Abstract:

Some interpretations frequently argue that three Disability Models (DM) (Charity, Medical/Rehabilitation, and Social) correspond to historical periods in terms of chronological succession. These views permeate a priori within major official documents on the subject in Mexico. This paper intends to test whether this association is plausible by applying a timeline method. A document search was made with inclusion and exclusion criteria in databases to select representative studies with which to depict milestones in the timelines for each period. The following is demonstrated: 1) models should be considered as categories of analysis and not as historical periods, in that the prevalence of elements of the three models is present to date, and 2) the association between disability models and historical periods results in teleological interpretations of the history of disability in Mexico.

Keywords:
disability evaluation; attitude to health; Mexico

Resumen:

Se argumenta que tres modelos de discapacidad (de prescindencia, médico/rehabilitador y social) se corresponden con periodos históricos en sucesión cronológica. Esta visión a priori ha permeado dentro de los principales documentos oficiales sobre el tema en México. El presente trabajo se propone probar si esta asociación es plausible, mediante la aplicación de una metodología de línea temporal. Se diseñó una estrategia de búsqueda con criterios de inclusión y exclusión en bases de datos para seleccionar estudios representativos, con los cuales se retomaron hitos a representar en la línea temporal por cada periodo. Se muestra que los modelos deben plantearse como categorías de análisis y no como periodos históricos, dado que: 1) existe prevalencia de elementos de los tres modelos en la coyuntura actual y 2) la asociación entre modelos y periodos da lugar a interpretaciones teleológicas de la historia de la discapacidad en México.

Palabras clave:
evaluación de la discapacidad; actitud frente a la salud; México

Introduction

The care of persons with disabilities in Mexico is characterized by inequalities. A total of 23.1% of the Mexican population with disabilities >15 years of age lack access to formal education, and their participation in economic activities is 39.1%, compared with 64.7% of their counterparts without disabilities.¹1. Instituto Nacional de Estadística y Geografía. Estadísticas a propósito del día internacional de las personas con discapacidad [internet document]. INEGI México [accessed on February 2016]. Available from: http://www.inegi.org.mx/saladeprensa/aproposito/2015/discapacidad0.pdf
http://www.inegi.org.mx/saladeprensa/apr... Among indigenous population above the age of three years, the prevalence of disability is 7.1%, while in whole Mexican population, this is 6%. Furthermore, only 46.5% of the disabled population aged 3-29 years attends school, compared with 60.5% of the population without disabilities.¹1. Instituto Nacional de Estadística y Geografía. Estadísticas a propósito del día internacional de las personas con discapacidad [internet document]. INEGI México [accessed on February 2016]. Available from: http://www.inegi.org.mx/saladeprensa/aproposito/2015/discapacidad0.pdf
http://www.inegi.org.mx/saladeprensa/apr...

Inequalities are influenced by systematized preconceptions from large descriptive representations denominated disability models (DM). The DM discussed in this work include the following: 1) charity; 2) medical/rehabilitation, and 3) the social model.²2. Palacios A. El modelo social de discapacidad: orígenes, caracterización y plasmación en la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA, 2008.^,33. Palacios A, Bariffi F. La discapacidad como una cuestión de derechos humanos. Una aproximación a la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA , 2007.^,44. Velarde V. Los modelos de la discapacidad: un recorrido histórico. Revista Empresa y Humanismo 2012;XV(1):115-136.

In the charity DM, disabilities are identified with imperfections, impurities, faults, penalties, or damages that obey supernatural causes resulting from the irascibility of the gods, the expiation of sins, misfortune caused by spirits, ill omens, or sorcery.²2. Palacios A. El modelo social de discapacidad: orígenes, caracterización y plasmación en la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA, 2008. In this view, persons with disabilities are depicted as unproductive, useless, dangerous, or unnecessary to society.

Two variants of this model are recognized: 1) the eugenics submodel, with an emphasis on practices such as infanticide or forced sterilization, and 2) the marginalization submodel, which promotes the segregation, abandonment, or confinement of persons with disabilities.⁵5. Aparicio-Payá M. Trato justo con las personas con diversidad funcional. Reconocimiento e identidad, distribución, inclusión social (Tesis). España: Universidad de Murcia, 2015.

