Since 2001, Mexico has been designing, legislating and implementing a major health system reform. A key component of this reform was the creation of Seguro Popular which is intended to expand insurance coverage over a seven year period to the uninsured, nearly half of the total population at the beginning of 2001. The reform included five distinct actions: legislation of an entitlement per family affiliated which, with full implementation, will increase public spending on health by 0.8-1.0% of GDP; creation of an explicit benefits package; allocation of monies to decentralized state ministries of health in proportion to the number of families affiliated; division of federal resources flowing to the states into separate funds for personal and non-personal health services; and creation of a catastrophic healthcare fund. Using the WHO health systems framework, we have examined a wide array of datasets to evaluate the impact of this reform on different dimensions of the health system. Key findings include: affiliation is preferentially reaching the poor and the marginalized communities; federal non-social security expenditure in real per capita terms increased by 38% from 2000 to 2005; the equity of public health expenditure across states has improved; Seguro Popular affiliates have higher utilization of inpatient and outpatient services than the uninsured; effective coverage of interventions has improved between 2000 and 2005-06; inequalities in effective coverage over this period across states and wealth deciles have declined; catastrophic expenditures for SP affiliates are lower than for the uninsured even though utilization has increased. The paper presents some lessons for Mexico based on this interim evaluation and explores potential implications for other countries considering health reforms.

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