List of countries with universal health care - Wikipedia
North America:: Mexico Print. Page last updated on December 31, The World Factbook Country/Location Flag Modal ×. North America:: Mexico Print. The views expressed in documents by named authors are solely the It is generally agreed that, all things being equal, the health of a population will determinants in particular, namely the performance of health care providers and, more is some form of contractual relationship because some form of agreement has. In addition, the chapter discusses the responsibility of the health care system to recognize Medicare provides coverage to percent of the population, whereas .. a lack of mechanisms for follow-up, issues related to managed care contracting, . Mexican-American adults and children are more likely to have untreated.
NEGLECTED CARE The committee is concerned that the specific types of care that are important for population health—clinical preventive services, mental health care, treatment for substance abuse, and oral health care—are less available because of the current organization and financing of health care services. Many forms of publicly or privately purchased health insurance provide limited coverage, and sometimes no coverage, for these services.
Clinical Preventive Services The evidence that insurance makes a difference in health outcomes is well documented for preventive, screening, and chronic disease care IOM, b.
Such services include immunizations and screening tests, as well as counseling aimed at changing the personal health behaviors of patients long before clinical disease develops. The importance of counseling and behavioral interventions is evident, given the influence on health of factors such as tobacco, alcohol, and illicit drug use; unsafe sexual behavior; and lack of exercise and poor diets. These risk behaviors are estimated to account for more than half of all premature deaths; smoking alone contributes to one out of five deaths McGinnis and Foege, Coverage of clinical preventive services has increased steadily over the past decade.
Inabout three-quarters of adults with employment-based health insurance had a benefit package that included adult physical examinations. Two years later, the proportion had risen to 90 percent Rice et al. The type of health plan is the most important predictor of coverage RWJF, The use of financial incentives and data-driven performance measurement strategies to improve physicians' delivery of services such as immunizations IOM, c may account for the fact that managed care plans tend to offer the most comprehensive coverage of clinical preventive services and traditional indemnity plans tend to offer the least comprehensive coverage.
Although the trend toward inclusion of clinical preventive services is positive, such benefits are still limited in scope and are not well correlated with evidence regarding the effectiveness of individual services.
Public Health Service, has endorsed a core set of clinical preventive services for asymptomatic individuals with no known risk factors.
In the committee's view, this guidance to clinicians on the services that should be offered to specific patients should also inform the design of insurance plans for coverage of age-appropriate services. However, the USPSTF recommendations have had relatively little influence on the design of insurance benefits, and recommended counseling and screening services are often not covered and, consequently, not used Partnership for Prevention, see Box 5—3.
As might be expected, though, adults without health insurance are the least likely to receive recommended preventive and screening services or to receive them at the recommended frequencies Ayanian et al.
Counseling to address serious health risks—tobacco use, physical inactivity, risky drinking, poor nutrition—is least likely to be covered by an employer-sponsored more Having any health insurance, even without coverage for any preventive services, increases the probability that an individual will receive appropriate preventive care Hayward et al. Studies of the use of preventive services by Hispanics and African Americans find that health insurance is strongly associated with the increased receipt of preventive services Solis et al.
However, the higher rates of uninsurance among racial and ethnic minorities contribute significantly to their reduced overall likelihood of receiving clinical preventive services and to their poorer clinical outcomes Haas and Adler, For example, African Americans and members of other minority groups who are diagnosed with cancer are more likely to be diagnosed at advanced stages of disease than are whites Farley and Flannery, ; Mandelblatt et al.
Medicare Coverage of Preventive Services Preventive services are important for older adults, for whom they can reduce premature morbidity and mortality, help preserve function, and enhance quality of life. Unfortunately, the Medicare program was not designed with a focus on prevention, and the process for adding preventive services to the Medicare benefit package is complex and difficult.
Unlike forms of treatment that are incorporated into the payment system on a relatively routine basis as they come into general use, preventive services are subject to a greater degree of scrutiny and a demand for a higher level of effectiveness, and there is no routine process for making such assessments.
