Promoting Efficiency Throughout IMSS

Q: During your tenure as COFEPRIS Commissioner you drove an agenda of simplification of bureaucratic procedures and digitalization. How do you bring those subjects to a much larger institution like IMSS?

A: One of the main aims of our strategy at IMSS is deregulation toward increased efficiency, both in medical services and the economic services related to the pensions system, such as retirement and disability. We tend to 70 million people, more than half the country. Regarding deregulation, we provide medical and social security services to around 1 million people daily and back in 2012 all bureaucratic procedures had to be done in person, at an annual cost of about MX$3.0 billion (US$158.7 million). From 2013 at the behest of President Enrique Peña Nieto, IMSS started changing to a digital platform called IMSS Digital and now 72 percent of the 25 formal procedures we review are done digitally, meaning that in the last three years we have served 80 million procedures in a digital manner, saving around MX$2.5 billion(US$132.3million).Weaimtoclosethisadministration in 2018 with 35 million digital procedures a year and nearly zero done in person. This includes everything from proof-of- life certification for pensioners to employee registration and from day-care registration for toddlers to maternity leave registration for pregnant women.

Q: In terms of health services, how much has IMSS advanced on easing procedures and digitalization?

A: We operate about 6,000 medical facilities, we are the largest healthcare provider in Latin America with a capacity for 500,000 medical consultations, 6,000 surgical procedures and 1,070 daily births, around 30,000 beds, 36 third-level hospitals, including 25 specialty units and 350 second-level hospitals. We are also dealing with an increase in chronic diseases like diabetes, cancer and hypertension and heart disease. These patients represent 20 percent of our affiliated population but demand 80 percent of our budget for preventable diseases which were not prevented.

We are looking to modernize bureaucratic procedures. We cannot forgo face-to-face consultations but on the primary- care level we have since March put in place new procedures, such as the Unifila program, now adopted by 46 percent of our hospitals, so that people who arrive without an appointment don’t have to wait at least a day as before, but can be in front of a healthcare professional in less than an hour. Another problem was appointments with doctors on the second level of care, which had taken up to four days and now takes half an hour in 60 percent of our hospitals.

We also had a hospitalization bottleneck because it took 24 hours to ready a bed for a new patient after the last one left and now it takes only eight, increasing availability. We have implemented this new procedure in 46 percent of our hospitals. We also had to reduce a backlog of about 8,700 surgeries but since mid-April we started using surgical theaters on weekends, adding around 200 more surgical procedures per weekend. We have performed 2,237 programmed surgeries on weekends.

Another subject we attacked was chronic-patient prescription. Whereas before a patient with a chronic illness had to attend a medical consultation once a month to fill out his or her prescription, after a medical-risk evaluation we were able to determine nine treatments where we could fill prescriptions quarterly, saving 8 million consultations a year.

We are also trying new protocols in 44 percent of our hospitals for triage in emergency situations to properly and efficiently classify patients according to the urgency level. In 12 facilities for example, we have implemented a protocol for heart attack patients, called Código Infarto, that has reduced the treatment time from the first early symptoms to when a stent is put in to half an hour from three hours. That has cut mortality rates by 60 percent.

Q: According to the OECD, IMSS receives far less financing from the system’s final users than in other countries in the group. How has IMSS learned to work around this deficit?

A: The OECD provides data but what needs to be compared is the tax burden in terms of salary for affiliates. After doing that you can say the current burden is acceptable. If by increasing the burden we affect the size of the workforce, we would have a serious problem. We need more jobs. That is what helps in the end in terms of financial terms for IMSS. The 2.04 million jobs created in the three years and seven months to July 2016 have helped increase IMSS intake by 26 percent, some MX$50 billion (US$2.6 billion).

IMSS has two main financial pressures. Firstly, the pensions from the old retirement system that was modified in 1997 and are fully funded by the State. That creates a financial burden of MX$2.0 trillion (US$105.8 billion), close to 10 percent of Mexico’s GDP, with 10 percent annual growth, causing payments of about MX$70 billion (US$3.7 billion) every year. Secondly, the epidemiological and demographic transition the Mexican population is undergoing creates financial pressures on IMSS to provide medical services.

In the last three years we have reduced the IMSS deficit by 60 percent and now sport a fiscal surplus, which means we have been able to pay for pensions and medical services.

Q: Regarding costs, the possibility of having PPPs building hospitals has been increasingly in the spotlight. Is IMSS involved in this at all?

A: What IMSS has done is to take advantage of this new legislation to facilitate the construction of new infrastructure, clearly without medical care being in the hands of the private sector at any point. That is a legal impossibility. We are having facilities built at a faster pace, more efficiently and without the hurdles associated with direct public investment. We have had bidding processes for four hospitals. We are looking to be more efficient. We want to build more hospitals with less money, we have MX$20 billion (US$1.06 billion) to build 12 hospitals and four of those will be through PPPs.

Q: Another important cost-cutting strategy goes through preventive care, as with campaigns like the “Chécate, Mídete, Muévete.” But what other efforts are being made to reduce costs tending to illnesses like diabetes?

A: We can no longer avoid the issue of preventive medicine. This is not trivial. We need to stop the encroachment of chronic diseases. At IMSS we are working on a concrete policy to correct two big flaws of our health system, which are detection and control. We are working on a new model for community family health units with the ability to lead youths toward better habits, with metrics we can track to detect diabetes and hypertension and also breast and prostate cancer, and to treat adults with early stage diabetes and hypertension. This will be our turning point to get from curing a disease to preventing it. We can no longer spend 80 percent of our budget on 20 percent of the population that failed to prevent their health condition. If we do nothing, by 2050 we will go from spending MX$80 billion (US$4.2 billion) treating chronic disease to spending MX$350 billion (US$18.5 billion), which is unsustainable.

Q: What fallout has IMSS had to deal with after this year’s budget cuts?

A: We are an independent government entity with our own resources coming from taxation and contributions by employers. We are not affected by budget cuts, but that is not an excuse not to be more efficient. This year we are committing to fiscal savings of MX$7.0 billion (US$370 million). We started to consolidate medical supplies purchasing, we have also had savings in medical services such as tests and also promoting competition via bidding processes for procedures like dialysis that has led to savings of around MX$7.0 billion (US$370 million) annually for the last three years, with a similar goal for 2016.