Mutual exclusivity across programmes can also lead to inefficiencies in the production of health care (for example low use of capacities in health facilities and suboptimal allocation of care, duplication of facilities). This is particularly the case in China where the thousands of county/municipal-level programmes within each province increase the overall cost of health protection, generate significant regional inequalities, and raise equity issues for migrants as workers cannot claim health benefits outside the region where they contributed. In Mexico, there are at least five contributory programmes and Seguro Popular, and spending on administration represents more than 11% of total health expenditure, the highest level in the OECD (Joumard and Andre, 2010). Chile, in the mid-1980s, actually merged the social security institution and the national health system into the current public health programme (FONASA).