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Doña Remedios and her daughter at the pharmacy of the National Cancer Institute in Mexico City, Mexico on September 1, 2014 to fill a prescription for morphine. They have to travel for several hours to procure the medication because there are no hospitals with palliative care in Hidalgo, their home state.  © 2014 Ed Kashi for Human Rights Watch

Ensuring good health care at the start of life is a longstanding goal for the global community, and major funding backs efforts to reduce maternal and child deaths. By contrast, health care at the end of life – a need almost as universal as care during pregnancy, child birth, and infancy – has long been neglected. A new report in the medical journal Lancet calls on countries to include such care under the universal health insurance provided by governments. Mexico is one of few low- and middle-income countries that has already taken steps to do so, working to ensure no one suffers needlessly as their life comes to a close.

In 2003, Mexico reformed its healthcare system to provide insurance for millions of its uninsured citizens. Through this new health insurance, Seguro Popular, the government began subsidizing medical assistance people needed to stay healthy, ranging from prenatal care to vaccination, to treatment of diabetes and some forms of cancer – all for Mexicans who previously had to pay for such care out of their own pockets.

By 2016, more than 57 million people had enrolled in Seguro Popular.

However, as Human Rights Watch found in 2014, Seguro Popular initially did not cover medical care at the end of life. Those enrolled were entitled to preventive care and treatment focused on cures, but once a disease became incurable the coverage ended. Seguro Popular covered hundreds of medicines – but not key medications for pain and shortness of breath, both common and distressing symptoms of incurable illness. Hospitals had little incentive to provide palliative care, which focuses on pain relief and quality of life for patients, as they could not get reimbursed. This contributed to the poor availability of such health services.

As part of a broader effort to improve palliative care, however, the government took steps to address this. In 2014, it added several key palliative care medications to the list of medicines covered by insurance. A year later, it added palliative care to the list of services enrollees are entitled to.

To be sure, much work remains to be done. Many hospitals still do not offer end-of-life care, forcing patients to travel long distances at a time when they are least able to do so, and most healthcare workers are still not trained in palliative care. But any journey starts with a few small steps. Other countries should follow Mexico’s example. 

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