Mexique

OECD countries are increasingly attempting to achieve savings through their public procurement systems, in particular in healthcare. In 2012, the State’s Employees’ Social Security and Social Services Institute in Mexico (ISSSTE) asked the OECD to review the effectiveness and integrity of its procurement system and to address bid-rigging. Many of the OECD’s recommendations led to enduring reforms at ISSSTE. In 2015 the OECD conducted a new review focusing on planning and coordination of procurement activities, market research and improvement of medical services. This report presents the findings of the review and notes the ISSSTE’s recent achievements. It also makes recommendations to support the alignment of the ISSSTE’s procurement practices with the 2015 OECD Recommendation of the Council on Public Procurement and includes action plans for priority activities.

Ten years after the introduction of publically-funded universal health insurance, the Mexican health system finds itself at a critical juncture. Unquestionably, some measures of health and health system performance have improved: those previously uninsured now use health services more often, whilst numbers reporting impoverishing health expenditure having fallen from 3.3% to 0.8%. Other indicators, however, remain worrying. Rates of survival after heart attack or stroke are markedly worse than in other OECD countries. Prevention is a particular concern: with 32% of the adult population obese, Mexico ranks as the second most obese nation in the OECD and almost 1 in 6 adults are diabetic. Other key metrics imply deep-rooted inefficiencies in the system: administrative costs, at 8.9% of total health spending, are the highest in the OECD and have not reduced over the past decade. Likewise, out-of-pocket spending has stuck at nearly 50% of total health spending - the highest in the OECD - and implies that individuals feel the need to visit private clinic despite having health insurance. In short, Mexico’s massive public investment in its health system has failed to translate into better health and health system performance to the extent wished and a programme of continued, extensive reform is needed. This report sets out the OECD’s recommendations on the steps Mexico should take to achieve this.

Building on the 2008 OECD Principles for Enhancing Integrity in Public Procurement and good practices of similar organisations in other OECD countries, this review provides a comprehensive assessment of IMSS procurement strategies, systems and processes and proposes a roadmap for the reform of its procurement function.