Reproduction of social inequality: access to health services in Mexico City

Abstract

Statistics of disease and mortality rates in Mexico paint a familiar picture: a high birth rate coincides with a rapidly falling death rate giving a high rate of population increase; the most prevalent diseases are ones which are caused by poor living conditions and poverty. Yet the orientation of health care policies is still largely curative: the primary health care approach which would be the most suitable for tackling the health problems of Mexico receives lip service but little concrete support. The coverage with basic health care facilities is better in Mexico City than elsewhere in the country but there are considerable inequalities within the urban areas. This shows up clearly when the location of health service facilities is considered. Although all those living in the irregular settlements in the poorer areas of Mexico City are eligible for care either by 1 of the social security institutes or by the state a high proportion elected to pay for private care. The evidence suggests that this is due not to a dissatisfaction with the quality of the public health care but rather to the inconvenience and cost of attending public health facilities many of which are located far away from the poorer irregular settlements. For minor ailments requiring inexpensive treatment many would rather pay for private treatment. The richer areas of the city in contrast are well served with public health care facilities. (authors)