Pharmacies are Key to the Mexican Health System

The health system of every nation reflects historical events, doctrinal beliefs and the particular circumstances that have shaped it. Pharmacy practices are an important component of the Mexican health system and an example of how some circumstances, in this case economic, have shaped that system. 

I believe that the main factor in the birth of the consultation offices attached to pharmacies in the country and their rapid growth has been based on the great opportunity that generates an under-served basic need. The lack of public investment in health has generated a gap that requires at least 2 percentage points of gross domestic product to reach the average of the OECD countries, which has negatively impacted the indicators of installed capacity in health.

Mexicans found in these offices an opportunity to attend mainly acute conditions, where availability, wait times and easy access offer a better level of convenience than any other public or private option. 
Let's try an idea. I challenge the reader to drive randomly in any urban area looking for a healthcare facility. Studies indicate that the first thing you will find is a pharmacy office demanding on average a 23-minute drive, almost half the time of other options. The convenience is further complemented by shorter wait times, no appointment required and extended hours of operation.

The second feature that integrates the value proposition of these facilities is the low disbursement that the patient needs to make to receive access. That is to say that 41 percent of health expenditure is financed directly out of pocket, the second-highest percentage of all OECD member countries, pointing again to the need for historical expenditure. Health insurance covers only 7 percent of total expenditure and it is only accessible to the population's highest income segment. 

On the other hand, pharmacy-adjacent consultation offices offer services for less than half of the minimum wage, on average. In addition, in compliance with the regulations and in line with keeping the prescription option accessible, it is mainly generic drugs that are prescribed. For less than MX$150 on average, a Mexican can attend to his or her acute suffering in a pharmacy office, an option many times cheaper than other private care options and perhaps even better than attending to it through public options if you consider hidden costs such as time away from economic activity due to long wait times, cost of transportation, and perhaps even filling the prescription by directly purchasing the missing medication at the institution.

Many things are said about the service. It is perhaps the least developed of the three pillars of its value proposal and it is a frequent target of voices that do not agree with the service. The truth is that public and private surveys qualify this intangible aspect as equal or superior to other existing options. 

The convenience, low disbursement and adequate level of service offered by the pharmacy offices, in an environment where the existing options are insufficient, led these establishments to surpass IMSS as the main generator of first-contact consultations, growing significantly and constantly since 2006 to become an important and difficult piece to replace in our health system.

For pharmacy offices, there are many challenges. I think the first is to enhance the perception of service, which is often described as a business tool for generating demand for health services. Second, we must make it clear to everyone that in their practice, health professionals have total freedom. And third, we need to dignify their work and acknowledge the critical role played by health professionals and pharmacy offices in the healthcare system.