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The Lancet, Volume 380, Issue 9842, Page 622, 18 August 2012

as reported by A I Fumagalli

Earlier this year, Mexico reached a truly immense landmark in its pioneering journey of health reform: achieving universal health coverage (UHC) for its 100 million citizens. This remarkable feat has been realised in less than a decade, and is detailed in a Lancet Health Policy paper published online on Aug 16—an update on The Lancet’s 2006 Series on Mexico’s early experiences of health reform.
Central to Mexico’s progress is an ideological shift: health insurance is no longer seen as an employment benefit, but a right of citizenship. The outcome? 52 million previously uninsured Mexicans now have state-protected health cover via the public insurance system and instrument of Mexico’s health reform, Seguro Popular.
It would be naive to assume that achieving UHC is the final destination in Mexico’s journey of health reform. Despite many crucial new changes in the way Mexico organises its health services—such as the investment in disease prevention through public health programmes (the ban on tobacco use in public places being a good example), and encouraging signs of access to the latest drugs in clinical medicine (such as the availability of trastuzumab for breast cancer treatment)—large challenges lie ahead. The threat of a rise in the burden of non-communicable diseases looms large.
There are also important lessons for other low-income and middle-income countries who share Mexico’s quest for UHC, notably the positioning of health reform within a legal framework to secure protection from future political interference. And, crucially, Mexico has showed how UHC, as well as being ethically the right thing to do, is the smart thing to do. Health reform, done properly, boosts economic development.
UHC in other regions will be explored further in a themed issue of The Lancet on Sept 8. And let us not forget Mexico’s northern neighbour, where President Barack Obama is seeking to drive through the most radical reforms in the history of US health care. But for now, let us celebrate success, and hope for a sustained Mexican wave of UHC worldwide.

Perugia and Montessori : The “Centro Internazionale Montessori ” of Perugia is a wonderful piece that integrated the activities of academic institutions (universities Italian and foreign) providing that special something to the city educational system. Google yesterday delighted us with a doodle dedicated to the great pedagogue, lucky that someone remembers.

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The new laws in force next September, cuts funding for illegal immigrants free medical care in Spain. Health professionals in Spain are registering as conscientious objectors in protest against a new law that requires them to deny treatment to immigrants.

Seems that immigrants according to the upcaming reforms if without residency cards will be refused treatment at public hospitals and health centres.

The new law is part of an austerity package introduced by Prime Minister Mariano Rajoy’s conservative government to reduce public spending to meet deficit targets imposed by Brussels.

An outpatients service for immigrants in Perugia reccommended by ​Catholic doctors (amci) and Caritas. To pursue the matter at the conference in honor of Vittorio Trancanelli, 23 June, came to Perugia, Riccardo Poli, medical director at Prato, founder of the medical center for immigrants in Florence known as “the clinic of the Stenone”, the whose clinic several years ago was named after the doctor Vittorio Trancanelli Perugia, a sign of understanding and closeness between Florence and Perugia mentioned by Professor Fausto Santeusanio. “I could not come, Poli said, remembering his long friendship with the Archbishop. Gualtiero Bassetti when he was still in Florence, and that this clinic for immigrants know the story well. Even for this Mgr. Bassetti convincingly supports the initiative which it wishes to be a work “sign” in addition to those already implemented by Caritas. The intervention by Riccardo Poli was like a journey through the past twenty years. A relatively short time in which there have been radical changes in the legislation on immigrants. Poli recalled the beginning of the surgery of Stenone, when Msgr. Bassetti was vicar general of the diocese of Florence. It was the early 90’s, there was the Martelli Law and no medical care was granted to immigrants. Many doctors began to provision by a voluntary service and a lay association was founded, although very close to Christianity, to accommodate medical or non-believers of other faiths. The wives of doctors’ office, the drugs were applied to the pharmaceutical and private laboratories every week for years have given free samples for analysis. The experience of Florence was born after that of Rome had been active since 1981. In 1997 things changed, reminded Poli, with health care reform desired by the Minister Bindi, who wanted the same Poli consultant to the Ministry. We had to change mentalities Poli said recalling for example the work of mediation with the Ministry of the Interior that raises the problem of “traceability” of foreigners without papers. It was not easy, but in law went through the line of those who supported the obligation “not to report” illegal immigrants to the police except in cases provided for the Italians themselves. So, after the State ensured health care for immigrants, the doctors decided to focus on the Stenone dentistry, general medicine and pediatric surgery, or offering a specialist service on the one hand and the other a general assumption for those who may not have the “family doctor”. Contrary to what is feared, said Poli, immigrants do not suffer and do not carry exotic diseases, but more often they get sick of smoking, and stress that is leading to reactive depression, creating the phenomenon of “migrant exhausted.” “I think today to make medicine for the immigrant is easier,” concluded Poli, because, he added, “makes no sense to think of a specialist, but should focus on general pediatric medicine and dentistry because illegal immigrants can not get the medical family or in programs of prevention “. The key, he added, is to have a relationship with the local health authorities, a Memorandum of Understanding that allows to have the recipe and the cup.

Daniela Monni, director of Caritas dicoesana, recalled that in Perugia had been opened many years ago, a clinic for immigrants who then was closed and not reopened because there was no need. “Remember Trancanelli Vittorio – he added – means remembering a way of being, a way” to doctors “who provide the other with their lives.” What and how to act today, on the face of health care to immigrants, are the themes on which the AMCI and Caritas are now considering.

…Affluent Arabs used to head to hospitals in the US when they needed treatment. But now, post-Iraq, they are increasingly choosing Germany’s private clinics. With the average foreign patient spending an estimated €80,000 a stay, competition to attract the medical tourists is fierce…. by Monocle 2008…

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