June 2000 41 Enhancing the Political Feasibility of Health Reform: The Mexico Case Enhancing the Political Feasibility of Health Reform: The Mexico Case Alejandra González Rossetti, M.Sc., M.P.A. Harvard School of Public Health Olivia Mogollon June 2000 This publication was produced by the Data for Decision Making (DDM) project, funded by the U.S. Agency for International Development under Cooperative Agreement No. DPE-5991-A-00- 1052-00 with the Harvard School of Public Health. It was done in collaboration with the Latin America and Caribbean Regional Health Sector Reform Initiative, funded by USAID under Contract No. HRN-5974-C-00-5024-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. TABLE OF CONTENTS ACRONYMS.................................................................................................................................................. ii INTRODUCTION........................................................................................................................................... 1 POLITICAL AND ECONOMIC CONTEXT ................................................................................................................ 1 POLICY PROCESS .......................................................................................................................................... 4 CHANGE TEAMS AND OTHER POLITICAL STRATEGIES ............................................................................................. 9 I. POLITICAL ECONOMY CONTEXT ............................................................................................................. 12 THE MEXICAN POLITICAL SYSTEM.................................................................................................................. 12 RESTRUCTURING THE POLITICAL SYSTEM......................................................................................................... 29 II. POLICY PROCESS.................................................................................................................................... 40 BACKGROUND ........................................................................................................................................... 40 THE HEALTH SECTOR REFORM PROGRAM (PRSS) ............................................................................................. 45 SOCIAL SECURITY REFORM ........................................................................................................................... 47 IMSS REFORM OBJECTIVES........................................................................................................................... 49 PROBLEM DEFINITION AND REFORM FORMULATION (1992-94) ............................................................................ 49 THE ECONOMIC TEAM AND THE IMSS CHANGE TEAM......................................................................................... 50 OTHER GROUPS IN THE STATE AND IN SOCIETY ................................................................................................. 55 LEGISLATION (NOVEMBER/DECEMBER 1995) ................................................................................................... 62 APPROVAL IN CONGRESS.............................................................................................................................. 63 IMPLEMENTATION (1996 – 1998) ................................................................................................................ 66 ANOTHER ATTEMPT AT HEALTH REFORM.......................................................................................................... 67 CLOSING REMARKS: KEY POLICY NODES AND ACTORS.......................................................................................... 69 III. CHANGE TEAMS AND OTHER POLITICAL STRATEGIES .......................................................................... 71 THE ECONOMIC CHANGE TEAM .................................................................................................................... 71 THE CHANGE TEAM WITHIN IMSS.................................................................................................................. 80 THE EXECUTIVE’S INTER–AGENCY HEALTH CARE GROUP .................................................................................... 81 CONCLUSIONS ........................................................................................................................................... 84 ANNEX I: POLICY TRACER .......................................................................................................................... 85 I. INTRODUCTION....................................................................................................................................... 85 II. BACKGROUND ....................................................................................................................................... 86 III. ANALYSIS OF THE HEALTH COMPONENT OF THE IMSS BY POLICY TRACERS ...................................................... 91 IV. CONCLUSTIONS .................................................................................................................................. 104 BIBLIOGRAPHY......................................................................................................................................... 106 I. POLITICAL ECONOMY CONTEXT................................................................................................................ 106 II. POLICY PROCESS.................................................................................................................................. 110 III. CHANGE TEAM AND OTHER POLITICAL STRATEGIES..................................................................................... 113 i ACRONYMS Acronym (Terms) Spanish English Translation ABM Asociación de Mexico’s Bankers Business Association Banqueros de México Association AMCB Asociación Mexicana Mexican Brokerage Business Association de Casas de Bolsa Houses Association AFORE Administradora de Pension Funds Private Fondos para el Retiro Administrator AMCB Asociación Mexicana Mexican Brokerage Business Association de Casas de Bolsa Houses Association AMDG Areas Médicas de Deconcentrated Gestión Medical Areas Desconcentrada AMIS Asociación Mexicana Mexican Association Business Association de Instituciones de of Insurance Seguros Institutions CAMCO Cámara Americana de American Chamber of Business Association Comercio Commerce CANACINTRA Cámara Nacional de la National Chamber of Business Association Industria de la Transformation Transformación Industry CANCO-MEX Cámara Nacional de Mexico City’s National Business Association Comercio de la Ciudad Commerce Chamber de México CCE Consejo Coordinador Business Coordinating Business Association Empresarial Counsel CEDESS Centro de Desarrollo Strategic Private Estratégico para la Development Center Seguridad Social for Social Security CGT Confederación General Workers’ Union General de Confederation Trabajadores CMHN Consejo Mexicano de Mexican Businessmen Business Association Hombres de Negocios Counsel CNA Consejo Nacional National Agricultural Business Association Agropecuario Counsel CNC Confederación National Peasant Peasants Union/PRI Nacional Campesina Confederation CNG Confederación National Cattle Business Association Nacional Ganadera Raising Confederation ii Enahancing the Political Feasibility of Health Reform: The Mexico Case CNOP Confederación National Public/PRI Nacional de Confederation of Organizaciones Popular Organizations Populares CNPC Confederación National Business Association Nacional de Cámaras Confederation of de Pequeño Comercio Small Commerce Chambers CNPP Confederación National Small Business Association Nacional de la Property Pequeña Propiedad Confederation CNSF Comisión Nacional de National Commission Public Seguros y Fianzas of Insurance and Bail Bonds. CONAPO Consejo Nacional de National Population Población Council CONCAMIN Confederación de Confederation of Business Association Cámaras Industriales Industrial Chambers CONCANACO Confederación de Confederation of Business Association Cámaras Nacionales National Commerce de Comercio Chambers CONSAR Comisión Nacional del National Committee Public Sistema de Ahorro for the Retirement para el retiro Savings System COPARMEX Confederación Mexican Republic Business Association Patronal de la Employers República Mexicana Confederation COR Confederación Obrera Revolutionary Labor Union Revolucionaria Confederation CROC Confederación Revolutionary Union Revolucionaria de Confederation of Obreros y Campesinos Workers and Peasants CROM Confederación Mexico’s Workers Union Revolucionaria de Revolutionary Obreros de México Confederation CROM Confederación Mexico’s Workers Union Revolucionaria de Revolutionary Obreros de México Confederation CT Congreso del Trabajo Workers Union Confederation CTM Confederación de Mexico’s Workers Union/PRI Trabajadores de Confederation México iii Acronyms CURP Código Unico de Code of Population Registro Poblacional Registration DALYS Años de Vida Daily Adjusted Life Saludable (AVISA) Years DDF Distrito Federal Federal District DIF Instituto para el System for the Desarrollo Integral de Integral Development la Familia of the Family DRGs Grupos relacionados Diagnostic-related por diagnóstico groups FAT Frente Auténtico del Authentic Labor Front Union Trabajo FDN Frente Democrático National Democratic Political Party Nacional