En los ultimos anos, Mexico ha registrado avances importantes en materia de salud. La esperanza de vida ha aumentado, la mortalidad infantil ha disminuido y, gracias a la implementacion del programa Seguro Popular, la cobertura de los servicios de salud se ha ampliado considerablemente. Sin embargo, el ritmo de estos avances ha sido mas lento que en otros paises de la OCDE. Por ello el pais sigue estando por debajo del promedio de la OCDE en un gran numero de indicadores clave de desempeno, como la esperanza de vida, el gasto en salud, la mortalidad por enfermedades cardiovasculares y la incidencia de la obesidad.

Mexico has made significant progress on health in recent years. Life expectancy is up, infant mortality is down and, thanks to the introduction of the programme Seguro Popular, health care coverage has risen dramatically. Yet, progress has been slower in Mexico than in other OECD countries. For this reason, Mexico still remains well below OECD averages on a number of key performance indicators, including life expectancy, health spending, cardiovascular mortality and obesity. Low health care spending and high outof- pocket costs lead to inequalities in access to quality services and have impeded progress. The fragmentation of the health system also must be addressed in order to harmonise performance across sub-systems and states, and enhance its overall level. Obesity is a significant and growing public health problem in Mexico, resulting in high rates of diabetes and cardiovascular death. In order to deliver on the objectives set out for equality of care in the 2012 Pact for Mexico, significant reforms are necessary, including raising health spending in low-spending areas and on prevention, ensuring greater equality of care through a more harmonised system and expanded services, particularly in rural areas.

Several low-and middle-income countries are interested in extending their existing health insurance for specific groups to eventually cover their entire populations. For those countries interested in such an extension, it is important to understand the factors that affect the transition from incomplete to universal coverage. This paper analyses the experience of eight countries in the implementation of social health insurance. It highlights the importance of the socioeconomic and political context, particularly in relation to the level of income, structure of the economy, distribution of the population, ability to administer and level of solidarity within the country, but also stresses the important stewardship role government can play in facilitating the transition to universal coverage via social health insurance.