Box 5—4 lists the preventive services currently covered by Medicare. For individuals with Medicare, the following services are covered by Medicare Part B: Bone mass measurements for people at risk of losing bone mass The level of use of preventive services among older adults has been relatively low CDC, This may reflect the limited range of benefits covered by Medicare, as well as other barriers such as copayments, participants' unfamiliarity with the services, or the failure of physicians to recommend them.
Cardiovascular disease and diabetes exemplify the problem. Although cardiovascular disease is the leading cause of death and diabetes is one of the most significant chronic diseases affecting Medicare beneficiaries, physicians cannot screen for lipids disorders or diabetes unless the patient agrees to pay out-of-pocket for the tests. Medicaid Coverage of Preventive Services Medicaid benefits vary by state in terms of both the individuals who are eligible for coverage and the actual services for which coverage is provided.
The exception is preventive services for children. Inthe U. This entitled poor children to a comprehensive package of preventive health care and medically necessary diagnostic and treatment services. Given its potential to reach such a high proportion of the nation's neediest children, the program could have a very positive, widespread impact on children's health. Unfortunately, data on the program's progress are incomplete and inconsistent across the country, despite federal requirements for state reports GAO, a.
However, some studies have demonstrated that EPSDT has never been fully implemented, and the percentage of children receiving preventive care through it remains low for reasons ranging from systemic state or local deficiencies e. Additionally, data show that as many as 50 percent of children who have an EPSDT visit are identified as requiring medical attention, but if they are referred for follow-up care, only one-third to two-thirds go for their referral visit Rosenbach and Gavin, Children's Preventive Health Care under Medicaid.
Number of eligible children. Mental Health Care The Surgeon General's report on mental illness DHHS, estimates that more than one in five adults are affected by mental disorders in any given year see Box 5—6 and 5. Data for children are less reliable, but the overall prevalence of mental disorders is also estimated to be about 20 percent DHHS, Mental disorders are a major public health issue because they affect such a large proportion of the population, have implications for other health problems, and impose high costs, both financial and emotional, on affected individuals and their families.
About 40 million people more than one in five ages 18 to 64 are estimated to have a single mental disorder of any severity or both a mental and an addictive disorder in a given year Regier et al. For the most prevalent mental health disorders such as depression and anxiety, receipt of appropriate care is associated with improved functional outcomes at 2 years Sturm et al. Access to care is constrained by limitations on insurance coverage that are greater than those imposed for other diseases.
Annual and lifetime coverage limits are frequently less, and mental health coverage often has more hidden costs in the forms of copayments and higher deductibles Zuvekas et al. Table 5—2 shows the distribution of sources of payment for treatment for mental health and addictive disorders in Additionally, those with no insurance all year paid nearly 60 percent of costs out-of-pocket, whereas those with some private insurance paid 40 percent of costs out-of-pocket in Zuvekas, Adults' use of mental health services in both the general and the specialty mental health sectors correlates highly with health insurance coverage Cooper-Patrick et al.
Recent studies have shown impressive results for treatment of depression in primary care settings Sturm and Wells, ; Schoenbaum et al. The provision of such services is cost-effective and comparable to the cost-effectiveness of other common procedures.
However, reimbursement policies for primary care do not support the services necessary to provide evidence-based care for depression Wells et al. Adults with either no insurance coverage or coverage that excludes or limits extended treatment of mental illness receive less appropriate care and may experience delays in receiving services until they gain public insurance Rabinowitz et al.
Adults with mental disorders are also more likely to lose health insurance coverage within a year following their diagnosis than those without a mental disorder Sturm and Wells, The limited and unstable nature of insurance for treatment of mental illness has several implications for governmental public health agencies because the severely mentally ill are likely to end up receiving care in publicly funded safety-net programs Rabinowitz et al.
