Financing Care: The Challenge of Increasing Coverage
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Financing Care: The Challenge of Increasing Coverage

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Miriam Bello By Miriam Bello | Senior Journalist and Industry Analyst - Thu, 09/01/2022 - 16:33

Health financing plays a fundamental role in the provision of health services and while it is not the only determinant factor, it is the first step in the universalization of care provision. However, public health models have to evolve to make the most out of public finances in health, say industry experts.

Financing in healthcare must consider the number of people active in the system and the services they have access to, explained Judith Senyacen Méndez, Health and Public Finance Coordinator, CIEP. Proper consideration of these aspects is a key step in the allocation of healthcare budgets. “Mexico was close to achieving universal affiliation. Additionally, Seguro Popular did have good coverage, which was of 49 ailments when it began and then expanded its services to a total of 66 in 2019. But, the COVID-19 pandemic worsened the gap in services,” Méndez said.

Additionally, the sector has been suffering from evident inequality between subsystems for a long time due to its fragmentation. For example, PEMEX’s affiliates have access to health services valued at over MS$20,000 (US$991.4), including aesthetic and cosmetic surgeries, while those affiliated to IMSS-Bienestar have an average expenditure of MX$2,000 (US$99.1), explained Méndez.

Healthcare budgets “have been falling year after year. This year we only saw it increase for IMSS-Bienestar because this group was prioritized by the federal government,” said Méndez.

IMSS-Bienestar has recently become the official provider of healthcare for those without social security. “IMSS-Bienestar is a primary care model for rural communities, very different to what PEMEX offers,” said Sonia López, Executive Director, SMSP. “However, individuals do not know what they have access to and how much they have to pay for services under this new scheme.” Coverage needs to be equitable at IMSS-Bienestar to include promotion, prevention, treatment and long-term care equally, she added.

The Mexican health sector currently offers unequal coverage and services.  “The current system has Mexicans of first, second and third class, which is unacceptable,” said Andrés Castañeda, Health and Wellness Coordinator, Nosotrxs. Moreover, “the last survey on affiliation to Mexican subsystems revealed that one of four Mexicans do not have access to any public health service, which contradicts the subsystems’ official figures,” he said. According to Castañeda, IMSS-Bienestar reported 12 million affiliates in 2020, but only 1 million people claimed they were affiliated to this program. Offering similar quality across all subsystems is also fundamental, as is increasing the budget to cover more people under a more equal system, he added.

“A good first step to improve equity is the recentralization of subsystems. This could put on equal ground the quality, infrastructure and services. It could also consider the specific needs of each region in the country, which are different and need a response that fits accordingly,” said Castañeda.

A recent study by CIEP found that health services have been reduced during the past decade. For Mexico, this has led to a reduction of the health fund for catastrophic expenses, which are the ones with the highest costs, explained Méndez.

Use of Private Health Services Increases

Another signal of the system’s inability to meet the population’s needs is the increased use of private services. “People are stopping using public services at the first level of care, the National Health and Nutrition Survey (ENSANUT) reports that the opening of private general medical offices has increased overwhelmingly. In 2018 around 3,500 new offices opened per year and in 2021, it increased to 8,200. This could be due to COVID-19 but could also reflect the shortages of many services and supplies in the public sector,” said Castañeda.

Another problem is that physicians are preferring to work in pharmacy adjacent medical offices than in first-level clinics, said Castañeda. “The question here is how to create a better environment that offers dignified opportunities to medical professionals and that responds to the population’s actual needs,” he added.

“Pharmacy adjacent medical offices are responding to the needs unmet by public services. However, more regulation is then necessary to guarantee their quality,” said Javier Marín, Senior Director Healthcare Americas, LLYC. Moreover, out-of-pocket expenditure and public expenditure in healthcare are almost the same in Mexico. “Private expenditure is at 47 percent while public expenditure is at 53 percent, which is very close,” said Marín.

Most out-of-pocket spending is for medicines, López explained. “In the Americas, the number of people falling into poverty is increasing because of out-of-pocket spending in health, but the sector is still ignoring other payment methods such as pre-payment and co-payment, which are already in use in countries like Costa Rica and Chile,” she said.

López called for stewardship and governance to expand equitable access and improve opportunities for medical professionals. “We do not meet the quota for doctors and nurses and despite the current efforts to recruit specialists, no one wants to work in rural areas because there is no security, supplies or support,” said López.

In the private sector, providers are increasingly relying on tech to increase access. “Tech has actually been an ally for the private sector to offer accessible, quality services for those in need,” said Andrés González-Silen, Executive President, Asistensi. Tech has improved admissibility processes that facilitate access to services and enable more efficient health models, which allow patients and doctors to connect in real-time without having to go to a clinic,” he said.

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