Hard-Hitting Initiatives to Combat Priority Maladies

Q: How is FUNSALUD contributing to improve and promote the healthcare system?

A: Every year we refine our mission of generating scientific evidence to support public policies. Simultaneously, we are an internationally recognized think tank, acting as a platform to discuss ideas and opinions. We adapt to problems and opportunities as they present themselves.

President Peña Nieto’s administration has prioritized other industries over a profound reform of the healthcare system. A significant Energy Reform and a very complicated educational reform in which political leverage was slowly dwindling, took precedence. We then saw crude oil price drops, and by the time the planned health reform was due, the sociopolitical factors to support it were no longer present. Therefore, the Health Plan has been put on hold. We are not yet resigning ourselves to a lame duck administration as we still have three years in front of us. A new and very experienced Minister of Health is in office and is also an expert in local political mechanisms to take effective action. We are replanting our strategy to aid the Ministry of Health with the most relevant topics in the health sector.

Q: What are the most relevant health issues and in which is FUNSALUD prioritizing its participation?

A: The concerns seem to be similar to last year although we may add one or two new issues. Budgetary needs are struggling to solve problems such as chronic diseases. Diabetes, breast cancer, obesity and mental illness are prevalent. By 2030, a third of productive years and life expectancy lost will be due to mental illnesses. Funds ought to be transferred to chronic degenerative diseases, for which there is an attention deficit of more than 70 percent.

In addition, Dr. José Narro has identified underage pregnancy as a serious problem. An oversight in campaigning for safe sex and prevention has aggravated a multitude of factors affecting our youth, who begin their active sex life from a very young age. Primary care is our priority and we want to call on different sectors to adopt models of primary care that can start acting on our goals for universal healthcare. There is a clear commitment to universality, but there is misunderstanding surrounding what that entails. It means being able to provide basic services little by little regardless of a patient’s employment status. Employed by the private sector or the public sector, in the armed forces or not, everyone should be able to access a basic set of health services and have one assigned provider. To achieve this, we must finish the implementation of a registry called the Padrón Único de Beneficiarios (PUB). Some citizens are registered with up to three different health providers and have private health insurance. As a result, our calculations of the amount of resources needed are inflated. Institutions reap the benefits of patients that will never come. Improving this issue requires purifying the PUB.

Q: How should spending on healthcare be allocated to use resources efficiently?

A: We are spending more than 6 percent of GDP on health, most of which goes toward the acquisition of health technology. Despite being a lot of money, it is still insufficient. We are not sure that purchases match the ideal strategy for the country. We therefore want to conduct studies that can help us define the technology we need. Incredible technology exists, such as remote attention and diagnosis centers that allow experts concentrated in specialized institutions to interpret diagnosis images. We do not limit the health system to the personnel onsite at each hospital or clinic. Having this information available would allow every universal case file to be assessed by specialists, improving spending allocations. We need to move toward technology that can allow us to provide massive medical attention without depersonalizing it.

Q: What other public policy initiatives have you been encouraging since last year?

We are very optimistic about the Ministry of Health’s support on two initiatives that FUNSALUD proposed. We do not have a national register for cancer or chronic kidney diseases, two conditions that affect Mexicans greatly. The lack of these numerical registries means that any strategy we propose could be thwarted. Nevertheless, the Ministry  of Health has begun preliminary data-gathering and we should have the first results of these registries during the course of this year.

FUNSALUD has been carrying out studies on the integrated cost of diabetes. We also released a study on doctors’ offices that are adjacent to pharmacies, which was highly polemic and interesting. Their increasing presence shows a problem in the public sector’s level of attention. Next, we want to measure satisfaction and attention received by patients to understand the trend and decide how to take advantage of this newly created infrastructure. We also need to measure doctors’ ability to identify serious illnesses and to direct patients to specialized care. We know that these offices mostly treat digestive, respiratory and skin problems as small, but necessary fixes, but in more serious cases we do not know if patients are receiving referrals.

We are also working with the Inter-American Development Bank (IADB) to engage important telephone companies in raising awareness on health issues. The initiative is called M-Salud and uses a bi-directional platform to care for diabetic patients. The IADB is interested in the Mexican population due to its size, its level of development and the spread of cell phones. Moreover, given our racial and genetic similarities, Mexico could be a springboard to the rest of Latin America.

Q: How did your Niño Sano y Activo program help create a prevention culture around chronic diseases, particularly diabetes?

A: The Niño Sano y Activo program concluded with some interesting results. Obesity in children begins at home. We have tried to tackle this problem in two distinct manners, one with the Nestlé Nutrition Foundation (NNF) and the other through a new council inside FUNSALUD that promotes nutrition and health.

The UK is following Mexico’s example of a sugar and fat tax and is already heading toward a 20 percent tax rate. To what extent these disincentives can help is not known, but a tax will not be enough in Mexico. We could restrict expenses on food, education and transport, but sodas have become indispensable in our diet. FUNSALUD must be at the center of the nutrition, wellbeing, and metabolic syndromes discussion to reach a consensus as to how to tackle the problem appropriately. The obesity problem is multi-factorial and we should re-evaluate our sedentary lifestyle. All technological advances are designed to avoid non-necessary or unwanted physical activity so we need to study scenarios focused on inactivity, to confront this issue’s effect on our weight.

Q: Where do you see your projects in 2016?

A: As a foundation, we must amplify our membership base, and go beyond pharmaceutical companies. We could strengthen the presence of insurance companies and hotel chains, due to the growing trend of medical tourism. Mexico has stumbled on a market that creates nearly US$3.5 billion a year in revenues and has the potential to improve medical practices.

There are two important legislative initiatives. One is the reform on the Law of Science and Technology together with the Law of Responsibilities of Public Servants, which will improve the relationship between the public and private sector for scientific research and enable new support systems to be built for researchers. Scientists can benefit from this in terms of discoveries, patents and in general, but it has not been given the importance it deserves. There is also a project to reform the law surrounding public health institutes, which has been the same since 2000. As hospitals and specialized institutions are at the forefront of R&D, reform could have an extremely favorable impact on innovation in Mexico.