Funding to support the public mental health system comes from reimbursements for services provided to Medicare and Medicaid participants, from federal block grants to states, and from state and local funds that support community-based programs and hospital care. Taken in the aggregate, these funding streams are neither adequate nor reliable enough to meet the needs of individuals with serious mental disorders IOM, a. As with other forms of safety-net care, the urgency of providing treatment to the severely mentally ill erodes funds available for prevention purposes.
Substance abuse, like mental illness, exacts enormous social costs across all segments of society. Most recipients 87 percent of specialty treatment for alcohol or drug abuse receive it in outpatient settings RWJF,but overall, less than one-fourth of those who need treatment get it.
Barriers to treatment include stigma, lack of available treatment facilities, unwillingness to admit that treatment is needed, and inability to pay for care. Public sources provide more than two-thirds of the funding for alcohol and drug treatment facilities. Half of such funds come from dedicated funding at the federal, state, and local levels in the form of various block grants to state safety-net programs. Medicaid and Medicare cover 21 percent of treatment, private insurance covers 14 percent, and 10 percent is paid directly by patients as out-of-pocket costs.
Another 5 percent is covered through various charitable sources. Insurance policies held by many individuals constrain the use of substance abuse services by the exclusion of benefits for such services and by the use of annual and lifetime limits on benefits and other controls on service utilization.
Between andprivate insurance for substance abuse services fell 0. Over the same period, out-of-pocket payments for specific types of substance abuse treatment increased Coffey et al. However, the high out-of-pocket costs faced by individuals who pay for their own treatment discourage many who need care from seeking it. Oral Health Care Like mental illness and addiction disorders, oral health has been neglected in the health care delivery system. The consequences in terms of individual and population health are significant—oral health is a matter of public health concern because it affects a large proportion of the population and is linked with overall health status see Box 5—7.
Oral diseases are causally related to a range of significant health problems and chronic diseases, as well as individuals' ability to succeed in school, work, and the community DHHS, b.
The effects of oral diseases are cumulative and influence aspects of life as fundamental as the foods people can eat, their ability to communicate effectively, and their social acceptability.
The problems in the way the health care delivery system relates to oral health include lack of dental coverage and low coverage payments, the separation of medicine and dentistry in training and practice, and the high proportion of the population that lacks any dental insurance.
The committee focused on the problem of insurance and access to care. When people think about the components of good health, they often forget about the importance of good oral health. This oversight is often reflected by health insurance coverage restrictions that exclude oral more According to the Department of Health and Human Services DHHS Office of Health Promotion and Disease Prevention, more than million Americans have limited or no dental insurance, nearly four times the number who lack insurance for medical care cited by Allukian, As with other types of health services, insurance is a strong predictor of access to and use of dental services, and minorities and low-income populations are much less likely to have dental insurance or to receive dental care.
Individuals and families living below the poverty level experience more dental decay than higher-income groups, and their cavities are less likely to be treated GAO, More than a third of poor children ages 2 to 9 have one or more primary teeth with untreated decay, compared with Mexican-American adults and children are more likely to have untreated decayed teeth than any other population group.
Poor Mexican-American children ages 2 to 9 have the highest proportion of untreated decayed teeth The pattern for adults is similar DHHS, b: Medicare excludes coverage of routine dental care, and many state Medicaid programs do not provide dental coverage for eligible children or adults.
According to a report of the Surgeon General, fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period DHHS, b. Low-income Hispanic children and adults are less likely to be eligible for Medicaid than other groups, so even the limited Medicaid benefits are unlikely to be available to them. The forecast for major oral health problems among the nation's fastest-growing population group, Hispanics, is especially alarming.
The committee found that preventive, oral health, mental health, and substance abuse treatment services must be considered part of the comprehensive spectrum of care necessary to help assure maximum health. Therefore, the committee recommends that all public and privately funded insurance plans include age-appropriate preventive services as recommended by the U.
Preventive Services Task Force and provide evidence-based coverage of oral health, mental health, and substance abuse treatment services. As noted, it is often the responsibility of state departments of health to monitor providers and levy sanctions when quality problems are identified.
