Gabriel O'Shea
National Commissioner for Social Protection in Health
Seguro Popular
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View from the Top

Caring for Half of Mexicans

Wed, 09/06/2017 - 11:11

Q: The Seguro Popular registered over 8,000 migrants returning to Mexico in early 2017. How is it reaching these people?

A: This has become quite a theme since President Trump announced he would repatriate 3 million Mexicans. We have created 50 booths in the 50 consulates in the US managed by the Ministry of Health from where we distribute information to our citizens about what the Seguro Popular is. We tell them that it is free, what it covers and what it does not, so that when they return to Mexico they can sign up. In addition, we placed 24 sign-up centers in the five Mexican border states solely aimed at reaching those being repatriated. However, we have not seen an increase in deportations and the number of people registered in the first three months of 2017 was the same as the first three months of 2016.

Q: The Seguro Popular expects millions of people to renew their policies this year. How do you cope with such volume?

A: As of March 2017, there were 54.9 million Mexicans a liated with the Seguro Popular. The policies of 17 million Mexicans will expire in 2017, although there is a tendency to leave things to the last minute, and so on the last day we see huge queues of people. Therefore, we expect only 50 percent of those 17 million to re-a liate. We had 57 million policyholders last time we spoke with Mexico Health Review in 2016. We have since cleaned up our database and no longer have 9 million duplicate registrations. The Seguro Popular has been sharing information with the other health systems since 2016, a year in which we lowered the number of policyholders by three million.

Q: How have public-sector budget cuts impacted the Seguro Popular? How is it ensuring patients are not negatively a ected?

A: The Seguro Popular has su ered from budget cuts to programs such as catastrophic expenses or Médico Siglo XXI, which is aimed at children. To face these cuts, we have lowered duplicate registrations and we have cut some programs. We have also reduced trips to other states to check on how things are going and employees no longer have company cellphones. A program I would have liked to implement but have not been able to is the milk bank in hospitals to encourage exclusive breastfeeding for the first six months.

Q: Of all the Seguro Popular’s programs, which is your favorite?

A: My favorite program is probably the cataract one because I am an ophthalmologist. However, the program that has had the most impact is that which cares for children with cancer. In 15 years we have managed to reduce by 11 points the out-of-pocket expenditure of Mexicans, although we still remain the country in the OECD with the highest rate of out-of-pocket expenditure. I am certain that with the modifications to the law we have made we will achieve a reduction of 15 points within the next few years. We expect that from 2017 onwards this will help state health services carry larger stocks of medicine, which is what is most hitting the wallets of Mexicans.

Q: The Seguro Popular now has bariatric surgery among its services. What has been the result of that?

A: This is happening in Mexico City mostly, but it is hard to implement in other states because there may not be as many bariatric surgeons. It is aimed at cases of obesity in which the patient is incapacitated in his or her daily activities. I believe everything should be tried before resorting to surgery: dieting and exercise or even taking medicine. Unless we Mexicans change our diet and exercise, it will be di cult to justify resorting to bariatric surgery because we have done nothing to try and fight the root cause. It is all well and good for the public sector to instill healthy habits in schools, but what good is it if parents undo this work once the child gets home? This is a complex theme that requires engagement from all sides: municipalities and mayors, but the largest commitment is that of parents. We have made great strides through the Prospera program in teaching people to eat well, which does not cost a lot of money.

Q: You are an ophthalmologist. What trends in Mexican ocular health are most concerning?

A: Cataract is the first reversible cause of eyesight loss in the world and in Mexico the first cause of non-reversible sight loss is glaucoma. The main problems I see when giving consultations and operating are diabetes and obesity. They are our nightmare. If I could, I would focus resources on fighting these two conditions, which would have a huge ripple e ect on other health costs.

In consolidated purchasing, we have saved MX$11 billion (US$611 million) over the past three years. We want health centers to be on the lookout for these things and be testing for them. In addition, it angers me if centers are lacking tests because I send the states money to buy test strips for them. Now, instead of sending money, I buy material and send that to them. The same thing happens with condoms. Twenty percent of pregnancies in Mexico are in girls under the age of 19, so now we buy condoms directly and ship them to the states.

Q: In which areas has the Seguro Popular seen the largest increase and decrease in costs in 2016?

A: The largest increase has been in NCDs, mostly cardio- pathologies and diabetes mellitus, and treatment of ensuing complications like hemodialysis, amputations, laser surgery for diabetic retinopathy and implanting an Ahmed valve. All of this is extremely expensive for a healthcare system and we see this increase every day. There are 12 million diabetics in Mexico, of which only 38 percent have their condition under control. The others are su ering from side-e ects.

We have seen a decrease in the costs of cancer patients due to generic medicine. Today, a patient with breast cancer costs less than three years ago and we have seen the same e ect with HIV patients. The Seguro Popular monitors 81,000 HIV patients, each costing MX$37,600 (US$2,089) per year. This is a great burden for healthcare systems because they now live longer. HIV is not a death sentence as it was in the 1980s.

Q: How will the Seguro Popular continue to face the diabetes and obesity epidemic in 2017?

A: It is no longer about building large hospitals. We have to continue what we have started: the interchange of services. The theme of universality we all dreamed of is surely not so. It has steps, each of which can take years. We began interchanging during this six-year presidential term, meaning patients can be treated where there is room, even if the facilities belong to another health system. We need to make the most of infrastructure that is already in place. There are 35 private medical providers that o er services to the Seguro Popular. We need to increase this number and we should reach 50 by the end of the year.