Antonio Chemor
National Commissioner
Seguro Popular
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View from the Top

Increasing Service Quality by Optimizing Expenditure

Wed, 09/05/2018 - 18:14

Q: How has Seguro Popular reinforced its mission since its creation in 2004?

A: We have made four important changes. The first is that states now have five working days to transfer the money that goes to the health sector. The second important change is how the money is transferred, which is done partly through state finance ministries and partly through the federal treasury. We started using this method with 30 percent of the total money allocated and in 2018 we will boost the amount transferred this way to 50 percent of the MX$54 billion that states are expected to receive. States do not have direct access to the money but must go through a digital platform, which prevents them from using the money for other purposes. The third important change in the law is related to economic compensation. Seguro Popular was localized in the country’s 32 states but the changes have allowed the agency to become national. A fourth change in the law relates to transparency and accountability.

Seguro Popular pays a premium to guarantee attention to the three largest portfolios that we manage. The first is the Universal Catalog for Health Services (CAUSES) and includes 1,663 diseases. The second portfolio is catastrophic expenses, which includes 61 diseases that tend to be the most expensive and most complex. The third portfolio is Medical Insurance XXI Century, which includes diseases that impact children up to 5 years old. The premium for this year is MX$3,123.99 per person, a figure that is updated according to the country’s inflation rate. In 2016, the premium was MX$3,022.44. Add on the 3.36 percent rate of inflation and that gives you this year’s premium. This amount is enough to cover the 54 million Mexicans that are affiliated with Seguro Popular.

In the past, we had problems because the states did not contribute economically. To address this, in 2017 we forced states to provide at least 30 percent of their state contribution and, additionally, states must provide proof of having received and spent federal resources on health services. If a state is not able to corroborate that they spent the money on health services, then they no longer receive funding. The second condition is that they must comply with economic compensation requirements.

Q: Seguro Popular has prevailed through three administrations. What has been the key to its success?

A: We have achieved transparency and accountability regarding the resources that are sent to the states, which in 2017 totaled MX$68.7 billion. In 2016, we began to work intensively on quality and implemented a program of health managers that includes 1,576 individuals working in the medical centers and acting as a link between Seguro Popular and affiliates to guarantee their rights. According to the OECD, since 2004 Mexicans’ medical expenses have dropped by approximately 12 percent thanks to services such as Seguro Popular.

Q: How is the Seguro Popular working to make health a priority for the new administration?

A: Seguro Popular is a scheme for all those people who do not have any other medical coverage. With the creation of almost 3 million new formal jobs, Seguro Popular has successfully reduced the number of registered affiliates. In 2014, we had over 57 million Mexicans affiliated. Between 2016 and 2017, we reduced the registry to approximately 54 million Mexicans. Peña Nieto’s administration has also driven the creation of a universal health system. We now need to sit down with IMSS and ISSSTE and figure out a common tab that will allow us to easily exchange services and allow affiliates of Seguro Popular to go to IMSS or ISSSTE facilities. This is something that needs to be consolidated in the next presidential administration.

Q: Are there any plans to generate exchange services, not only with public institutions but with private health service providers?

A: Those states that have weak health-related infrastructure and that cannot cope with the number of patients they have are authorized to hire services from private hospitals. For instance, Hospital Puerta de Hierro in Nayarit, which is a private hospital, is subrogated by the Health Ministry of Nayarit. I hope we continue to have the opportunity to participate with private hospitals, but I believe that the consolidation of the public health network must be a priority.

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Q: What technology strategies are you implementing to increase coordination among hospitals?

A: Among the commitments that then presidential candidate Peña Nieto agreed to was the creation of oncological hospitals, which have been built in states such as Tamaulipas, Coahuila, State of Mexico and Quintana Roo. However, we are also building hospitals in other states, such as Baja California Sur, Guerrero and Oaxaca. The lack of specialist doctors has led us to embrace technology. We have found that some people from small towns stop going to doctors or taking their medicines because they do not have money to make a trip to the city. For this reason, we are heavily supporting technological innovations like telemedicine projects that will allow specialists to provide consultations to patients in small towns.

Q: How is the institution ensuring the welfare of patients with diseases like HIV and cancer when dealing with budget cuts?

A: In 2016, our budget was reduced to MX$75.4 billion and in 2017 it fell to MX$68.7 billion. When looking at the total number of people that Seguro Popular, IMSS, ISSSTE, SEDENA, ISSFAM, ISSEMyM and other social security institutions attend to, we can see that almost the entire population has health coverage. It is our belief that the new administration should not cut the budget for health services.

Q: How does Seguro Popular guarantee a fair distribution of the concessions in tenders? 

A: We do not buy things per se; we give money to the state and the state concludes the acquisitions. However, we have put in place certain conditions to make sure that there are no abuses. For instance, with medicine, we set a maximum price that we get from IMSS’ consolidated purchases. We have put in place a system that detects when a state makes a purchase above the reference price and automatically alerts that state. This also happens with human resources. The system detects whether there are duplicated names on a payroll. This has allowed us to control the money and to guarantee that there are no abuses.

Q: What has Seguro Popular done to generate awareness and attract those segments of the population that do not have coverage from other institutions?

A: In 2016, we spent MX$2 billion in affiliation and re- affiliation programs aimed at detecting the open population, or people who do not have medical coverage from any institution. Still, I believe the public sector can provide health coverage for the entire Mexican population. There might still be a small number of Mexicans without access to health services, so we will continue with our campaigns to convince people who do not have coverage to affiliate with Seguro Popular.

Q: What is Seguro Popular doing to promote prevention, especially related to chronic diseases?

A: Every year, we force states to apply at least 20 percent of what they receive to prevention. This means that almost MX$11 billion each year is spent on health promotion and prevention. The Deputy Ministry of Health Promotion and Prevention of the Federal Ministry of Health sets the guidelines and the programs that states must enact.