The elusive new health model

Government López Obrador he seems determined to undertake a way out of the labyrinth in which his promise of a universal public health system is found, which grants the same access, service and quality in health care to any patient. The new model places the Mexican Institute of Social Security (IMSS) as the engine to consolidate public hospital infrastructure in the country, but from its early stages it has begun to face gaps and resistance.

The finances of the sector look exhausted not only because of the impact of the pandemic, but because of the disaster caused by three failed bets by López Obrador: the National Welfare Institute (Insabi), entrusted to his countryman Juan Antonio Ferrer, who for more than 30 years only knew how to manage archaeological zones; the agreement for UNOPS, a modest United Nations organization, to organize the purchase of medicines, and the relaunch of the government system of pharmaceutical laboratories known as Birmex, led by Pedro Zenteno, an activist from the State of Mexico who has spent months and resources in being promoted to be a candidate for the governorship of that entity.

The nightmare of the shortage of medicines and supplies that has marked the present six-year term due to the presence of monopolies and “cartels” among the main suppliers, as well as due to incompetence and discretion in the authorities, will be subjected to a new experiment by handing over control of the purchases from the Ministry of Public Administration, which conducts Robert Salcedo. This will mean a legal reform that is already being analyzed in the Chamber of Deputies.

According to reports entrusted to this space, this project will be headed by Thalía Lagunes Aragón, who would move from the powerful Mayor’s Office of the Treasury, where she was appointed in December 2019 as the replacement of Raquel Buenrostro, current holder of the SAT. The latter concentrated the entire government procurement system in the entity that Rogelio Ramírez de la O currently leads. In the case of medicines, this brought about a long crisis in supply, final prices and quality.

It is not clear whether Lagunes will act in Public Function as part of the long arm of his current boss or will be subject to the dictates of the Palace, from where they have been appointed in the Insabi countrymen and improvised who exercise budgets of billions of pesos through direct assignments and other opaque modalities.

On the front of the consolidation of a single national infrastructure that absorbs hospital networks and equipment under current state control, things are beginning to get stuck. The model assumes keeping the IMSS, which directs Zoe Robledo, in its current legal, operational and labor modality. And create an independent network under the name of IMSS Bienestar. It will be left to the next government to decide whether the two schemes merge. Palace sources assure that López Obrador proposed to Robledo to remain in the post beyond 2024 if Morena retains power, which would jeopardize his legitimate aspiration to govern his native Chiapas.

The pilot test in this strategy was offered by Nayarit, which governs the morenista Miguel Ángel Navarro, doctor by profession and former president of the Senate Health Commission. This made the transition easy, along with the modest number of existing facilities. In other states under Morena, such as Tlaxcala, with Lorena Cuéllar, union tensions have arisen. And entities with the most consolidated networks, such as Nuevo León, Guanajuato or Jalisco, exhibit ample reservations to join this model.

Our profound health crisis reminds us that things at the Palace are going slowly.

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