Children's Heart Fund
2004, 2006, 2007
may click the flag for further
information about Mexico
On Location -
Mexico - November 2006
Mexico is a vibrant
country of 106.2 million people (figure
1) (1). This democratic country has made significant progress
over the past 50 years. The economy continues to grow with an annual GDP of
2.7%. The Health Development Index (HDI) is a composite of adult literacy
(92.2%), average years of schooling, income level, and life expectancy (2). The
HDI of Mexico in 2006 is 81.4 (>80 is high; 50-79 is medium; and <50 is low).
The life expectancy is 73.7 years for males and 78.6 for females. The health
care budget is 6.2% of GDP (USA
is >14% of GDP). Health care coverage is uneven with approximately 40% of the
entire population receiving care from the federal social security system, local
state support, and major corporate coverage, e.g. the state owned PEMEX oil
corporation. There is little private insurance, with out of pocket payment
rounding out the financial support. The northern part of the country is better
served than the central and southern regions. The new Popular Health Insurance (Seguro
Popular) is an attempt to alleviate the imbalance in health care access and
delivery (3) over the past six years. This program has given gradual health care
protection for a variety of services to over 50 million Mexicans.
A more detailed history of the national health
system dates back to 1943 with the establishment of the Ministry of Health and
the Mexican Institute for Social Security (Instituto Mexicano del Seguro Social,
IMSS) (4). In 1959, the
Social Security and
services for Civil Servants (ISSTE) was formed to cover public – sector workers
and their families. These two systems covered public and private employed
workers, with the uninsured sector being able to access state and federal health
– service facilities, but paying a user fee, especially for supplies (e.g.
open-heart disposables; valves, grafts, etc – amounting to about $2,000-2,500
per patient). As of 2000, the IMSS accounted for 40% of the population, the
ISSTE an additional 7%, and private insurance 3-4%. This was the basis for
establishment of the Seguro Popular. The horizontal component or coverage is
designed to provide coverage for the uninsured (roughly 12 million families by
2010, at an average of 1.7 million families/year). Vertical coverage is designed
to cover explicit intervention priorities. This means coverage of high-priority
health conditions, like AIDS, childhood cancers, cervical cancer, and cataract
surgery. Cardiac surgery is not one of the initial high priority conditions.
Against this background, Cardiac surgery has
grown slowly, but progressively over the past 15 years (figure
2 ). Few Mexican cardiothoracic surgeons have received formal training
USA in either accredited
residency programs, or non-accredited one or two year fellowship programs. There
has been little interaction between
USA CT surgeons, centers,
NGO’s or foundations with
Mexican CT surgery programs.
At present there are four formal CT surgery residency programs in
Mexico. The program is
eight years duration following medical school, with 4 years general surgery and
4 years CT surgery. There is a formal board and credentialing process.
Approximately 15 residents / year are trained. There is one major society – the
Mexican Society of Cardiac Surgery – which meets annually. There is no formal CT
surgery dedicated journal. At the present time there are at least 41 identified
centers performing cardiac surgery. There are less than
200 Mexican CT surgeons, with
fewer than 100 doing the majority of cases. Approximately 7,000 cases are done
annually with an approximate one third coronary, one third valve and one third
congenital cases. Coronary artery disease continues to rise with increased urban
lifestyle and diet changes (figure
3 ). The largest centers include the social security hospitals in
Mexico City, and
Guadalajara. The National Center of
Mexico City is a major center both
in caseload, training, and research.
In 2004, a short trip was made to
Mexico City, and
Monterrey. A tour of the
Mexico City was conducted. An
interview was conducted with Dr. Rodolfo Barragan Garcia (email@example.com)
who gave a very candid overview of cardiac surgery in
Mexico. His major concern
was the imbalance in the number of cardiac surgery centers with resultant poor
access for the major part of the population. In
Monterrey, over 60% of the
population had coverage from the Social Security System, whereas 10-20% are
indigent and have no financial help.
A subsequent recent visit to
Monterrey was taken in November,
2006. The primary purpose was to update the given statistics and spend two weeks
working with Dr Felipe Rendon (drfrendon@yahoo,com.mx)
and his CT surgery staff at the
4 ). This is the only Mexican medical school with an associated
university hospital. They serve primarily the indigent, uninsured patient
population. Less than 200 open heart operations are done there per year. The
Social Security hospital (IHSS) in
Monterrey is the largest center in
Mexico, with over 1,200
open heart procedures performed per year (figure
6 ). The Chief of pediatric cardiac surgery Dr. Humberto
6 ) has established a voluntary humanitarian program in Chiapas, in
cooperation with ADANEC, a non-profit organization devoted to developing and
assisting cardiac surgery in underserved areas of Mexico. Contact Rosa Alicia
Ramirez de Zepeda (firstname.lastname@example.org)
for more details re. this voluntary project.
There are a few notable examples of
USA cooperation with
J. Mark Morales (Jmarkmorales@aol.com),
a pediatric cardiac surgeon from
Texas has developed a voluntary humanitarian
Monterrey. With assistance from Dr.
Carlos Xavier Lopez Uribe (email@example.com)
, a pediatric cardiac surgeon from the Social Security center in
Monterrey, they have performed over
170 cardiac surgery operations on poor children from that area. Another example
is the cooperative effort at Texas Heart Institute. Dr. Charles Frazer, a
pediatric cardiac surgeon, has hosted surgeons, and cardiac surgery team members
from the Monterrey Social Security hospital to come to
Houston for short periods of
The Rotary Gift of Life program from
MA, coordinated by Barry Friedman (firstname.lastname@example.org)
,has been active in recent years in bringing selected complex children to Boston
Children’s Hospital for complex pediatric cardiac surgery.
There is certainly a desire and willingness on
the part of the Mexican cardiac surgery community to develop and foster
co-operative projects with their
USA counterparts. For more
detailed information and contacts, please contact A.
Thomas Pezzella MD , e-mail (email@example.com).
1. The World Fact Book. Prepared by C.I.A.
Barnes and Noble, New York 2006; p. 395-398.
2. The Economist-Pocket World in Figures
– 2007; p. 178-179.
3. Frenk, J. Bridging the Divide: global
lessons from evidence based health policy in
Mexico. Lancet 2006; 368:
4. Frenk, J., Gonzalez-Pier, E., Gomez-Dantes,
O, Lezana, MA., Knaul, FM. Health System Reform in
Mexico – Comprehensive reform
to improve health system performance in
2006; 368: 1524-34.