Dr. José Antonio González Anaya
Director General
IMSS
/
Insight

Purchasing Powerhouse Bringing Better Healthcare

Sat, 09/05/2015 - 13:31

As the most important health institution in Mexico, the Mexican Social Security Institute (IMSS) currently has two main priorities: to improve the quality and speed of medical services, and to financially heal the institution. The institute is constantly faced with difficult decisions, as, while the health needs of the population keep growing, the budget to meet those needs does not. Thus, IMSS must constantly evaluate the effectiveness of the measures it implements in order to decide the best way to spend its budget, always taking into consideration the need to improve services for its affiliates. As IMSS states, “the most important part is ensuring the best possible impact for the 70 million Mexicans that we are responsible for.”

Last year, IMSS faced an substancial deficit that led it to implement a process for financial healing. By the president’s instructions, from the beginning of the current administration, IMSS implemented a series of measures to raise the productivity and efficiency of the services provided by IMSS, without increasing the financial resources invested in them. In order to do this, the institute established a program focused on the deregulation, simplification, and digitalization of services, which became the most ambitious program in its history. IMSS also aims to strengthen transparency and competency for all buying processes, due to the fact that it is the second largest purchaser of goods and services in the country. Additionally, the institute intends to increase the excellence of medical attention. An example of the results of these measures is the digitalization of worker-employer fees, which 650,000 out of 800,000 registered businesses now pay online. This measure allowed the institute to save MX$200 million a year on bank commissions, mail commissions, and paper. Another example is consolidated purchases of medications, which are now led by IMSS for the health sector as a whole. These purchases allow several institutions to buy medicines and supplies at wholesale prices, which are very low. This initiative has allowed IMSS to save MX$4 billion on medicines over the last two years, enabling it to buy more. Finally, the institute has created re-fillable prescriptions. Previously, some patients with controlled chronic degenerative diseases, such as diabetes and hypertension, had to visit their main practitioner every  month in order to renew their prescription. Now doctors can provide re-fillable prescriptions to those patients, which save time and can be used for up to three months. Patients with these prescriptions can visit the pharmacy at IMSS to pick up medication without visiting their doctors, releasing seven million spaces for consultations.

The institute also has strong plans to renew and expand its infrastructure, thus it has developed an ambitious program for this purpose in which MX$5 billion (US$333 million) will be invested in 2015. This expansion program will promote the growth of medical units under savings and efficiency criteria. In order to do this, a new model for medical 

units, which takes into account the needs of our affiliates, was created. Through an analysis of IMSS infrastructure, existing demand, and productivity of existing infrastructure, the locations where it was necessary to prioritize new infrastructure were determined. The considered expansion for 2015 includes the construction of 28 new units for general practitioners and the substitution of 12 in bad condition or which are located on sublet property. Recently, the new Hospital General Regional de Reynosa was put into partial operation and now second level hospitals in Villa de Alvarez, Leon, Nogales, and El Marques are under construction, and tenders will soon begin for four more hospitals.

In 2015, IMSS led the largest consolidated purchase of medications for the public sector, which incorporated 42 participants and consisted of about MX$51 billion (US$340 million). This acquisition represented savings of MX$4 billion in comparison to 2014, which, added to the savings from 2013, represent a total of MX$8.3 billion (US$533 million) for all participants. For IMSS, savings from these consolidated purchases for this year represented MX$2.5 billion (US$166 million), which, added to the MX$2 billion (US$133 million) savings of last year, represent a total of MX$4.5 billion (US$300 million) savings. To strengthen this integral strategy, in March 2015, IMSS implemented the pilot program called Vales Medicamentos (Medication Vouchers) in Mexico City. This program allows patients to acquire medicine at any of IMSS’ 60 pharmacies in Mexico City if it is not available from the local general practitioner’s unit. This program has been highly successful. At this point the institution is buying 20% of medicines and expending MX$4 billion (US$260 million) less in order to ensure opportune supply to help patients acquire their medicines as soon as possible.

Mexico is facing an epidemiological shift with chronic non-communicable diseases affecting a larger number of Mexicans than infectious ones. This situation has grown to the point that if the government does not invest enough to handle these diseases, the costs associated to obesity and diabetes will completely consume the budget for public health services by 2050. In order to tackle this growing problem, several government institutions are implementing strategies to handle these diseases, including IMSS. While the rate of these diseases is growing, for the last few years the institution has managed to reduce the mortality rate linked to chronic non-communicable diseases in comparison to the rest of the health sector. Even so, IMSS believes that there are still opportunities to improve the efficiency of prevention processes and detection and control of patients without raising costs.

On the matter of prevention, IMSS has focused on increasing the number of preventive checkups through PREVENIMSS, a highly successful program. Through the last decade, the number of checkups went from eight million to 29 million by the end of 2014. The goal for this year is to get to 30 million of checkups for PREVENIMSS. IMSS has also successfully led the program Chécate, Mídete, Muévete, managing to align the efforts of the government to change Mexico’s eating and exercise habits. In order to handle diabetes, strong efforts have been implemented for early detection. Between 2006 and 2014, the child obesity rate monitored by IMSS diminished from 6.3% to 5.8% and from 14.8% to 12% for children between five and nine years of age. During that same period, the number of diabetes diagnoses has risen from 2.1 million to 7.4 million, and early detection has expanded to the age of 20. Given the importance of early nutrition, a change was implemented to the eating regimes of IMSS’ daycares in 2013. As a result, a significant decrease on the percentage of overweight and obese children from two to five years old was perceived. “From January 2013 to May 2015, we perceived that children who spent more time in IMSS daycare would pass from an overweight or obese status to a normal weight,” IMSS mentioned. “On average, 4% of overweight children and 7% of obese children who attended for less than a year reduced their weight to a normal level. When children attended between one and two years, these percentages were raised to 18% and 21%, respectively, while they were again raised to 45% and 27% respectively for children who attended for more than two years.”

IMSS is extremely mindful of its achievements and responsibilities. The institute states that “the results we have obtained these last two years do not mean that the financial pressures of the institute have been solved, there is still a lot of work to be done and the challenges for the next few years are still formidable.” The reduction in the use of reserves in 2013 managed to place the institution on an inflexion point which set the way towards a healing process of its financial situation. For IMSS, 2014 was a year for consolidation of results, since the use of reserves was halved for the second consecutive year while the service was improved. The results accomplished over the last few years will give the institute financial breathing room and allow it to expand its infrastructure and consolidate and institutionalize its services in 2015 and the rest of this administration. These improvements will provide tangible benefits in favor of the more than 70 million affiliates.