This adds to potential tensions with the public health system. Two particular quality problems have special significance in terms of assuring the health of the population: As the American population grows both older and more racially and ethnically diverse and as rates of chronic disease increase, important vulnerabilities in the health care delivery system are compromising individual and population health Murray and Lopez, ; Hetzel and Smith, Evidence shows that racial and ethnic minorities do not receive the same quality of care afforded white Americans.
These findings are consistent across a range of illnesses and health care services and remain even after adjustment for socioeconomic differences and other factors that are related to access to health care IOM, b. Furthermore, poor-quality health care is an important independent variable contributing to lower health status for minorities IOM, b. For example, racial differences in cervical cancer deaths have increased over time, despite the greater use of screening tests by minority women Mitchell and McCormack, The lower quality of care also compounds the adverse health effects of other disadvantages faced by minorities, including lower incomes and education, less healthy living environments, and a greater likelihood of being uninsured.
As discussed in Unequal Treatment IOM, bthe factors that may produce disparities in health care include the role of bias, discrimination, and stereotyping at the individual provider and patientinstitution, and health system levels.
The report found that aspects of the health care system—its organization, financing, and availability of services—may have adverse effects specifically for racial and ethnic minorities. For example, time pressures on physicians hamper their ability to accurately assess presenting symptoms, especially when cultural or language barriers are present. Nearly 14 million people in the United States are not proficient in English. Changes in the financing and delivery of health care services, such as the emphasis on cost controls and the almost complete conversion to managed care for the delivery of services under Medicaid, may be especially problematic for racial and ethnic minorities.
The disruption of traditional community-based care and the displacement of providers who are familiar with the language, culture, and values of ethnic communities create barriers to effective care Leigh et al. Such plans are characterized by higher per capita resource constraints and stricter limits on covered services Phillips et al. Fragmentation of health plans along socioeconomic lines engenders different clinical cultures, with different practice norms Bloche, The committee encourages the health care system and policy makers in the public and private sectors to give careful consideration to the interventions that are identified in Unequal Treatment IOM, b and aimed at eliminating racial and ethnic disparities in health care see Box 5—8.
Avoid fragmentation of health plans along socioeconomic lines. Strengthen the stability of patient—provider relationships in publicly funded more Care for Chronic Conditions Americans now live longer. A child born today can expect to live more than 75 years, and advances in medicine have also extended the life spans of earlier generations. As detailed in Chapter 1the result is that individuals over age 65 constitute an increasingly large proportion of the U.
Embedded in these demographic changes is a dramatic increase in the prevalence of chronic conditions. Chronic conditions, defined as illnesses that last longer than 3 months and that are not self-limiting, affect nearly half of the U. An estimated million Americans have one or more chronic conditions, and that number is estimated to reach million by Pew Environmental Health Commission, Nearly half of those with a chronic illness have more than one such condition IOM, a.
Additionally, disabling chronic conditions affect all age groups, but about two-thirds are found in individuals over age With the projected growth in the number of people over age 65 increasing from 13 percent of the population to 20 percent, the need for care for chronic conditions will also continue to grow.
Wagner and colleagues identified five elements required to improve outcomes for chronically ill patients: Reorganization of practices to meet the needs of patients who require more time, a broad array of resources, and closer follow-up. Systematic attention to patients' need for information and behavioral change. Ready access to necessary clinical expertise. The mission of the U.
Strategic actions addressing the healthcare issues of the region can be found at the BHC Initiatives section of its website. Arizona, California, New Mexico, and Texas all have state offices working to solve border health problems at the state level. Please see the How can I find specific information about border health in my state? One example of the BIDS programs' work is a capacity building project for surveillance and diagnostic testing of coccidioidomycosis Valley Fever in the four-state region of Arizona and New Mexico in the U.
Special binational tuberculosis TB projects, which include continued treatment in Mexico, notification of cases, and related activities, occur in many places along the border.
For additional information about these projects see: Establishing Binational Border Surveillance. What are the living conditions like for border populations and how do those conditions impact their health? Typically rural border populations live in settlements called colonias.
