Recommendations

The implementation of the law will require a progression of actions that address several key challenges. First, the normative and conceptual basis for México’s palliative care system needs to be finalized. The law and regulation decide many big picture legal and conceptual questions but do not offer a specific model for the delivery of palliative care and leave a number of legal questions unresolved. Secondly, the healthcare system itself needs to be prepared to support and deliver palliative care services. This means that palliative care needs to be incorporated into insurance packages and financing structures and integrated into educational programs for healthcare workers. Finally, México will need to build the delivery system for palliative care by setting up services, training existing healthcare workers and creating referral systems.

As noted above, the Mexican government has taken a number of encouraging steps to integrate palliative care into the country’s health system. We welcome its commitment to ensure people with life-limiting illnesses do not have to face unnecessary suffering. To help make palliative care available to all people in México who need it, we believe the following steps are essential:

Finalize Legal Base and Interpretation of the Law

The palliative care chapter in the health law leaves the interpretation of key provisions and guidance on implementation to the discretion of the health ministry. According to the law, the ministry was mandated to provide the official implementation norm by mid-2009 but has yet to do so. The ministry is currently finalizing the norm, which is expected to be published in October 2014. Among others, the norm should create a clear legal and conceptual basis to facilitate palliative care for adults and children in the home and by primary care providers.

The law currently does not cover palliative care for people with a prognosis of more than six months of survival. Yet, under international law these people have a right to palliative care if they meet clinical criteria for it. The government should reform the law to ensure these patients have access to adequate palliative care regardless of diagnosis or prognosis.

Develop Models of Care

The government needs to decide what model(s) of care should be used in public healthcare institutions in México. In particular, it needs to determine:

• the role of primary care givers in the provision of palliative care;
• how home-based palliative care will be provided;
• what referral mechanisms should be put in place;
• how palliative care should be covered through health insurance policies; and
• what models of palliative care are most effective to meet the needs of children with life-limiting illnesses.

Adapt Healthcare System to Deliver Palliative Care

Based on the normative basis and models of care chosen, the government should take steps to prepare the health system to start delivering palliative care. Among key steps required are:

• adapt medicines lists to include all essential palliative care medicines;
• include palliative care interventions in insurance packages;
• implement the new system for prescribing opioid medications;
• include palliative care, including for children, in undergraduate training curricula for students of medicine, nursing, psychology, social work, and pharmacy.

Building the Delivery System

Finally, the government should ensure that the delivery system for palliative care is developed. To facilitate that process, it should:

• allocate funds to allow hospitals and clinics to set up palliative care services, referral systems, and train staff;
• specify requirements and timeframes hospitals and clinics must meet in rolling out palliative care.
• put in place a strong accountability system to monitor the development of palliative care by different parts of the system and allow for appropriate adjustments or other remedial action when requirements and timeframes are not met.