The World Health Organisation (2019) outlines that universal healthcare enables people to “have access to the health services they need (prevention, promotion, treatment, rehabilitation and palliative care) without the risk of financial hardship when paying for them.” The benefits of universal healthcare go beyond the maintenance or improvement of population health; the World Health Organisation recognises that, because of its affordability and effectiveness, there are also social and economic benefits that, especially in developing and third-world countries, could be crucial foundations for significant progress in society.
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The World Health Organisation (2019) identifies five factors pivotal to the successful implementation of universal healthcare in a country/community: an efficient, well-run health system requires the placement of person-centred care at the forefront of treatment and the satisfaction of all health needs at all phases of healthcare; affordability of treatment through a financing system that prevents placing an economic burden on patients and their families. availability to “essential medicines and technologies” vital for effective treatment of patients; a sufficient workforce of trained, motivated workers to provide service tailored to the needs of the patient; “[actions] to address social determinants of health”, which can lead to the prevention of health problems and, hence, better functioning of society and health workplaces by decreasing the number of people needing health treatment.
Australia’s health system aims to practice affordable treatment for all populations through Medicare, which has been critical in the catering of healthcare for populations whose circumstances mean that the reception of healthcare could place a financial burden on them (Australian Government Department of Human Services, 2019). Medicare covers a range of essential healthcare treatments, such as visits to general practitioners and specialists, tests and scans and surgical or general procedures. Through this, Medicare ensures that the burden placed on populations susceptible to health problems or financial hardship is reduced and that all Australians have adequate access to their personal healthcare needs. However, dental, ambulance and some doctor services, all of which could be essential to the treatment of an option, are have no or limited coverage by Medicare (Australian Government Department of Human Services, 2019). Hence, there is still the risk of placing an economic burden on populations whose social circumstances make them vulnerable to health problems as they may have to pay the full cost for expensive dental, ambulance or doctor services essential for the treatment of a patient.
There have been efforts made by the Mexican government and other organisations in the successful employment of universal healthcare, particularly through the addressing of social determinants affecting population health and access to services. The biggest exponent of Mexico’s employment of universal healthcare is the Seguro Popular scheme. This scheme addressed a problem concerning lack of health insurance coverage for a significant Mexican population, who had to pay largely out-of-pocket for essential healthcare because the only main source of health insurance came through employers (World Bank Group, 2015). For the poorer population, this created a significant risk of placing a financial burden on them. It has since been reported in 2012 that 72.3% of the poor population that did not have health insurance has benefitted from the introduction of Seguro Popular (World Bank Group, 2015).
However, Mexico faces challenges in the implementation of universal healthcare. One factor is wealth inequality and the significant amount of investment needed to provide healthcare for Mexico’s substantial poverty-stricken population. As of 2016, 58.2% and 39.2% of the rural and urban Mexican population, respectively, were reported to be in some form of poverty, and despite a 9.7% and 1.5% decrease in extreme poverty in rural and urban populations since 2010, only a 4.3% and -0.3% in decrease in those classified as being in some form of poverty in rural and urban populations respectively was reported. (Consejo Nacional de Evaluación de la Política de Desarrollo Social, 2016).
Alongside Seguro Popular, an initiative designed to aid the Mexican population in poverty is Prospera. By giving money to families as an incentive to send their children to school and health treatments, the Prospera program is encouraging and enabling families to invest money into nutritious food and housing amenities (World Bank Group, 2014). Through this, Mexican children in poorer families, are placed in a prime situation to be able to get their families out of poverty in the future. The World Bank Group (2014) reported that Prospera has had a positive impact on education, nutrition and, hence, health prevention: children are spending eight to ten months more in schools and poverty has been reduced in rural areas. Prospera has also expanded into alleviating the pathway to vocational training and formal employment (World Bank Group, 2014). This would further assist in eliminating poverty in families as it would allow children to have a set pathway to employment and financial security.
Alongside wealth inequality, obesity, which has risen in the last few decades to now affect nearly 30% of Mexicans, is also a major issue contributing to numerous preventable incidences of chronic illnesses and deaths and, thus, healthcare expenditure (DiBonaventura et al., 2017). It was reported that 276.9 deaths per 100,000 resulted from non-communicable diseases, a figure that has slightly decreased in the last 27 years, (Institute for Health Metrics and Evaluation, 2019).
Turnbull, Gordon, Martínez-Andrade & González-Unzaga (2019) highlight a number of social determinants and factors that have influenced behaviours such as increased sedentary behaviour, reduced physical activity and an unhealthy diet that has contributed to a growing obese population: unsafe environments, particularly in low-income areas, due to crime and underdevelopment, increased consumption and advancements in social media and video games, abundance of unhealthy foods and the idea of giving desirable food, usually unhealthy, as an expression of love. Whilst technological advancements would be a difficult barrier to overcome to increase physical activity levels as they are pivotal to the development of Mexican society, convincing parents not to feed their children unhealthy food, whilst it might conflict with personal values, can be overcome with the right education.
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The Mexican government has only tried to rectify one of these determinants, unhealthy diet choices, through the introduction of a sugar tax on added-sugar beverages. The World Health Organisation (2018) reported a decrease in the purchase of added-sugar beverages, particularly amongst the poorer population, in Mexico after the application of a “1 peso per litre” tax.
