MEXICAN HEALTHCARE SYSTEM 2019 1 GENERAL INFORMATION CONCERNING THE DEMOGRAPHIC AND ECONOMIC STRUCTURE OF THE COUNTRY Population and official languages of the country, age-gender dispersion in the country, the share of elderly population (+65) in the overall population There is no official language in the Federal constitution of the United Mexican States. Mexico has a population of nearly 125 million in 2018 which makes it 11th most populous country in world. Age-Gender Dispersion Percentage Indicator 1910 1921 1930 1940 1950 1960 1970 1980 1990 1995 2000 2005 2010 2015 Percentage of men 49.5 48.9 49.0 49.3 49.2 49.9 49.9 49.4 49.1 49.3 48.8 48.7 48.8 48.6 Percentage of women 50.5 51.1 51.0 50.7 50.8 50.1 50.1 50.6 50.9 50.7 51.2 51.3 51.2 51.4 Source: INEGI Yellow: Percentage of men, Red: Percentage of women (INEGI) Main economic activities and sectors, general import and export figures and their ratio to Turkey In Mexico, which has a GDP of 1.2 trillion USD, per capita income is around 9,807 USD. In 2018, the inflation rate was 4.9%, the unemployment rate was 3.3% and the GDP growth rate was 2%. 67% of the population lives in cities and poverty is very high in rural areas. 46% of the population is poor throughout the country and with this ratio Mexico ranks the first among OECD countries in terms of the difference between the richest and poorest 10%. 1 According to the data of 2018, Mexico is our biggest export market in Latin America with a share of 19%. Our bilateral trade volume increased by 1.8% in 2018 and reached USD 1.2 billion. In the same year, our exports to Mexico increased by 36% and imports from this country decreased by 18%, thus the foreign trade deficit against Turkey in our bilateral trade decreased by 90%. In the last 10 years, our bilateral trade volume has doubled and our exports to Mexico have quadrupled. Mexico is the second largest economy in Latin America after Brazil and the 15th largest in the world. Mexico is the world's 12th largest exporter and importer of Latin America and the Caribbean region alone, accounting for 42% of total exports and imports of the region. 77% of the country's exports and 47% of its imports are realized with the USA. In 2018, Turkey ranked 32nd with a share of 0.2% in Mexico's imports. In the first three months of 2019, FDI inflows to Mexico amounted to USD 10.16 billion. Investments increased by 7% compared to the same period of the previous year. It is estimated that approximately 37 million Mexican people live in the United States. Workers' remittances transferred by Mexicans working abroad have been one of the major sources of foreign currency inflow. It is known that approximately 33.5 billion USD of workers' remittances entered Mexico in 2018, of which 95% was sent by Mexicans living in the USA. 65% of Mexican GDP is composed of services sector, whereas share of industry is 32% and agriculture 4%. The National Institute of Statistics and Geography (INEGI) reports that based on the results of the Monthly Survey of the Manufacturing Industry (EMIM), in May of the current year 2019, the total employed personnel of the manufacturing sector showed an increase of 0.3% in to the previous month, with data adjusted for seasonality. The hours worked did not change in the fifth month of 2019 in relation to the previous month, while the average real wages paid, which include salaries, salaries and social benefits increased 0.5% in their monthly comparison, with seasonally adjusted figures. At the annual rate, total employed personnel grew 1.3%, hours worked were higher by 0.9% and average real wages by 2.2% compared to May 2018. Industrial Production (seasonally adjusted figures, percentage change, 2019 May) % Variation with % Variation with respect to respect to the the same month of the Concept previous month previous year Total -2.1 -3.1 Mining -1.3 -8.9 Generation, transmission and -0.6 1.6 distribution of electrical energy, water and gas supply through pipelines to the final consumer 2 % Variation with % Variation with respect to respect to the the same month of the Concept previous month previous year Building -6.2 -9.0 Manufacturing industries -0.2 0.4 Source: INEGI See Excel Table and IMF (https://www.imf.org/en/News/Articles/2018/11/07/NA110818-Mexico- Economic-Outlook-in-5-Charts) for more information. The location in and around Mexico City has been chosen by many medical and pharmaceutical companies for their Mexican headquarters. It is not only the central location and the well-developed infrastructure that speak for this region, but also its proximity to the economically strong regions of Puebla and the