The medical/rehabilitation DM states that the etiology of disabilities is due to scientific reasons. Disability is defined as a deficiency, an alteration, a failure, or a need to be addressed: “as a ’personal’ problem caused by disease, trauma, or any other impairment of health requiring medical and rehabilitation assistance such as a individualized treatment provided by professionals”.⁶6. Lara A. Conceptos y tipologías de la discapacidad: documentos y normativas de clasificación más relevantes. In: de Lorenzo-García R (coord). Tratado sobre discapacidad. Madrid, España: Editorial Aranzadi, 2007:177-205. To the extent possible, medical intervention seeks the social inclusion of people affected by the failure, loss, or injury of an organ, a sense, or a bodily function. To achieve this, medical facilities have developed services staffed by specialists, among which are rehabilitation medicine, orthopedics, ophthalmology, neurology, neumology, and rheumatology. In this DM, persons with disabilities are considered to be useful provided that they can be standardized through their habilitation or integral rehabilitation.

The social DM assumes that the causes of disability are not religious or medical, but that they result from a society designed to meet the needs of “normal” people; thus, diversities are not taken into account. It also presupposes that all human life is equally worthwhile and valuable; therefore, persons with disabilities can contribute to society, as does the remainder of persons without disabilities, always by means of inclusion, equity, and respect. This model is related with the defense of human rights. It attaches great importance to principles such as autonomy, allowing advocacy for the removal of barriers to equal opportunities. Even the right of persons with disabilities to live outside of health care institutions (as do persons without disabilities) is promoted, through deinstitutionalization policies.²2. Palacios A. El modelo social de discapacidad: orígenes, caracterización y plasmación en la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA, 2008.

There is a mixture of medical/rehabilitation and social DM ⁷7. Secretaría de Salud. Programa de Prevención y Rehabilitación de Discapacidades PreveR-Dis. México: SSa, 2001. that is known as the integrator or biopsychosocial DM. Driven by the World Health Organization (WHO), this DM is characterized by supporting principles such as personal autonomy, while maintaining the preponderance of certain deficiencies and medical conditions. This perspective attempts to balance the interaction of contextual, environmental, or social factors with the health status of individuals.⁸8. Díaz-Velázquez E. Reflexiones epistemológicas para una sociología de la discapacidad. Intersticios: Revista Sociológica de Pensamiento Crítico 2009;3(2):85-99.^,99. Organización Mundial de la Salud. Informe mundial sobre la discapacidad. Malta: OMS, 2011.

Tacitly, some documents often argue that DM correspond to historical periods in chronological succession.²2. Palacios A. El modelo social de discapacidad: orígenes, caracterización y plasmación en la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA, 2008.^,33. Palacios A, Bariffi F. La discapacidad como una cuestión de derechos humanos. Una aproximación a la Convención Internacional sobre los Derechos de las Personas con Discapacidad. Madrid, España: Grupo Editorial CINCA , 2007. This a priori view has permeated the main official documents on this subject in Mexico. To test whether this association is correct or not, in this paper we analyzed the three main DM described, by means of periodization with timelines, depicting the major milestones in disability in the country.

Materials and methods

Study selection. We designed a search strategy focused on documents published in English and Spanish from 1980 to 2015, conducted in the following specialized databases: Medline; ScienceDirect; EBSCO; Google Scholar, and Bibliounam, seeking studies on the three DM analyzed in the Mexican official discourse on disability.

Inclusion criteria were as follows: 1) articles analyzing DM in Mexico over time; 2) official documents where these models apply to particular historical periods, and 3) federal care programs in disability. Exclusion criteria were the following: 1) fragmentary studies in which DM have no direct application to historical periods or are incomplete, and 2) studies referring other classifications or typologies of DM. By not including patients, this study does not require the evaluation of an Ethics Committee.

