Getting to universal health coverage

Julio Frenk is dean of the Faculty at the Harvard School of Public Health and T & G Angelopoulos Professor of Public Health and International Development, a joint appointment with the Harvard Kennedy School of Government.

What does it take to develop a successful universal health coverage program in a state or a country?

When I became Mexico’s minister of health in 2000, my single most important goal—the thing I quickly became most passionate about—was expanding health insurance coverage to all of our citizens. At that point, half of the country’s 100 million inhabitants were uninsured. Of course, I knew this was ambitious—very ambitious—but it never occurred to me that it was impossible. I just got to work.

And then, through the indiscretion of someone, an email from a very high ranking person in the Ministry of Health wound up in my hands. It said, in essence, “The minister has lost his marbles. How does he think it is possible to insure 50 million people?”

This was a competent civil servant, and I didn’t want to fire him—even if I he did think I was losing my mind. Instead, I called him to my office and I said: “Look, it’s come to my attention that you’ve been questioning my sanity, so let me tell you why I’m not crazy.”

I’m proud to say that the universal coverage program we instituted, known as Seguro Popular, is firmly ensconced in Mexico—and it does indeed now cover 58 million previously uninsured people, my colleague’s doubts notwithstanding.