The proposal for Federal Income Law 2023 includes the dissolution of the Well-Being Health Fund (FONSABI) and reduces spending on IMSS-Bienestar and the Institute of Health for Welfare (INSABI). The government asks to complete the liquidation of FONSABI by 1H23.
FONSABI was created in 2019, after the reform of the Social Protection System in Health Trust (FSPSS) that existed from 2004 to 2019. The FSPSS received 8 percent of the now-defunct Seguro Popular’s resources and covered 66 chronic and severe illnesses. FONSABI covered the same ground but used INSABI’s resources. FSPSS would devote these resources to battle health crises and FONSABI to the acquisition of medication. Two of the major changes for the funds were that FONSABI would have to send back resources to the treasury and the disappearance of certain transparency mechanisms.
“Uncertainty in acquisition processes is at the root of medicine shortages. While the old medicine acquisition process did have flaws, it allowed for more actors to participate and had clear procedures. These newer procedures often led to late payments to suppliers, a problem that the new process tried to avoid by modifying the Acquisitions Law to allow United Nations Office for Project Services (UNOPS) to mediate tenders and pay suppliers. But this has not happened as was designed,” Andrés Castañeda, Health and Wellness Coordinator, Nostrxs said.
Another major change in healthcare is the provision and acquisition of services and supplies. The government does not work with distributors anymore but directly with manufacturers through bidding processes and direct sales. Last year, Mexico and the UNOPS signed an agreement to provide technical assistance for the acquisition of medication to promote better management practices and have access to a larger pharmaceutical market. However, the healthcare system has struggled with drug shortages, and the contracts for medical supplies ended up going mostly to Mexican companies.
Experts have said that the constant changes in institutions have undermined the capacities of these institutions to do their work. “The reorganization has not been clear. The only way to achieve clarity is through regulations, laws or rules because this is the way our legal system provides transparency to the patient, letting them know which benefits they are entitled to. Each administrative reorganization causes changes and problems, generating delays in daily patient care,” said Juan Luis Serrano, Partner, Sánchez Devanny Eseverri.
According to México Evalúa, the 2023 Economic Package contemplates a 4 percent cut in resources for INSABI and IMSS-Bienestar as well. The Center for Economic and Budget Research (CIEP) reported that while spending per capita will increase 4.2 percent for IMSS, ISSTE and PEMEX beneficiaries, it will decrease for the population without access to social security.
“It is unclear how IMSS-Bienestar will manage demand and what role INSABI will play in the transfer of resources. However, IMSS-Bienestar is an attractive alternative from a universal health perspective because its functionality is better established than INSABI’s. However, the mechanisms for its services to reach people are still unclear, as is the way its funds will be divided in providing healthcare. The future of IMS-Bienestar's regular funds, its own projects and its power to redirect patients to other institutions are also in question,” said Castañeda.
PRI Lawmaker Frinné Azuara Yarzábal, part of the government’s opposition, questioned the initiative and the location of FONSABI resources. The regular reforms in healthcare have led to a series of inconsistencies that affect the efficiency of healthcare, she said.
“The Mexican health system is divided into many providers: IMSS, ISSSTE, PEMEX, SEDENA, SEMAR and now INSABI. This division generates inefficiency in the system. At Funsalud, we believe that a system with fewer divisions could have better results and be more cost-effective. Conceptually, we would like to move toward a more integrated system but there is much work to be done to achieve this goal,” said Héctor Valle, Executive President, Funsalud.