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This paper discusses the situation of healthcare in Mesoamerica before and immediately after 1519. In the first 50 years after the Conquest, the Spaniards made extensive use of Nahuatl medicine. However, the influence of this medical tradition was limited due to the rapid imposition of a very different medical system which took little advantage of, among other things, the therapeutic wealth of pre-Hispanic healing traditions., Competing Interests: Declaration of conflict of interests. The authors declare that they have no conflict of interests.

Objective: This paper focuses on public and private healthcare utilization among dependents living in Mexico of Mexican migrants in California, analyzing the link between remittances and enrollment in Seguro Popular, a social health insurance plan., Materials and Methods: We surveyed 1353 migrants who visited the Mexican consulate of Los Angeles in 2010., Results: 53.9% sent remittances; 72.2% of households receiving remittances used a share of remittances for health care and 74.4% of them were covered by Seguro Popular. The annual median with private health care expenditure was USD 825, compared to USD 293 for public providers. The main predictors remittances utilization for healthcare were having a sick dependent, purchase of prescription drugs, experiencing problems paying for health care and time of U.S. residence., Conclusions: Seguro Popular increases healthcare utilization with public providers, which provides an opportunity to reallocate the use of migrant's remittances for health purposes.

The Mexican health system requires an agency to support the legal actions that are implemented, such as legal support for the implementation of programs that must be observed by the health authorities at all levels. This organism is called General Health Council, and in this paper the role of this Council within the Ministry of Health, and its role in transforming our health system are described.

The scope of this paper was to identify the role of gender for women as workers, through the perception and discourse of health service providers at the 'Health Centers for Indigenous Women' ("Casas de Salud de las Mujeres Indígenas") in Ometepec, Guerrero and Matías Romero, Oaxaca, Mexico. It is a qualitative study, based on a secondary analysis of the interviews conducted as part of the "Rescatando la experiencia de la Casa de la Mujer Indígena: sistematización y evaluación del proceso" project. A strong sense of the value of work and a strong commitment towards the community were identified. Guilt appears as the result of tension between work outside the home and the responsibilities as mothers and wives. The possibility of helping other women is a source of gratification that dissipates these conflicts; prestige and recognition are added to the benefits of their role. The labor experience of female workers in the "Casas de Salud de las Mujeres Indígenas" of Matías Romero, Oaxaca and Ometepec, Guerrero, described in this paper, reveals that it has very specific characteristics, which are difficult to replicate in other regions of the country. In future studies it is necessary to consider the different contexts of vulnerability.

Since the forties, the National Health System has been organized based on a segmented and shortly linked model by the different service providers. This segmentation is because the population has always been the criterion that differentiates the provision among institutions. Additionally, these institutions have followed strategies conditioned by their own development and in accordance with the needs of population segments that they care (vertical system: each institution is responsible for stewardship, financing and service delivery). According to the Organization for Economic Cooperation and Development (OECD), the fragmentation of the National Health System (NHS) in various organizations that vertically integrate the functions of financing, security and provision, generates inefficiencies and inequities that affect the Federal government's efforts to achieve universal coverage, and impacting on its financial viability. One of the first challenges facing the NHS is associated with the financing; therefore, this paper aims to develop a proposal for structural change in the way of financing the system and changes in management and delivery of health services Mexico.

The repercussion of health-disease state on social life or individual includes his/her work performance. In many countries, social security is one of the options for diffusing and buffering the impact of the disease. This paper is focused on the analysis of the unjustified prescription of temporary sick leave certificates (CITT), which combines the social security medical components and economic benefits (subsidies). The objective is to analyze the mechanism of prescription of CITT from the perspective of health economics and health care services. The detailed flow of CITT at the Mexican Institute of Social Security is described, as are some concepts of the health economics perspective that contribute to explain the prescription of CITT. Statistical data of sick leaves due to work-related and non-work-related diseases are presented from the institutional perspective. Finally, it is emphasized that although CITT are a medical prescription, it is advisable to take into account the economic perspective and its concepts in order to achieve an efficient use of resources.