The Australian Institute of Health and Welfare (2017) devised a health performance framework that can evaluate the current state of Australia’s health system to improve healthcare and ensure that it is inclusive and sustainable. One dimension within this framework is health status, and, with a focus on health conditions and deaths, it can be used in the analysis of Australia’s and Mexico’s practice of universal healthcare.
The current state of health conditions in Australia and Mexico reflect both the effectiveness of universal healthcare practice in both countries and the factors affecting these. Data from the Institute for Health Metrics and Evaluation (2019) reveal a stark difference in the prevalence of “15 neglected tropical diseases”, with an estimate of 0.02% and 16.3% in Australia and Mexico (16.2% decrease since 1990) respectively. The Institute for Health Metrics and Evaluation (2019) also revealed that Australia outperforms Mexico in essential universal health coverage (95.2% to 63.6%) and vaccines coverage (95.4% to 84.2%), thus it is apparent that whilst it has improved as evidenced by the 16.2% decrease, Mexico’s universal healthcare coverage is insufficient in rural populations, and hence essential treatments that enable the prevention of neglected tropical diseases are unavailable to Mexicans in rural areas. International Diabetes Federation (2019, 2019) data on the diabetes prevalence in the adult population show that 14.8% of Mexicans are affected by the health condition, compared to 6.5% of Australians. Whilst not all cases of diabetes are related to being overweight, both countries’ health systems could improve in the prevention of diabetes through the conception of solutions to tackle the problem of a substantial amount of people becoming overweight.
The causes of deaths in Australia and Mexico are an indication of the strengths and weaknesses of each country’s universal healthcare. According to data from the Institute for Health Metrics and Evaluation (2019), both countries perform poorly in self-harm deaths, which arises from a non-communicable disease, and it is more prevalent in Australia (10.8 per 100000) than Mexico (5.8 per 10000). This suggests that mental health problems are a major issue in both countries and, because Mexico’s only significant form of universal healthcare is Seguro Popular and Australia’s universal healthcare is geared towards equity and the prevention, and treatment of, biomedical risk factors and chronic conditions, both countries could improve in addressing mental health and investigating the factors leading to mental health illnesses to reduce the incidence of suicide (World Bank Group, 2015; Australian Government Department of Health, 2019). Data on cardiovascular-related non-communicable deaths from the Institute for Health Metrics and Evaluation (2019) show that, despite underperforming in overweight children aged two to four and a 9.6% increase in that statistic, Australia performs effectively in non-communicable deaths, with 190.8 deaths per 100000 compared to Mexico’s 276.9 deaths per 100000. Considering the statistics for diabetes for both populations, this demonstrates the effectiveness of universal healthcare, with the offered services and targets set by the Australia Government Department of Health (2019), which include Medicare and its Medicare Benefits Schedule and Pharmaceutical Benefits Scheme, and Mexico’s Seguro Popular scheme having a positive effect on health problems such as cardiovascular-related non-communicable diseases.
- Australian Government Department of Health. (2019). The Australian health system. Retrieved from https://www.health.gov.au/about-us/the-australian-health-system
- Australian Government Department of Human Services. (2019). What’s covered by Medicare – Health care and Medicine. Retrieved from https://www.humanservices.gov.au/individuals/subjects/whats-covered-medicare/health-care-and-medicare
- Australian Government Department of Human Services. (2019). Who’s covered by Medicare. Retrieved from https://www.humanservices.gov.au/individuals/subjects/whos-covered-medicare
- Consejo Nacional de Evaluación de la Política de Desarrollo Social. (2016). Rural poverty in Mexico: prevalence and challenges. Retrieved from https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2019/03/RURAL-POVERTY-IN-MEXICO.-CONEVAL.-Expert-Meeting.-15022019.pdf
- DiBonaventura, M., Meincke, H., Le Lay, A., Fournier, J., Bakker, E., & Ehrenreich, A. (2017). Obesity in Mexico: prevalence, comorbidities, associations with patient outcomes, and treatment experiences. Diabetes, Metabolic Syndrome And Obesity: Targets And Therapy, 11, 1-10. doi: 10.2147/dmso.s129247
- International Diabetes Federation. (2019). IDF North America and Caribbean members. Retrieved from https://www.idf.org/our-network/regions-members/north-america-and-caribbean/members/66-mexico.html
- International Diabetes Federation. (2019). IDF Western Pacific members. Retrieved from https://www.idf.org/our-network/regions-members/western-pacific/members/99-australia.html
- Institute for Health Metrics and Evaluation. (2019). Health-related SDGs | IHME Viz Hub. Retrieved from https://vizhub.healthdata.org/sdg/
- Turnbull, B., Gordon, S., Martínez-Andrade, G. and González-Unzaga, M. (2019). Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic. Health Psychology Open, 1, 6(1), p.205510291984940.
- World Bank Group. (2014). A Model from Mexico for the World. Retrieved from https://www.worldbank.org/en/news/feature/2014/11/19/un-modelo-de-mexico-para-el-mundo
- World Bank Group. (2015). Seguro Popular: Health Coverage For All in Mexico. Retrieved from https://www.worldbank.org/en/results/2015/02/26/health-coverage-for-all-in-mexico
- World Health Organisation. (2018). Taking Action on Childhood Obesity. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/274792/WHO-NMH-PND-ECHO-18.1-eng.pdf
- World Health Organisation. (2019). Questions and Answers on Universal Health Coverage. Retrieved from http://www.who.int/healthsystems/topics/financing/uhc_qa/en/
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