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To accomplish these endeavours, the SSPH, which is a non-contributory social health insurance programme, includes access to ambulatory and hospital healthcare in public institutions and provision of no-cost prescribed medications at the point of care.This represents actual financial protection, particularly for low-income groups.3 SSPH was launched in 2002.
Furthermore, DAPPs challenge current regulations and norms for doctors’ offices and private pharmacies.The policies to improve access to medicines and safe prescriptions face multiple challenges such as the conflict of interest and may have unanticipated results.Until recently, in Japan and the USA,8 Korea9 and China10 11 among other countries,12 medical doctors and pharmacists were allowed to prescribe and dispense medicines.The private sector provides care for the uninsured population and for up to 31% of those insured who choose to use this system for ambulatory care.Reaching universal coverage is expected to improve access and protect the population from the financial burden of healthcare.The availability of medicines is a key determinant of access to and utilisation of health services.
In Mexico, most medications are being paid for with private resources (mostly out-of-pocket) despite the important public investment in healthcare.
In some countries, this strategy decreased the irrational use of medicines,13 although in other countries it provoked the practice that health providers hired onsite pharmacists.14 As the provider paid a salary to the pharmacists, the provider's incentives and irrational prescription patterns remained unchanged.
In Mexico, the expansion of DAPPs indicates that prescribing and dispensing of medicines is related instead of being separated as the international experience suggests.
By 2011, the programme reached 52.6 million affiliates, and the benefit package increased from 91 to 284 interventions.
This package covers the treatment of ∼95% of the causes of visits in primary care clinics and admissions to general hospitals.4 During the same period, the proportion of patients reporting complete provision of medications at the Mo H facilities increased from 55% to 62%, whereas in the SS the increase was from 70% to 87%.4 Despite the progress, Mexican policies on access to healthcare and, in particular, to medications still stand at a crossroad and deserve careful analysis.
The public sector covers an estimated 78.6% of Mexico’s population (∼112 million).