After a first inclusion of 169 documents, five of them were considered to be representative of DM associated with historical periods within the Mexican official discourse, and were finally analyzed: three from the Instituto Nacional de Estadística y Geografía (INEGI) ¹1. Instituto Nacional de Estadística y Geografía. Estadísticas a propósito del día internacional de las personas con discapacidad [internet document]. INEGI México [accessed on February 2016]. Available from: http://www.inegi.org.mx/saladeprensa/aproposito/2015/discapacidad0.pdf
http://www.inegi.org.mx/saladeprensa/apr... ^,1010. Instituto Nacional de Geografía y Estadística. Las personas con discapacidad en México: una visión censal. México: INEGI, 2004.^,1111. Instituto Nacional de Geografía y Estadística. Las personas con discapacidad en México: una visión al 2010. México: INEGI , 2013. and two federal programs.¹²12. Consejo Nacional para las Personas con Discapacidad. Programa Nacional para el Desarrollo de las Personas con Discapacidad 2009-2012 [internet document]. CNPD México [accessed on February 2016]. Available from: http://www.educacionespecial.sep.gob.mx/pdf/issuu/pronaddis_2009_2012.pdf
http://www.educacionespecial.sep.gob.mx/... ^,77. Secretaría de Salud. Programa de Prevención y Rehabilitación de Discapacidades PreveR-Dis. México: SSa, 2001.

Timelines. Once the documents were selected, we employed timelines to plot visual structures in the corresponding historical periods within each DM. Situating events through this proposed method, in addition to being a valuable tool for thinking,¹³13. Davis SB. History on the line: time as dimension. Design Issues 2012;28(4):4-17. https://doi.org/10.1162/DESI_a_00171
https://doi.org/10.1162/DESI_a_00171... can help locate patterns, non-numerical trends, gaps, and turning points.

Applied to the historical analysis of DM in Mexico, the resulting timelines provide the graphic representation of a chronological sequence of events,¹⁴14. Tabin HK, Shaugat AS, Ahmed R, Giunchiglia F. The history of temporal data visualization and a proposed event centric timeline visualization model. International Journal of Computer Applications 2013;70(27):27-33. https://doi.org/10.5120/12241-8497
https://doi.org/10.5120/12241-8497... ^,1515. Friendly M, Sigal M, Harnanansingh D. The Milestones Project: a database for the history of data visualization. In: Charles K, Miles K (eds). Visible Numbers: the History of Data Visualization. London, UK: Ashgate Press, 2012: 1-19. [accessed on February 2016]. Available at: http://datavis.ca/papers/Milestones-Project.pdf
http://datavis.ca/papers/Milestones-Proj... ^,1616. Rosenberg D, Anthony G. Cartographies of time: a history of the timeline. New York: Princeton Architectural Press, 2010. with an emphasis on the specific milestones outlined in each period.¹⁷17. Cansino C. Tiempo largo y tiempo corto (elementos para el estudio de la dimensión temporal en los procesos de cambio político). Revista Mexicana de Ciencias Políticas y Sociales 1996;41(164). The timelines allowed us to examine the relevance of the association of DM with historical periods, as assumed in the official discourse on disability in Mexico.

Results

The use of timelines permits a graphic representation of the relative distribution of the major DM milestones for each period analyzed, as depicted in tables I, II, and III, in which the sequence of the items is highlighted by date, but the interval was omitted for simplicity. Time is represented from top to bottom, and from the past to the present.¹³13. Davis SB. History on the line: time as dimension. Design Issues 2012;28(4):4-17. https://doi.org/10.1162/DESI_a_00171
https://doi.org/10.1162/DESI_a_00171...

Discussion

Charity period

This period is the longest, but also the most difficult to document, given the scarcity of sources. Its antecedents comprise the pre-Hispanic Era, during which certain benign attitudes toward persons with disabilities deviate from the conventional characteristics of the charity DM, as documented by leading chroniclers of that time: Diego de Landa ¹⁸18. De Landa D. Relación de las Cosas de Yucatán. 9 ed. México: Porrúa, 1966. and Juan de Torquemada.¹⁹19. De Torquemada J. Monarquía indiana de los veinte y un libros rituales y monarquía indiana, con el origen y guerras de los indios occidentales, de sus poblazones, descubrimiento, conquista, conversión y otras cosas maravillosas de la mesma tierra. 3a ed. México: Universidad Nacional Autónoma de México, Instituto de Investigaciones Históricas, 1975. There are few references on eugenic practices, although it is possible to infer negative attitudes and exclusion towards persons with diversities¹¹11. Instituto Nacional de Geografía y Estadística. Las personas con discapacidad en México: una visión al 2010. México: INEGI , 2013. and a sophisticated knowledge of the herbolary tradition.²⁰20. De la Cruz M. Libellus de medicinalibus indorum herbis. Manuscrito Azteca de 1552. México: Instituto Mexicano del Seguro Social, 1964.

