Javier Potes
Consorcio Mexicano de Hospitales
View from the Top

Private sector Steps up to the Plate

Thu, 09/07/2017 - 12:53

Q: How has the consortium’s business model evolved with the healthcare system?

 A: The first goal of the consortium was to achieve operational effectiveness, cost reduction, training and information exchange. Our idea was to become the largest hospital network in Mexico even though our bed average is only around 34 per hospital. However, this vision has changed. Instead of being the largest hospital network we want to become the first private healthcare system in Mexico. We wanted to save patients money and avoid out-of-pocket expenditure. We did a study on health coverage in Mexico and we found that 6 percent of the population has coverage for major medical expenses, 60 percent have social security and the rest cannot afford insurance. This last group is the one that usually comes to us and spends a lot of money. The reason for this situation is because insurance in Mexico was created for hospitals, not for patients. The main problem in Mexico is the lack of money. Insurance systems can help us organize the market and become efficient in managing hospital expenses so that premiums do not rise as they usually increase 15 to 25 percent every year. Last year, 20 percent of insurance holders canceled their policy. Insurance is also limited and there are only options to cover catastrophic diseases but not for the most common causes of hospitalization. We want our model to bridge these gaps.

Q: What is the consortium’s plan to address this situation as a group?

A: We approached insurance companies and proposed an system we designed for patients at consortium hospitals. It will be delivered to the segment of the population that has no coverage through private insurance or social security. It costs no more than MX$5,000 (US$277) a year and is available with Seguros Atlas and Seguros Banorte. It includes up to MX$170,000 (US$9,444) of medical expenses at our hospitals and covers 90 to 95 percent of hospitalizations.

It does not cover cancer or a heart attack; in those cases, patients should use their social security. This will be the only insurance in Mexico for the middle segment in cost. Besides, the system works with deductibles instead of refunds.

To arrange all these benefits we will launch a mobile application that works with an algorithm that performs a risk evaluation for each patient and provides personalized information. It also will have a patient’s history uploaded so even if a patient changes doctors, the doctor can still access records. In the future, this platform will provide incentives for prevention, such as gaining points to access gyms. The idea is also to provide better prices to our patients and to allow doctors to achieve more volume.

Q: What are the main advantages for hospitals, doctors and patients as part of the consortium?

A: The initial advantage was achieving better purchase prices because if all the small to medium-sized hospitals buy together, they can get lower costs. The second idea was to share information. The hospitals needed to see if they were doing things right, so we developed manuals and organized exchanges of professionals between the hospitals. Then we started developing training opportunities for the employees of each hospital. We developed online courses for 13 different positions with different modules in each and planned 30 annual talks on different topics. Now we have four certification courses in hospital management, marketing, purchasing and quality.

Q: What are your main objectives for 2017?

A: We want to reach 250,000 memberships for our system in the next two years. It will be possible because at the consortium there are 100,000 hospitalized patients every year and 300,000 more who undergo ambulatory procedures. The consortium will keep training and providing information exchanges. We also want to integrate specialty clinics to reach the goal of becoming the first private healthcare system in Mexico. It is not an easy task because Mexicans do not understand what a healthcare system is. But we are working to create a model that includes all types of services, like social security does, for a similar price and with better service.