Bajío. The capital region has attracted companies from the chemical industry such as BASF and Bayer. Export-Import Balance of Chemistry Sector (million dollars) Variable May 2018 May 2019 Variation % TOTAL EXPORT 34,251.8 36,974.8 8.0 Chemistry Export 908.2 902.9 -0.6 TOTAL IMPORT 34,899.0 34,934.2 0.1 Chemistry Import 2,455.7 2,419.6 -1.5 Source: INEGI 2 MAIN HEALTHCARE SYSTEM AND FINANCIAL MODELS FOR HEALTHCARE EXPENDITURES What is the number of hospitals in the country? (private and public sector separately) According to OECD data, there are 4,629 hospitals in Mexico as of 2018. The number of public hospitals is around 1,500. For more information about hospitals in Mexico please refer to Ministry of Health web page http://www.oic.salud.gob.mx. Particular Health Establishments in Mexico Period Number of private health facilities 2004 3,020 2005 3,172 3 2006 3,131 2007 3,141 2008 3,111 2009 3,108 2010 3,144 2011 3,088 2012 3,064 2013 3,071 2014 3,014 2015 2,960 2016 2,906 2017 2,877 Source: INEGI What is the number of beds per patient? (private and public sector separately) and what is the number of doctors and nurses per patient? (private and public sector separately) According to OECD, on average there are 1.4 beds per 1,000 population in 2017. In Mexico City this number increases to 2.4 beds per 1,000 inhabitants whereas in the state of Chiapas it is only 1 bed per 2,000 inhabitants. Number of Doctors per Censable Bed Period Number of doctors per censable bed 2004 1.51 2005 1.60 2006 1.82 2007 1.88 2008 1.87 4 2009 1.85 2010 1.97 2011 2.04 2012 2.05 2013 2.20 2014 2.30 2015 2.39 2016 2.32 2017 2.51 Source: INEGI According to the Organization for Economic Co-operation and Development (OECD), a country should have one doctor for every 333 residents. Based on a 2017 World Bank estimate, Mexico has only one doctor for every 477 people. President López Obrador says Mexico needs 123,000 more doctors to cover the country's needs. “There are 270,600 general practitioners in the country, and according to international norms, we should have 393,600 doctors,” he said during a visit to a rural hospital in Michoacán on July 13, 2019. The president added that the shortage of doctors is related to low admission rates at universities for medicine programs. He said the new “National Institute of Health for Well-Being” will work with universities to train more doctors. The institute, which has not yet been approved by Congress, will operate with a budget of 80 billion pesos (US $ 4.2 billion) and replace the Seguro Popular (Popular Health Insurance) , offering medical services to people who are not covered by social security. https://mexiconewsdaily.com/news/mexico-short-123000-doctors/ Are there any foreign national health staff working in the country? From which country foreign medical personnel mainly come from? What is the legal procedure to employ foreign national physicians in the country? Currently there is no study regarding foreign nationals working in the health sector, the closest study by the Mexican Government is a study called “Foreigners residing in Mexico” by the Center of Migratory Studies at the National Migration Institute, done in 2012, with data from 2009. It classifies foreigners in Mexico as “students, workers, pensioned or other” but it does not specify in which area they work. In 2017, the United Nations Department of Economic and Social Affairs Population Division gave a foreign born population in Mexico of 1,224,169. Unofficial estimates put the total number of foreigners in Mexico closer to four million. Not all of Mexico’s medical offerings are located in major medical centers. Mexico-bound health travelers often seek out smaller clinics run by two or three physicians, some of them second- and 5 even third-generation family enterprises. Unassuming yet clean and efficient, these clinics are often headed by either expatriate US physicians or practitioners trained in the US or Europe. Such clinics reliably treat tens of thousands of medical travelers each year, with many of their patients returning annually for checkups, dental cleanings, physicals, and a host of other treatments that can be had far less expensively than in the US, Europe, and even many Asian countries. The legal procedure to employ foreign national physicians in the country is not different. For foreign temporal or permanent residents in Mexico, they must present the following documents to the National Institute of Migration: • ID card as temporal or permanent resident • Pay administrative fee • Present a job offer, in case the foreigner will be self-employed a sworn letter must be stated.