The charity model exhibits a better fit within the Colonial Era, with the emergence of welfare centers comprising a constellation of hospices, houses of mercy, orphanages, nursing homes, and hospitals,²¹21. Muriel J. Hospitales de la Nueva España. Tomo I. Fundaciones del siglo XVI. México: Universidad Nacional Autónoma de México, Instituto de Investigaciones Históricas / Cruz Roja Mexicana, 1990. [accessed on March 2016]. Available at: http://www.historicas.unam.mx/publicaciones/publicadigital/libros/hospitales/HNET1029.pdf
http://www.historicas.unam.mx/publicacio... which represented the only chance of survival for the poorest individuals.²²22. Alarcón G, Acevedo E, Cabello E, Espinoza L, Reyna O. Medicina y reumatología peruanas: historia y aportes. Perú: PANLARM, 2006. The response to disability in this period is ambivalent: on the one hand, there was the discourse of compassion, applied through Christian charity, which considers that persons with diversities deserve compassion. On the other, there were exclusion and punishment practices, when disabilities were suspected to have a malefic origin, such as mental illness being attributed to witchcraft.²³23. Kraemer H, Sprenger J. El martillo de las brujas. Madrid, España: Felmar, 1976.

The first timeline is mapped from the pre-Colombian Era to a year before the enactment of the Reform Laws, as depicted in table I. However, the prominent features of this DM have prevailed until the present, such as the following: 1) a range of stereotypes that identify persons with disabilities as objects of charity and compassion;²⁴25. Amnistía Internacional. El Estado como “aparato reproductor” de violencia contra las mujeres. Violencia contra las mujeres y tortura u otros malos tratos en ámbitos de salud sexual y reproductiva en América Latina y el Caribe. Ciudad de México: AI, 2016. 2) practices of forced sterilization on girls, adolescents, and women with disabilities without their free and informed consent, and pressures to abort,²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1... ^,2525. Amnistía Internacional. El Estado como “aparato reproductor” de violencia contra las mujeres. Violencia contra las mujeres y tortura u otros malos tratos en ámbitos de salud sexual y reproductiva en América Latina y el Caribe. Ciudad de México: AI, 2016.^,2626. Rodríguez P. Abuso y negación de derechos sexuales y reproductivos a mujeres con discapacidad psicosocial en México. México: Disability Rights International y Colectivo Chuhcan, 2016. and 3) strong social exclusion, now leading back to variables such as level of disposable income, age, gender, ethnicity, rurality, migratory status, educational level, employment characteristics, and disability type.²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1...

Medical/rehabilitation period

Although it is difficult to establish the onset of this period accurately, its development is linked with the emergence of the Mexican secular state from the year 1859. Since that time, church property, including charity centers, became part of public property.²⁷27. Secretaría de Salud. Salud para el futuro de México: Centro Nacional de Rehabilitación. México2000. Later, the term “charity” is replaced by the concept ²⁸28. Presidencia de la República. Decreto que adiciona la Ley de Secretarías y Departamentos de Estado, creando el Departamento de Asistencia Social Infantil, 30 de junio de 1937. Revista de Administración Pública 1987;71-72:287-290 [accessed on February 2016]. Available from: http://www.juridicas.unam.mx/publica/librev/rev/rap/cont/71/doc/doc54.pdf
http://www.juridicas.unam.mx/publica/lib... of “public assistance”, provided to citizens by government institutions.

During this period, the religious causes of disability were left behind and a scientific etiology and medical treatments were imposed. As illustrated in table II, care for motor disabilities is stressed, deriving from a strong boost starting during the 1950s, ²⁹29. Ruiz L, Devesa I. La Medicina de Rehabilitación en la última mitad del siglo XX. In: Rivero-Serrano O, Tanimoto M, (coord.) El Ejercicio de la Medicina en la Segunda Mitad del Siglo XX (tercera parte). México: Siglo XXI, 2005. due to the need of caring for children affected by the polio epidemics at that time in the country ²⁷27. Secretaría de Salud. Salud para el futuro de México: Centro Nacional de Rehabilitación. México2000.^,3030. Ibarra LG. Estrategia para enfrentar el problema social y de salud pública creciente de la discapacidad mediante la investigación científica, la formación de recursos humanos y la atención médica de alta especialidad. Propuesta de trabajo para dirigir el Instituto Nacional de Rehabilitación Período 2010-2015. México: INR, 2010. (table II).

