Preamble
One of the first actions in this administration was the disappearance of Seguro Popular to create INSABI in its place. More than 3 years later, the balance has been painful: millions of Mexicans were left defenseless without access to health services, at a time as critical as the pandemic.
On April 1 there was a change of direction, a new stage of implementation of the IMSS-Well-being program began, which aims to provide medical services to Mexicans without social security. At COPARMEX we analyze this change and its implications to find out if this will really fulfill an aspiration that we all have: Achieving universal health services, so that all Mexicans have access to health.
Where are we
According to CONEVAL figures, in 2018 there were 20.1 million people who did not have access to health services, that figure for 2020 increased to 35.7 million Mexicans. Therefore, there is an enormous pending task to ensure that we all have medical attention and medicines.
First INSABI and now IMSS-Well-being have presented themselves as alternatives to Seguro Popular, which demonstrated achievements in coverage of the population, of diseases that cause catastrophic expenses and in the reduction of communicable diseases, although there have also been cases of diversion of resources and inconsistencies that were reported by the Superior Audit Office of the Federation.
Although it is considered of vital importance to try to achieve universal coverage of health services, we have to observe the development and impact of the implementation of this model, since there are still many doubts about the advisability of the change and the functions that by law should carry out the Institute of Health for Well-being (INSABI).
Background and operation of the IMSS Welfare
The IMSS-Wellness is not a new program. It was created in 1979 under the name of IMSS-Coplamar to bring IMSS services to the population not protected by social security systems throughout the country, much of this population living in extreme poverty and deep marginalization.
Currently, IMSS-Wellness operates in 19 entities in the country, providing health services to 11.6 million people, free first and second level medical services.
Its medical network is made up of 3,622 Rural Medical Units, 45 rural obstetric care centers, 140 Mobile Medical Units, and 184 health brigades at the first level of care; and 80 rural hospitals in the second level where the specialties of Pediatrics, Obstetrics-Gynecology, Internal Medicine and General Surgery are covered.
The renewed IMSS-Wellness program seeks to reach 13 entities in 2022: Baja California Sur, Campeche, Colima, CDMX, Durango, Michoacán, Nayarit, Oaxaca, Sonora, Sinaloa, Tlaxcala, Veracruz and Zacatecas. Three of them (Nayarit, Colima and Tlaxcala) have already signed the agreement for the federalization of their health services.
The authorities have announced that the IMSS-Wellness Program will operate with the Comprehensive Health Care Model (MAIS) that is made up of the following aspects:
1. Infrastructure. Modernize, rehabilitate and equip hospitals starting with first level care and later second level care.
2. Have health personnel. The contracting scheme and all those actions to transfer personnel to the IMSS-Well-being will be designed.
3. Supply of medicines and healing material. There will be supply levels and filled prescriptions in each medical care unit.
4. Staff regularization. The working conditions of more than 87,000 workers hired due to the pandemic will be improved, respecting seniority and job performance.
Elements that affect the viability of the proposal
However, several doubts arise about this initiative:
The proposal is announced without a legal structure or a clear guide that determines the path of implementation. This translates into a high risk of improvisation (which happened with INSABI).
It has not been clarified what will happen to third level care, since it has been stated that the new scheme is focused on the first and second level, with a focus on prevention. Apparently, highly specialized care is not being included.
It is unclear if the budget granted to IMSS-Bienestar is sufficient to operate the infrastructure and cover the payment of workers in each incorporated entity.
It is a commitment to the centralization of health, and has generated division. Some entities have announced that they will not join: Aguascalientes, Chihuahua, Guanajuato, Jalisco, Nuevo León and Tamaulipas.
COPARMEX Approach
We welcome the recent announcement by the President of the Republic that starting in May, progress in strengthening the public health system will be reported weekly to enforce Article 4 of the Constitution, which enshrines the right of all Mexicans to the protection of Health. To pay for this effort is that we propose 5 guiding axes for the creation of a health system that aspires to the universalization of services:
1. Patient at the Center (Quality of care): there is a false dilemma between covering more people and serving them better. Health is not an expense but an investment and the highest coverage with the highest quality of services should be privileged. This implies well-paid health professionals, supply of medicines and innovative medical devices, but above all indicators.
2. Results indicators: It is necessary to have realistic and transparent indicators, both qualitative and quantitative, to measure whether the services are improving in quality and coverage. Technical indicators, not political ones, to strengthen what works and correct what doesn’t.
3. Financial viability: One aspect that seems to us that is not contemplated in the initiative is the need to provide sufficient resources to the IMSS. Additional and sufficient resources should be contemplated to alleviate the lack of financing and the cuts that the sector has had.
4. Prevention and Health Promotion: This should be the bet. The more effective we are in these two tasks, the better health results we will have.
5. Specialized care: one of the great challenges facing the system is referencing, that is, resolving patient follow-up; adherence to treatments, rehabilitation, referral of patients between second and third level.
our call
At Coparmex we want a health system that works effectively and that meets its goal of achieving universal coverage. But we also want to contribute our “grain of sand” to have a healthy population. Proof of this is that in the most critical moments of the pandemic and to speed up vaccination, we offered the government support from the companies of 1,102 doctors, 312 facilities, 127 distribution centers and 2 million points of sale where information could be provided to the citizens.
It is time to put an end once and for all to the crisis in the health sector. Let’s banish deficiencies, delays, lack of quality, improvisation, corruption, and all those evils that today are an obstacle to walking towards a new system.
At COPARMEX we promote the Inclusive Development Model (MDI) whose principle is that each one contributes what corresponds to him and each one assumes his responsibility in the construction of a healthy, productive, fair, equitable Mexico of which we feel proud. Through the MDI we express our will to the authorities to join and propose solutions so that no one is left without care or medication. Teaming up is possible.