Javier Flores Hinojosa
Director General
Hospital San José / Hospital Zambrano Hellion
View from the Top

Leading Northern Teaching Hospital

Sat, 09/05/2015 - 19:50

Q: What is the relationship between Hospital San José and Hospital Zambrano Hellion?

A: Both hospitals are part of the health division of the Tecnológico de Monterrey. Hospital San José will turn 46 this year and has 200 beds, while Hospital Zambrano Hellion is only three years old and has 60 beds. Both are general hospitals that also provide highly specialized treatments as part of tertiary care, and are completely equipped with diagnostic imaging and hemodynamics. The main difference is that Hospital San José provides radiotherapy services. Our alliance with the School of Medicine of Tecnológico de Monterrey helps us support both hospitals. Hospital San José is perceived as both a medical school and as a specialized hospital, since we are heavily committed to educating our medical professionals.

Q: How would you compare Mexican health standards to those in other countries?

A: It is difficult to define a specific standard, since several indicators must be considered and several major Mexican institutions are interested in providing the best quality healthcare for patients. We are mainly concerned with clinical outcomes, so we are establishing standards to be used across Mexico. Sadly, there is little public information in Mexico comparing quality and patient outcome across hospitals, so we are obliged to compare ourselves with foreign hospitals. As affiliates of the Houston Methodist group in the US, we exchange and implement guidelines on best practices in our operation, administration, and clinical practice, thereby improving the quality of patient care.

Q: To what extent has the epidemiological shift in Mexico, changed the approach of the hospital?

A: The epidemiological profile has changed significantly in Mexico. Chronic diseases have replaced infectious diseases as the main cause of mortality in the Mexican population. In response, three years ago we established three strategic lines of action, prioritized at a financial and infrastructural level. The first is cardiology, treating myocardial infarctions, heart failure, and other vascular diseases. Our neurology strategy treats cerebrovascular accident and neurodegenerative diseases, while our oncology work is focused on breast cancer. Hospital Zambrano Hellion was built with the specific intention of specializing in oncology and cardiology, but afterwards we expanded our specialty portfolio to open several institutes that treat diverse diseases.

Q: Does belonging to Tecnológico de Monterrey give these hospitals any advantages?

A: Tecnológico de Monterrey shares our clear mission of providing improved services by educating excellent medical professionals. In 2014, we took an important step by establishing our National Medical School at three different campuses: Monterrey, Mexico City, and Guadalajara. Tecnológico de Monterrey also has a strong R&D area, and its biotechnology center carries out groundbreaking research. Sadly, we are unable to use any of its research because the expense involved in commercialization requires external financing.

Q: What are the benefits of being part of the Monterrey health cluster?

A: The health cluster was created as a public-private synergy in Monterrey, intended to position the city as a health hub. This is a long-term goal to which every hospital contributes by providing qualified professionals and to promote medical tourism. Moreover, the Director of Nursing at Hospital Zambrano Hellion is now the president of the cluster’s Nursing Committee.

Q: Do you consider Monterrey to be a popular destination for medical tourism?

A: We continue to treat many medical tourism patients, but numbers have declined since 2004-2007 for example when we received about 500 patients every year for bariatric surgery. At the time this procedure did not have FDA approval in the US, but it was approved in Mexico, which meant that this number dwindled once the FDA approved the procedure in the US. We have made several efforts to promote medical tourism through international fairs, and we work with several brokers who sell our services abroad. These brokers send us patients for highly specialized surgeries, but not as many as before. Niche work like bariatric surgery could boost sales again. Such procedures become popular abroad when performed by highly trained medical professionals. Other factors have negatively influenced medical tourism, such as the rise of organized crime. Generally, 15% of our patients come from outside of Monterrey, but between 2009 and 2011, we had very few patients from other parts of Mexico. During these years we received absolutely no foreign patients and the number of domestic patients plummeted, although the situation has greatly improved since.

Medical tourism comes about through efforts of individuals performing dental and cosmetic surgery. Other surgeries are usually covered by the patient’s health insurance in their home countries. However, opportunities still remain for other specializations, such as with trauma patients. These patients have either visited doctors who could not provide treatment or do not have medical insurance in their home country. Procedures carried out in Mexico are usually 30-40% less expensive than in the US, while the quality standards are the same. Insurance providers could lower their costs by outsourcing patients to Mexico.

Q: What percentage of your patients have medical insurance and how many pay out of pocket?

A: Numbers fluctuate but we estimate that 75% of our patients have medical insurance while the rest pay out of pocket. In Mexico, only 8.6 million people have health insurance, representing 7.3% of the population. In most of Mexico, there is little interest from consumers to acquire medical insurance, but larger cities like Mexico City and Monterrey are beginning to develop a different attitude.

As the Mexican population continues to increase, the government will have to outsource services to us, and it is the responsibility of the entire health sector, including public and private hospitals, medical insurers, and the government, to anticipate this change. Mixed plans that split the costs of medical care between the public health sector and private hospitals are possible. Primary care could be provided by the public health sector, with highly specialized medicine financed by health insurers and provided in private hospitals.

Q: Is the amount of services you provide increasing or decreasing as the public health sector strives to achieve universal healthcare?

A: We already sell services to the public health sector, including IMSS and ISSSTE. This involves a bidding process among the private hospitals interested in providing services to the public sector. Such services are beneficial for us because they increase our patient numbers, and we are able to incorporate public patients without affecting our own patients. Since 2010, we have had an agreement with

ISSSTE Nuevo Leon to provide tertiary care to federal workers. The negotiation process for subrogating services usually revolves around specific needs. For instance, Hospital San José is accredited to provide care for breast cancer, cervical cancer, and pediatric cancer to Seguro Popular. I can confidently state that our breast cancer program is the most successful in Mexico. Since 2010, we have treated 650 patients per year from Seguro Popular. The number of patients gradually increased as word spread about the availability of our services through Seguro Popular.

Q: What certifications do Hospital San José and Hospital Zambrano Hellion have today?

A: We are currently working towards becoming accredited as an academic medical center by Joint Commission International (JCI). We are likely to obtain this accreditation since we are collaborating with the School of Medicine of Tecnológico de Monterrey. JCI has accredited several organizations worldwide, three of which are in Latin America. We are currently submitting the necessary information and we expect to be accredited by the end of 2015. Hospital San José has already been certified by Mexico’s General Health Council (GHC), showing that we can adhere to strict certification standards, and Hospital Zambrano Hellion is in the final stages of GHC certification.

Q: There are a high number of specialized physicians in large cities, but this number is substantially lower in rural areas. What can private hospitals do to increase coverage?

A: The School of Medicine of the Tecnológico de Monterrey covers the entire state of Nuevo Leon. As mentioned, 15% of our patients come from rural areas. Besides collaborating with several smaller hospitals, our clinics provide emergency care for highly specialized procedures and we are building a clinic in Santa Catarina with the assistance of municipal and state governments to provide medical care for low-income patients. We also began by providing ophthalmological care at that clinic before developing medical treatments for women and children. Another project aims to improve the education of our doctors while increasing medical coverage in the entire Monterrey metropolitan area. The School of Medicine of Tecnológico de Monterrey offers undergraduate and graduate courses, as part of which we provide undergraduate education that takes place in our hospitals, while our postgraduate training at various centers throughout the state. This program has been made possible through collaboration between our hospitals and Nuevo Leon’s Ministry of Health. During the ten years since this work began, our students visited several hospitals to gain insight and experience, and medical coverage in the region has increased as a direct consequence.