By emphasizing their deficits and alterations during this period, persons with disabilities were often perceived as dependent and inferior from a biological perspective; thus, they were labeled as disabled or handicapped, notwithstanding the scientific progress achieved.³¹31. Asamblea General de las Naciones Unidas. Resoluciones aprobadas por la asamblea general durante el 47° período de sesiones. [internet document]. ONU [accessed on February 2016]. Available from: http://www.un.org/es/documents/ag/res/47/list47.htm
http://www.un.org/es/documents/ag/res/47... Also, a link was established between disability and welfarism under a paternalistic concept. This perception was institutionalized through coercive policies ²⁹29. Ruiz L, Devesa I. La Medicina de Rehabilitación en la última mitad del siglo XX. In: Rivero-Serrano O, Tanimoto M, (coord.) El Ejercicio de la Medicina en la Segunda Mitad del Siglo XX (tercera parte). México: Siglo XXI, 2005. and legal practices such as substitution, where persons with severe disabilities were subject to procedures of interdiction.³²32. Suprema Corte de Justicia de la Nación. Protocolo iberoamericano de actuación judicial para mejorar el acceso a la justicia de personas con discapacidad, migrantes, niñas, niños, adolescentes, comunidades y pueblos indígenas. México: SCJN, 2014.

From this period, the following endure until the present: 1) a model of “special” education and barriers to accessibility in schools;²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1... 2) the difficulty of eradicating the practice of substitution, and 3) legislation that continues to enforce the internment of persons with intellectual and psychosocial disabilities,²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1... without respecting their free and informed consent.

Social period

Again, there is no consensus on the exact date of onset of this period, which was characterized by greater legal recognition of inclusion and acceptance of diversity and the rights of persons with disabilities, starting from the signing of international treaties and amendments to the Mexican Political Constitution ³³33. Poder Ejecutivo Federal. Decreto por el que se aprueba el diverso por el que se adicionan un segundo y tercer párrafos al artículo 1o., se reforma el artículo 2o., se deroga el párrafo primero del artículo 4o.; y se adicionan un sexto párrafo al artículo 18, y un último párrafo a la fracción tercera del artículo 115 de la Constitución Política de los Estados Unidos Mexicanos. Diario Oficial de la Federación; México 2001. Available from: http://www.internet2.scjn.gob.mx/constitucion/pdfs/00130168.pdf
http://www.internet2.scjn.gob.mx/constit... (table III).

The transition that was underway formed part of the mainstreaming of human rights in public policy, which seeks to conceptualize disability as a collective subject. Within this context, society has a responsibility of not placing or allowing barriers to exist that discriminate or impede the full enjoyment of the rights of persons with disabilities.¹²12. Consejo Nacional para las Personas con Discapacidad. Programa Nacional para el Desarrollo de las Personas con Discapacidad 2009-2012 [internet document]. CNPD México [accessed on February 2016]. Available from: http://www.educacionespecial.sep.gob.mx/pdf/issuu/pronaddis_2009_2012.pdf
http://www.educacionespecial.sep.gob.mx/...

The social model faces the following difficulties to date:²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1... 1) a legislative framework on accessibility that does not include all aspects established in the Convention on the Rights of Persons with Disabilities; 2) a lack of regulation, monitoring mechanisms, a national accessibility plan (and another for situations-of-risk and humanitarian emergencies), with an emphasis on persons with diversities; 3) the low employment rate of people with disabilities and noncompliance with the labor quota of 3% in the government; 4) lack of updated statistics on disability and information on these persons’ current situation,³⁴34. Guzmán JM, Salazar EG. Disability and rehabilitation in Mexico. Am J Phys Med Rehab 2014;93(suppl 1):S36-S38. https://doi.org/10.1097/PHM.0000000000000019
https://doi.org/10.1097/PHM.000000000000... and 5) denial of the right to vote for persons with acute intellectual and psychosocial disabilities, in addition to the lack of accessibility alternatives to voting.²⁴24. Organización de las Naciones Unidas. Comité sobre los Derechos de las Personas con Discapacidad. Observaciones finales sobre el informe inicial de México. ONU [accessed on February 2016]. Available from: http://undocs.org/sp/CRPD/C/MEX/CO/1
http://undocs.org/sp/CRPD/C/MEX/CO/1...