Biomedical and social sciences are getting closer, thus reducing the existing chasm between the social determinants of health and health policy. The determinants such as income, education, health production at home, environment, employment, dietary habits, social support networks, gender, and migration, among others, have a strong and definitive influence on the health state of the population. This paper gains an insight into the influence on the population's health covered by the Instituto Mexicano del Seguro Social (IMSS) of some of these determinants, such as demographic changes (birth rate decrease, ageing, and increase of temporary migration), economic changes (progressive incorporation of women to the labour market), and lifestyle aspects. These determinants pose economic and ethical dilemmas, among others, that IMSS must solve through its policymaking process. The concept of effective health policy is proposed. This concept includes a comprehensive health policy capable of considering social determinants and epidemiological changes within its inception, and at the same time, it is able to respond to the population's health needs. It is deduced that it is necessary for the health system to implement and evaluate plans and interventions that are structured and consistent with the population's health needs, thus contributing to reduce social inequities.

The issue of how medical specialization does not represent a novelty is discussed. The authors also approach the question of how the advantages and shortcomings of medical care provided by both general practitioners and medical specialists have been equally addressed previously by the ancient Greek classics as well as by outstanding Mexican specialists more than 50 years ago. A short review is made of the main current demographic, social, and health-related conditions of Mexico's society and of the public health system built up in the last 60 years. Some relevant data pertaining to the number of physicians and medical specialists and their distribution Mexico's 32 states are presented. The paper also includes a short argumentation of views on medical education in Mexico, and sets forth aproposal regarding the professional profile of the general practitioner and its role within Mexico's health system, as well as the need to enhance and reconsider the role played by general physicians. Authors conclude that within a comprehensive medical assistance model, both general practitioners and medical specialists are required.

Objective: To identify the factors associated with complaints of patients against physicians who work at general hospitals of the Mexican Institute of Social Security (MISS)., Material and Methods: All the medical complaint files in a three-year period at the nine general hospitals of Mexico State MISS East District were examined. For each complaint filed, two control files were selected from the same hospital and clinical area. Associations were assessed using odds ratios and logistic regression., Results: A total of 130 complaint cases and 260 controls were included. Seven out of 14 risk factors were selected: complications during hospitalization (OR 2.8, 95% CI 1.3-5.8), diagnostic error (OR 3.18, 95% CI 1.7-5.6), use of diagnostic tests (OR 3.7, 95% CI 1.2-11.3), insufficient information given by physicians (OR 2.64, 95% CI 1.22-5.7), voluntary hospital discharge (OR 7.2, 95% CI 2.22-23.6), lack of clinical monitoring during hospitalization (OR 19.12, 95% CI 2.25-162.6), and multiple vaginal revisions during labor (OR 5.17, 95% CI 1.5 17.07). Complaints were filed more often when there was a poor patient-physician relationship, deficient monitoring during labor, therapeutic error, and delay in surgery. Statistical significance was not attained., Conclusions: Complaints against Mexico State MISS hospital physicians were associated with diagnostic technical factors, as well as with the patients' perception of receiving deficient information and care during hospitalization. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

This paper reports partial findings from a broader study on the experience of people with chronic diseases. The objective was to explore the perspectives of diabetic patients towards medical care. A qualitative study was conducted in a poor neighborhood of Guadalajara, Mexico. Thirty subjects with diabetes mellitus participated in the study. Data was gathered by open and semi-open interviews in the subjects' homes and over the course of one year. Data were analyzed using a combination of content and conversational analyzing techniques. Three perspectives predominated when participants evaluated medical care: some define it as good, some as ambivalent, and the rest as bad. These perspectives were closely linked to their disease experience and available medical options according to their material resources. These perspectives change with time, are specific to each available service and type of medical care, and are constructed in terms of all the subjects' present chronic illnesses. Those treated through the social security system evaluate the care in negative terms, with the opposite occurring with those treated in public health care centers and private facilities. Implications regarding health care reform are discussed.

