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Public-Private collaboration in Mexico Three
case studies
Gustavo Nigenda Luz María González Yetzi Rosales
April 22, 2004
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Description and objectives
Case 1. Jalisco. Through contracting Decentralized Public Entity (OPD-Ministry of Health) has set up a network of primary (independent basic team and health centers) and secondary (hospitals) care services in geographical areas (urban and rural) where no MOH units are available. The objective is to expand coverage.
Case 2. Veracruz. Selling of hospital services to private users by a tertiary-level public hospital. Users can have access through an institutional agreement with a social security or private institution, can refer themselves or can be referred from the hospitals public area. The objective is to create an alternative source of funds to subsidize public provision.
Case 3. Mexico City. Selling of laboratory tests and ambulatory treatment (eg chemotherapy) to private users by a tertiary-level public hospital. Users can have access through an institutional agreement with a social security of private institution or can refer themselves. The objective is to create an alternative source of funds to subsidize public provision.
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Jalisco case Public Financing private
provision with basic team
Public Financing
OPD Jalisco Health Services
Contracting. Basic salary plus productivity
payments
Contracting

Basic Team
Private service provision
Doctor
Nurse
Health Promoter
Medical consultation, health promotion and
disease prevention activities
Users
Demand
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Jalisco case Public financing private
provision at primary and secondary health units
OPD Jalisco Health Services
Public Financing
Contracting. Flat fee per intervention
Health care units
Private Service Provision
H. I Ievel of care
H. II level of care
Package of ambulatory and hospital services
Demand
Users
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Veracruz Hospital Financing Sources

Agreements PEMEX, ISSSTE, UV, private insurers


State Government Payrolll

Financing
Users payment

Hotel Services

Private payments

Laboratory, Images, etc.
Recovering Fees



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Veracruz Hospital Service provision
Service Provision
Private Area
Public Area
Private Doctor
Hospital Doctor / Private Doctor
Hospital Doctor
Hospital Nurse
Public / Public Users
Public / Private Users
Private / Private Users
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Mexico City Public Hospital Financing
Federal Budget
Own resources
Financing
Recovery fees
Third parties donations
Agreements PEMEX, ISSSTE, Private hospitals,
etc.
Payments by private patients without agreement
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Mexico City Public Hospital Services provision
Services provision
Doctors, Nurses, technicians
Open population with or without referal
Private with or without agreement
Radiations, Magnetic Resonance, Mastography Audio
logy
All services Including hospital care
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Benefits and Problems
Case Benefits Problems
Case 1. Jalisco Use of regulatory frame Increase of coverage High users satisfaction in both areas Providers dissatisfaction No evaluation of general performance of the model Locally designed payment system to be adjusted
Case 2. Veracruz Increase of access to poor populations Satisfaction of both public and private users No costing system Extra payments for doctors but not for rest of personnel No accreditation of private doctors No evaluation
Case 3. Mexico City More resources for public area Better utilization of technology No costing system Quality differences between public and private (waiting times) No evaluation
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Final remarks

• Public private collaboration requires a sound
  technical base for implementation in order to
  attain objectives pursued
• Costing systems should be used to estimate cost
  and prices of services, otherwise subsidies may
  be moving in the opposite direction to intended
• Increasing access and patients satisfaction are
  important but not definite to consider a
  collaboration model successful
• Regulatory guidelines should be developed and
  applied by federal or state-level Ministries of
  Health in order to guarantee that the model is
  technically and financially appropriate

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