Conclusion

The three DM analyzed should be used only as conceptual categories. The timeline method applied shows that DM are not historical periods, nor sequential chronologies, because of the following: 1) there is a prevalence of characteristic features of each DM in the current situation, and 2) some of their features overlap, thus frontiers between periods cannot be established precisely; therefore, start and end dates are unreliable.

DM should not be employed to presuppose evolutionary historical steps, assuming that a period represents an improvement or completion over the previous one, in terms of progression. This last approach leads to teleological interpretations of the history of disability ³⁵35. Egea-García C, Sarabia-Sánchez A. Visión y modelos conceptuales de la discapacidad. Polibea 2004;73:1-20. that minimize the serious complications present up to the present day, such as discrimination and substitution practices.

The timelines depicted suggest that the care of disabilities in Mexico requires a reconfiguration to a less unequal and more inclusive system, aligned with the principles and assumptions of social DM, which require strengthening. To date, disability healthcare comprises a constellation of four fragmented and heterogeneous disability healthcare subsystems,³⁶36. Organización para la Cooperación y el Desarrollo Económico. Estudios de la OCDE sobre los Sistemas de Salud: México. París: OECD Publisher, 2016.^,3737. Consejo Nacional de Evaluación de la Política de Desarrollo Social. Propuesta de un sistema nacional de servicios de salud. Componente de salud de una propuesta de seguridad social universal. México: CEESES, HIMFG, 2012. which continue to exhibit strain due to the inherited inertia of the charity and medical/rehabilitation DM:

Private providers. While not offering inclusive comprehensive care for disabilities, these provide personalized services to the population with economic solvency through a conglomerate of 28.6 privately owned hospitals per one million individuals, compared with 11.4 publicly owned hospitals.³⁶36. Organización para la Cooperación y el Desarrollo Económico. Estudios de la OCDE sobre los Sistemas de Salud: México. París: OECD Publisher, 2016.

Social security system (SSS). Includes the Mexican Social Security Institute, for private sector employees (IMSS, by its Spanish acronym), the Social Security Institute for Public Employees (ISSSTE), the Institute of Social Security for the Armed Forces (ISSSFAM), the Ministry of Navy (Semar), Mexico’s national oil company (Petróleos Mexicanos, Pemex), and the healthcare services of the state governments (SESA).

The SSS provides full disability healthcare benefits for public and private employees (including pensioners) and their households (such as paid sick days, retirement plans, and so forth). Funded by both the Mexican Federal Government and by contributions from employees and their employers, SSS encompasses a heterogeneous array of independent healthcare institutions.

Public insurance subsector. A set of agencies financed by the Mexican Federal Government, state governments, and/or individuals. It covers non-salaried, informal workers, and unemployed and rural persons without affiliation with the SSS. Main Institutions in this group include the following: 1) Ministry of Health (through the National Institute of Rehabilitation Luis Guillermo Ibarra Ibarra, and certain rehabilitation services offered by other National Institutes of Health, High Specialty Hospitals, and programs such as “Health Caravans”); 2) National Commission of Social Protection for Health, also referred to as “Seguro Popular”. This agency protects the poorest persons with some disabilities through a restricted package of services with fewer benefits, and omits important treatments of secondary and tertiary care,³⁶36. Organización para la Cooperación y el Desarrollo Económico. Estudios de la OCDE sobre los Sistemas de Salud: México. París: OECD Publisher, 2016. not providing benefits against temporary or permanent disability; 3) “Different Community” Program and “Care Program for Persons with Disabilities” of the National System for Integral Family Development (SNDIF); 4) Special Basic Community Healthcare Programs for the Uninsured, such as the IMSS-Prospera Program and Seguro Médico Siglo XXI-IMSS, among others.

Non-profit organizations. Civil societies, civil associations and private assistance institutions (IAP) that offer rehabilitation and orthopedics.

References

Publication Dates

History