When social health insurance goes wrong: Lessons from Argentina and Mexico

Social health insurance (SHI) has gained popularity in recent years as a health-care funding mechanism for developing countries in Latin America and beyond. This is reflected in a number of high-profile conferences sponsored by international agencies, and a profusion of externally funded reform projects. This article assesses the potential of SHI to provide a sound model of health-care financing, drawing on the experiences of Argentina and Mexico. It uses four criteria to assess the performance of SHI: coverage, equity, effectiveness and sustainability. The article begins by outlining key principles of SHI and comparing it to other models of health-care financing. It then gives a comparative overview of four SHI programmes in Argentina and Mexico, before analysing their performance in greater detail. The article finishes by extracting lessons from this comparative analysis, both for the countries studied and for global debates on SHI.