The Mexican health care system classifies its beneficiaries into three major groups in accordance with a person’s employment status and ability to pay; within these groups, access to care is divided between several institutions as follows:^{54, 55}

• by law, workers in the formal economy have to be affiliated with some social security institution (this sector represented around 50 million of the population in 2000)
• the Ministry of Health’s services (SSA) exist for the uninsured population (around 48 million people in 2000). These services exist in rural and urban areas throughout the country. In rural areas, there is also the IMSS-Solidarity Program that cares for around 14 million people
• people with the ability to pay can access a variety of private sector health care services according to the fee they can afford. Private health services are significantly diverse in terms of their quality and organization

Total health expenditure in Mexico represented 6.1 % of its GDP in 2001. This compares with other countries in Central America and the Caribbean, such as 8% in El Salvador (the highest percentage); 7.8% in Nicaragua; 7.2 % in Cuba; 7.0 % in Panama; a similar 6.1% in Honduras and the Dominican Republic and 4.8% in Guatemala (the lowest percentage) (Table 4).

 Table 4: Total health expenditure as a percentage of GDP: countries of Central America and the Caribbean for 2001

Country	Total health expenditure as % of GDP (2001)
Central America
Guatemala	4.8
Belize	5.2
Honduras	6.1
Mexico	6.1
Panama	7.0
Costa Rica	7.2
Nicaragua	7.8
El Salvador	8
The Caribbean
Haiti	5.0
Bahamas	5.7
Dominican Republic	6.1
Jamaica	6.8
Cuba	7.2

Source: Source: WHO statistics 2000-2002

Table 5 shows the principal sources for public and private health expenditure in the country.

Table 5: Selected national health account indicators⁵⁶ (2001 estimates)

	Value
Indicator
Per capita GDP in international dollars, 2001	8,903
Total health expenditure
Total expenditure on health as % of GDP, 2001	6.1
Public health expenditure
General Government expenditure on health as % of total expenditure on health, 2001	44.3
Per capita government expenditure on health in international dollars, 2001	241
Sources of public health expenditure
Social security expenditure on health as % of general government expenditure on health, 2001	66.5
Private health expenditure
Private expenditure on health as % of total expenditure on health, 2001 graph	55.7
Sources of private health expenditure
Prepaid plans as % of private expenditure on health, 2001	4.9
Out-of-pocket expenditure on health as % of private expenditure on health, 2001	92.40

Source: WHO statistics 2000-2002

In 2001, total health expenditure per capita in Mexico was Intl $544 as compared with $1.220 in the Bahamas which is the highest for the region, and Intl $ 56 in Haiti, which is the lowest figure for Central America and the Caribbean (Table 6)

 Table 6: Total health expenditure per capita (Intl $) in countries of Central America and the Caribbean, 2001

Country	Total health expenditure per capita (Intl $, 2001)
Central America
Honduras	153
Nicaragua	158
Guatemala	199
Belize	272
El Salvador	376
Panama	458
Mexico	544
Costa Rica	562
The Caribbean
Haiti	56
Cuba	229
Jamaica	253
Dominican Republic	353
Bahamas	1.220

 Human health resources are unevenly distributed both amongst health services and institutions and throughout the country. Physician/inhabitant and nurse/inhabitant ratios also vary considerably among regions. Rural and indigenous areas showed the least favourable indexes.

Graph 3 shows that there are more physicians than nurses in Mexico, as in most Central American and Caribbean countries.⁵⁷ Only in Cuba, Bahamas, Belize and Nicaragua are the ratios reversed. In Haiti, on the other hand, there seems to be a similar number of physicians and nurses. These figures illustrate the diversity in health resources available in the region.

Graph 3. Rate of physicians and nurses per 100,000 population per year in countries of Central American and the Caribbean. Source: The World Health Report 2003, WHO statistics 2002-2003