Although they may be thriving communities where the members support each other, colonias often exhibit substandard living conditions. Prior to the s, in Texas where most colonias are located, landowners could sell land — usually land that was not tillable and often located on a flood plain — to low-income individuals and families seeking affordable housing. These lands were typically sold on a contract for deed without any infrastructure improvements such as potable water and wastewater systems.
Often these properties did not have electricity, and there were no building codes in place to prevent the rapid expansion of substandard housing. In Arizona, California, and New Mexico, the colonias are much older.
In New Mexico, colonias date back to the s. In Arizona and California, they developed in the first half of the twentieth century. These colonias evolved from old mining towns and in retirement communities where infrastructure and services were in place. The Mexican Constitution of It stipulated that those wishing colonization contracts should make arrangements with the legislatures of individual states and not the federal government.
In the case of Texas, an empresario would have to negotiate with Saltillo, the capital of Coahuila since Texas was merged with that state. Government officials in Coahuila would thus define the course of immigration by determining whether those receiving contracts would be Anglos, Europeans, or Mexicans.
The National Colonization Law of resulted from a Federalist political philosophy advanced by some of Mexico's post-independence statesmen who envisioned establishing a republic patterned after the United States.
This republican document called for a constitutional arrangement by which the national government would grant powers to the states. The document resembled the United States Constitution in several ways, but also borrowed tenets from the Spanish Constitution of Map of the conjoined state of Coahuila and Texas with major land grants shown in color. Portrait of Green DeWitt. The legislature attempted to bring about the peopling of Coahuila and Texasencourage the tilling of the soil and the growth of ranches, and facilitate commerce.
It stated that Americans could settle in the state, though Mexicans were to have first choice of lands; that for a nominal payment a settler could receive as much as a league or sitio After accepting these terms and settling in Texas, immigrants earned the standing of naturalized Mexicans. The legislative provision addressing slavery was too ambiguous, and so the secretary of state at Saltillo declared that "What is not prohibited is to be understood as permitted.
In compensation, the government would award these contracting parties five sitios and five labores for each families brought and settled. Among the most prominent of these colonizers were Stephen F. Austin and Green DeWitt. By the mids Mexico began reconsidering its lenient immigration policy. Officials expressed consternation that some Americans squatted on lands without any formality and that most did not make a serious commitment to conform to the laws and traditions of their adopted land.
The Americans, who were settled in the eastern part of the province, violated colonization statutes when convenient and imposed their own practices on local affairs.
Though the episode was short-lived, as even fellow empresarios denounced Edwards, the Mexican government came to fear that continued immigration might well produce secessionist sentiments among Anglo-Texans. The Law of April 6, In response to the troubles in Texas, the Centralists in Mexico City, who ousted the Federalists in late and espoused a strong central government patterned after the monarchist Spain of old, implemented the Law of April 6, The law voided those empresario contracts still not in compliance.
It further curtailed immigration from the United States, although officials did permit continued settlement in the colonies of Austin and DeWitt because these two empresarios were ruled to have settled the required families; in actuality, however, both had yet to fulfill their contracts.
Military bases were to be established as a means of policing illegal immigration. Slaves, the law stipulated, were not to be imported from the United States, though blacks already in Texas would remain slaves. Among those inveighing against the Law of April 6 were Anglos, political leaders in Coahuila, and Tejano oligarchs who thought that inexpensive settlement from the United States portended the wealth of Texas. Federalists in Coahuila and Texas had welcomed Anglos as a way of providing security from Indians, developing the cotton lands of Texas, and establishing prosperity through commerce.
With more and more foreigners seeking to convert their land acquisitions into farmsteads, entrepreneurs in Texas and Coahuila foresaw the realization of their ambitious plan to develop the region.