This paper deals with public health in Mexico City from the 16th to the 18th century. The first part is about sickness and epidemics; the origin of a very high concerned with death rate at that time; general and private hospitals foundations, and about the role of the Church, Medical Board and the Viceroy in Health Care and Preventive Medicine. Medical care was efficient in these aspects. The second part deals with public services concerning public health as a clean environment and streets and collecting garbage, problems that caused sickness according to the ideas of those days. A clear environment was good until the second half of the 18th century. The paper is divided as follows: introduction; sickness and epidemics; medical care; actions against epidemics; public services, and final commentary.

This paper discusses some of the proposals regarding the improvement of the efficiency in the delivery of health care services. Several countries have implemented different strategies based on the experience of the Health Maintenance Organizations, which have used the market to stimulate competition between providers and insurance companies. One of the proposals includes the creation of agencies that would compete in quality and in price. Another one implies the creation of a National Health Service capable of hiring public or private services from local agencies. The ideal strategy would enable a consumer to choose between insurance companies and public and private providers, and would hopefully create cost conditions reasonably correlated with the efficiency and quality of the rendered services.

Financial options for the National Health System in Mexico are discussed in this paper. In the first part the conceptual elements needed to support financing schemes are presented. The second part deals with financing models of the National Health System. Finally, a map of financing proposals are discussed with the aim of enriching the financial options of the health sector.

In this paper the role of efficiency in health care delivery is discussed. In the first part several definitions of efficiency are presented and the most common efficiency analysis are described. In the second part of the paper some experiences aimed at improving the efficiency of health care delivery in England, Latin America and Mexico are discussed. Finally, the author presents four proposals for the improvement of efficiency of health care delivery in Mexico: monetary reward associated to performance, alternative organization of health services, investment in management training for health manpower, and operational research in the health systems.

In Mexico the Constitution defines the right to health care as a social right and, as such, confers to the state the guiding role in the access of the population to health services. Unfortunately, this constitutional principle has not been fully met. One of the reasons for this is the fragmentation of public action in health and the continuous postponement of the integration of health services. In this paper the conceptual and practical limits of integration of health services are discussed, using as starting point a brief diagnosis of inequity and fragmentation of the health system in Mexico. The doctrinaire principles of integration are also described, as well as its practical advantages and disadvantages. Finally, a typology of forms of integration and previous integration experiences in Mexico are discussed. In the concluding remarks the integration prospects for Mexico are analyzed.

This paper is a product of the reflection on the decentralization and sectorization experiences in Mexico since 1917 with particular emphasis on the 1980s. The historical analysis included the creation of an analytical model designed to identify the relationship between the distinct sanitary policies implemented in Mexico and the tendencies towards decentralization and integration. This analysis is combined with a critical review of the recent decentralization experiences undertaken in the states of Guerrero, Oaxaca and Nuevo León. While comparing Guerrero and Oaxaca, restitution and deconcentration under similar socio-economic conditions were discussed. The comparison between Guerrero and Nuevo Leon allowed the discussion of the benefits and limits of restitution under different socio-economic conditions. In addition, with this model the author discusses a few generalizations regarding the possible future of decentralization.

This paper discusses the right to health in Mexico. The authors present some ideas regarding equity and data which shows the existence of a deep inequity in the field of health in the country. The efforts of the social security agencies and of the Ministry of Health aimed at diminishing inequity in health are also described. The authors conclude that it is time to avoid retorical positions and attitudes of administrative solidarity and start to implement actions to improve the health conditions of those living in extreme poverty. These actions should include providing comprehensive health services to all the population, reinforcing specific preventive programs, improving certain basic health indicators and prompting intersectoral collaboration.

In this paper the concepts and criteria related to health coverage are discussed in the context of the organization of national health systems. The main international agreements based on WHO/PAHO proposals are also described. The relationship between primary health care and health coverage is analyzed and the evolution of the programs for the extension of health coverage in Mexico are discussed, with emphasis on the problems of overlap and definition of the universe in the several institutions of the health sector. Finally, the author reviews the problems to measure coverage in order to guarantee social and operative efficiency of the Mexican health system.

This paper discusses the transition of the organized social response in health with emphasis on local health systems. After reviewing a few basic definitions (health system, local health system, health care system, institutional system of health services), the author discusses the health transition (transition of the concept health-disease, technological transition, epidemiological transition, demographic transition, health care system transition) and the importance attributed to local health systems in Mexico.