Salud Migrante Proposals for integral health care

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Salud MigranteProposals for integral health care
Binacional Tecnical Group
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General Outline

• Conceptual framework, diagnosis and general
  design
• Miguel A. González Block
• Provision of services in the United States
• Anne Kaufmann Nolon
• Insurance options with managed care
• Manuel Navarro y Patrick Bucknum

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SALUD MIGRANTE Conceptual framework, diagnosis
and general design
Miguel Ángel González Block
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Outline

• Background
• Diagnosis
• Proposal for Salud Migrante
• Conclusion and Next Steps

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Project Development

• INSP Mission
• To contribute to social equity by generating
  knowledge and innovation in health systems
• Working Program of the Center for Health Systems
  Research
• Vulnerable Population migrants
• Social health protection Seguro Popular
• Binational Forums in Health Policies Guadalajara,
  October, 2006
• Los Angeles, October, 2007

BACKGROUND
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Project Formulation

• Objectives
• Diagnosis and identification of options for the
  grand vision of Binational Insurance
• Formation of a coalition to develop pilot
  projects
• Seed financing by the Ford Foundation
• June 2007 to April 2008
• Research Team
• INSP leadership, multi-institutional
  participation
• Researchers in Iowa and North Carolina
• Service providers in the States of Washington and
  New York
• Participation at the national level in Mexico

BACKGROUND
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Sample of Participating States

• Mexico
• Guanajuato
• Michoacán
• Puebla
• United States
• North Carolina
• Iowa
• New York
• Washington

BACKGROUND
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Methodology
BACKGROUND

• In-depth interviews
• Bibliographic review, narrative and summarized
• Participatory observation
• Consultations
• Technical validation

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Players to be interviewed

• High-level federal and state health and migration
  officials
• Insurance agencies
• Insurance regulators
• First-level health care providers
• Hospitals
• Community agencies for migrants and
  protection/support
• Financial intermediation agencies (BANSEFI)
• Agencies that protect migrants
• Federal (consulates, IME Institute of Mexicans
  Abroad)
• State (Mexican agencies in both countries)
• Community development and patrimonial migrant
  initiatives

BACKGROUND
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Conceptual Framework

• Right to health
• Vulnerability and exclusion of migrants in both
  countries
• Mexico/US integral diagnosis
• Vision of migration and health policies
• Functional international integration of health
  systems
• Mexican government leadership
• Linking strengths
• Mexican public sector
• U.S. Non-profit, private sector
• Participation of migrant organizations in both
  countries

BACKGROUND
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2. DIAGNOSIS
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Dimension of the 11.8 million Mexican migrants in
the U.S.

• 11 of the population of Mexico
• 5.8 annual increase
• Bidirectional flow
• 700,000 leave Mexico
• 250,000 return
• 60 without documents
• 21 have U.S. Citizenship
• 56 without health insurance

DIAGNOSIS
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Reference population for binational insurance

• 11.8 million migrants
• 4.3 million offspring born in the U.S.
• 5.5 million dependents in Mexico
• 21.6 million in transnational
• communities

DIAGNOSIS
85 of the migrants send remittances to Mexico
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Migrants impact on the U.S. population without
health insurance

• Migrants (of any nationality) and their offspring
  born in the U.S. make up
• 32 of the total population without health
  insurance (46 million)
• 86 of the growth of the population without
  health insurance
• Mexican migrants make up 14 of the total number
  of people in the U.S. without health insurance

DIAGNOSIS
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Importance of health insurance for migrants in
the U.S.

• The U.S. health system is the most expensive in
  the world, representing 14 of the GDP
• 5.6 of hospital costs in the U.S. end up as
  uncompensated debts
• This is attributed to the population without
  health insurance, mainly migrants
• It represents 0.2 of the U.S. GDP

DIAGNOSIS
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Willingness to pay for a binational health
insurance

• 62 of migrants are interested in binational
  health insurance
• 57 are willing to pay between 75 and 125 U.S.
  per month
• Private, primary care in the U.S.
• Public in Mexico
• Other studies have estimated the cost of an
  integral, binational package in the range of
  3,000 to 4,500 U.S. per family per year

DIAGNOSIS
Vargas-Bustamante A, Ojeda G, Castañeda X.
2008. Tim Waidmann Saad Ahmad. 2007.
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Remittance spending on health services in Mexico,
2002PERCENT
Head of Household
Modified from Amuedo-Dorantes et al 2007, based
on ENIGH 2002.
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Response capacity in the U.S.

• Community Health Centers in the U.S.
• 6,300 points of service in the entire U.S.
  territory
• Care provided to 17 million people
• This includes 147 health centers for migrants,
  with 800,000 patients
• They are very interested in binational insurance
• Hometown Associations
• Broad experience in health
• Not always available
• Problematic relationship with Mexico
• Non-profit insurance agencies
• Ventanillas de Salud

DIAGNOSIS
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Response capacity in Mexico

• Secretariat services in high migration areas
• State governments very interested in supporting
  migrants
• Community agencies with potential for binational
  collaboration
• Seguro Popular
• Interest and capacity to focus on migrants
• Need to strengthen affiliation

DIAGNOSIS
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3. SALUD MIGRANTE PROPOSAL
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Components of SALUD MIGRANTE

• Doctrine
• Policy
• Articulating agency
• Insurance agencies
• Service networks
• Community support

PROPOSAL
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SALUD MIGRANTE Doctrine

• Migrants have a right to health protection in the
  U.S.
• Temporary residency outside of Mexico should not
  limit the constitutional right to health in
  Mexico
• A constitutional obligation guarantees access to
  health services for migrants wherever they
  temporarily reside

PROPOSAL
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Functions of the SALUD MIGRANTE Agency

• Dissemination of the Salud Migrante Doctrine in
  Mexico and in the U.S.
• Building and strengthening capacities Amigos del
  Migrante Health Services
• Insurance companies and Seguro Popular
• Binational health service networks
• Civil society organizations
• Salud en el Norte Insurance
• Selling policies to migrants
• Insurance Agency Concessions / Franchises

PROPOSAL
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Politics of SALUD MIGRANTE
SALUD EN EL NORTE Primary Care in the U.S.
Seguro Popular Affiliation in the U.S.

• Dissemination of the Salud Migrante Doctrine in
  Mexico and in the U.S.
• Building and strengthening capacities Amigos del
  Migrante Health Services
• Insurance companies and Seguro Popular
• Binational health service networks
• Civil society organizations
• Salud en el Norte Insurance
• Selling policies to migrants
• Insurance Agency Concessions / Franchises

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Politics of SALUD MIGRANTE
SALUD EN EL NORTE Primary Care in the U.S.
Seguro Popular Affiliation in the U.S.
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Salud en el Norte Package of Primary Care
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4. CONCLUSIONS AND NEXT STEPS
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Conclusions

• Migration demands wide-reaching state policies
  and a grand vision
• Mexico can initiate a binational health insurance
  of great global interest
• Significant capacity and interest in
  collaboration exists among key players in both
  countries

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Next Steps

• Establishment in the binational arena of
• An Advisory Council for Salud Migrante
• A Task Force, coordinated from Mexico
• In-depth analysis and development of platforms in
  selected states
• Tentative cost 1.1 million
• Proposal of the implementation stages for Salud
  Migrante