MEXICAN TEXAS | The Handbook of Texas Online| Texas State Historical Association (TSHA)
As commercial activity grew, they envisaged for themselves an economic network extending into Louisiana, Coahuila, and the far north of Mexico. But Anglo immigrants could be attracted only if they were permitted to use the Gulf ports, exempted from taxes, and offered other inducements. Coahuila's colonizing program of had offered such incentives.
The establishment of slavery would also attract immigrants. Since the mids, the three groups opposed to the Law of April 6 mentioned above had lobbied for the recognition of human bondage. They had succeeded in when the legislature, noting the scarcity of field laborers in the state of Coahuila and Texas, decreed that slaves could be brought to Texas under indenture contracts; in Texas, they would work to pay the slaveowner for their freedom. Thus was Mexico's own form of economic bondage-debt peonage-utilized to rationalize the existence of slavery.
This move revealed the president's humanitarianism, but might also have been designed to control the flow of immigration from the United States. Political leaders in Texas and Coahuila remonstrated, however, and Guerrero excluded Texas from slave manumission by a decree on December 2, Subsequently, inthe Law of April 6 presented a more formidable obstacle.
Among those upset with the anti-immigration policy outlined in the Law of April 6 were Anglo-Americans who attacked the military post at Anahuac in the summer of Their pretext was the arrest for sedition of the lawyer William Barret Travis by the Anahuac commander Col.
On June 13,the attackers issued the Turtle Bayou Resolutionswherein they explained the attack as an expression of dissatisfaction with Bradburn, not the government in the interior. But Anglo volunteers and Mexican troops skirmished again at the battle of Velasco on June As ofhowever, the "War party"-as the radicals came to be labeled-lacked popular support; in fact many Anglo-Texan colonists branded them as adventurers.
Image courtesy of the San Jacinto Museum of History. The Federalist government then revoked the article in the Law of April 6,that curtailed immigration from the United States, and the Anglo-American influx resumed.
Now turned Centralist, Santa Anna abrogated the Constitution of and called for a new congress composed of officials faithful to Centralist doctrine. In October the new congress disbanded legislatures and converted the states into departments governed by appointees of the president. In effect, it established a Centralist state.
The rise of the Centralists incited uprisings in such states as Zacatecas, though these were not independence movements. In Coahuila, meanwhile, the Federalists rejected Centralist orders, and in the spring of the legislature promulgated a law authorizing the governor to dispose of up to leagues of land in order to raise the needed funds to meet the danger confronting federalism.
Another decree permitted the distribution of leagues to finance militia units to deal with threats from unfriendly Indian tribes. The Mexican commander in Bexar now feared that the Anglo-Texans would assemble an army against the government, and he called upon Santa Anna for reinforcements.
With reports spreading to Texas that Mexico had ordered troops into the north, a force of militant Texans under the leadership of William B. Travis headed for Anahuac on June 30,and captured the site to protect Texas from a Mexican military incursion.
To Mexico, the attack on the military post was an indication of a rebellion, and the refusal of Texans to surrender the Anahuac ringleaders confirmed suspicions of widespread defiance. The initial conflict between Anglo-Americans and Mexican authorities occurred in the battle of Gonzales in October This victory gave them new sources of military supplies and inhibited the Mexican military from using the Gulf to resupply the army.
Talk of Centralist forces coming to Texas, reversing the economic development of the province, and imposing repression brought the war and peace parties together. Towards the latter part of October, Texas volunteer soldiers laid siege to San Antonio, then defended by Gen. On December 10, after putting up a stiff defense in the streets and buildings of the beleaguered town, the Mexican commander surrendered.
The Texans made Cos and his army promise to withdraw into Mexico and not resist the Constitution of The Texas Declaration of Independence, signed November 7, But they also founded a provisional government and elected a general council -a parliament consisting of representatives from the different settlements. Then, in FebruarySanta Anna crossed the Rio Grande at the head of several thousand troops to suppress the insurrection.
On the first day of March, the general council reconvened, this time at Washington-on-the-Brazos, to draft a constitution and establish a new government separate from Coahuila under the Constitution of After some deliberation, however, on March 2 the delegates declared independence from the mother country.