Paying Doctors and Hospitals

Most Mexican doctors work as salaried government employees, although most also take private, fee-for-service patients on a part-time basis, and some work solely for private patients. Public hospitals receive their funds from the government out of tax revenues.

Access to Care Individuals who purchase health care in the private sector have, of course, a wide choice of doctors and hospitals. Most Mexicans, however, must use the doctor or the clinic to which they are assigned for primary care (although in theory they have some choice). To obtain specialty care, patients must first get referrals from their primary care doctors. Such referrals can be difficult to get, however, because of government cost controls that restrict the number of practicing specialists. For the same reason, patients who do get referrals typically have long waits before they can get appointments with specialists. As a result, many patients subvert the system by instead seeking specialty care at emergency clinics or from private doctors if they can afford it.

Mexicans average three doctor visits per person per year compared with four visits for U.S. citizens. Their access to technologically intensive care, however, remains limited. In addition, these services are haphazardly dis- tributed, with more services available in cities and wealthier regions (most in the north) than in rural areas and poorer regions (most in the south). Recent reforms, however, have reduced these differences.

Health Outcomes Although Mexico remains rife with social and economic inequities and resulting inequities in health, it has nevertheless achieved notable im- provements in health outcomes for much of its population. Consequently, by some measures, Mexico appears to have completed the epidemiological transition— cancer and heart disease now kill more Mexicans than do infectious diseases, and life expectancy is 77, only two years less than in the United States. Infant mortality, child mortality, and maternal mortality all decreased substantially between 2000 and 2010.