saying she was stable, they never let me see her," he said. "They gave me hope but they deceived me. They never said she wouldn't wake up."

OVERSTRETCHED

Mexico has made important health strides since 2000. A new program brings health care to the uninsured -- mainly the poor. AIDS patients can get affordable anti-retroviral drugs, with similar programs planned for childhood cancers.

Still, needed structural reform has not reached social security institute IMSS, which bears the brunt of the health burden with 53 million users and a $12 billion budget for medical services.

Today the IMSS has 0.93 beds per 1,000 members, compared to 2.3 beds 25 years ago.

Overcrowded, underfunded and often inefficient, with no incentive to improve care, the institute is rife with stories of botched treatment ending in tragedy.

Last year, Soberanes received nearly 600 complaints about health services, most of them at public hospitals.

In one case, a father charged hospital officials tried to "disappear" his son's body after he died from misdiagnosed appendicitis. In another, a woman's husband was disconnected from life support and his organs donated without her knowledge.

The IMSS and Mexico's quasi-independent medical arbitration board insist the record is good given the huge demand.

On a typical day, the IMSS sees 384,000 office visits, admits 5,000 hospital patients and performs 3,800 surgeries.

HELP FOR THE POOR

A recent study found sharp imbalances between health services in places like rural Chiapas state, where high child mortality rates rival those in Sudan, and in upscale Mexico City neighborhoods.

Half the Mexican population, or 50 million people, are not formally employed and have no insurance. They pay out of pocket for health care, pushing 3.5 million into poverty each year.

Now the poor who have been historically mistreated by the health system are getting the first benefits of reform.

Some 1.5 million uninsured families enrolled this year in a new Popular Health Insurance program, most of them headed by single women. The aim is to cover virtually all the uninsured by 2010, with about $700 million a year in federal funding.

They receive basic health care and catastrophic coverage, paying into the insurance pool based on income. The poorest pay nothing but all subscribers must follow specified prevention programs with vaccinations and regular checkups.

"The healthy should help finance the health care of the sick," said Frenk. "Since all of us will one day get sick, that is a very fair principle."

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