Health services decentralization in Mexico: formulation, implementation and results of policy

Abstract

This article provides a critique of decentralization of health care systems in underdeveloped countries, taking the Mexican case as an example. The formulation, implementation and interruption of integrative decentralization in the 1980s is analysed in the context of the interests served in Mexico by administrative centralization and institutional fragmentation. The short-term results of decentralization upon state-level politics, finance, planning and health service distribution and equity are analysed in their relationship to bureaucratic and political interests. Initially the most underdeveloped region of the country was selected for a special comparative study of the effects of decentralization upon health service planning and equity. One state of this region became decentralized, while the other underwent only minor changes. It was therefore possible to compare the specific effects of administrative changes in the two states. Decentralization was interrupted at the national level, with only 14 states actually undergoing administrative change. The policy was also short of its devolutionary intentions, actually becoming an attempt towards recentralizing power around a different administrative structure. Regional disparities in the distribution of health services were accentuated due to the privileges furthered by decentralization in the richer municipalities, and the fall in services in the poorer ones related to interinstitutional conflicts at the central level