Redefining Insurance in MexicoWed, 09/05/2018 - 12:43
Q: Why is there such a small amount of integral health insurance programs?
A: A major contributor is the lack of a health culture at both the institutional and corporate levels. In Mexico, health management is fragmented; we have public services and private services but there is no integration between them. The Mexican population is too large and many of the services are concentrated in big cities but there is a sizable population in more distant municipalities. Mexico is experiencing epidemiological, generational, political and environmental transitions that demand change.
Q: How do you make insurance affordable for more patients?
A: We have been working with insurance companies to correct this flaw in the system and we are trying to equilibrate the whole ecosystem. In this equation, the only unbalanced player is the insured population who cannot pay the premium or who can pay but receives few services. Today the most common policy in Mexico is the major expenses premium, created years ago for a lifestyle and an epidemiology very different from what we have today. We need to create new policies that address the country’s needs. To this end, MASZ is designing new products for launch in 2018. One is a policy only for heart attacks. The next product we will develop is a minor-medical expenses policy with wellness benefits that provide access to general practitioners, specialists and subspecialists. It covers anything that does not require hospitalization, such as medicine, basic lab work and emergencies.
Another product in our pipeline addresses personal accidents. This covers any eventuality and also includes prevention. Fifty percent of health expenditure in Mexico is out-of-pocket; people are willing to spend money on health but we need better insurance products.
Q: How is the insurance sector addressing Mexico’s aging population?
A: The insurance sector tends to cancel policies when the beneficiaries are in their late 60s. When people are elderly, they need better coverage that is very hard to find. There are insurance companies that do not insure patients with pre-existing conditions like hypertension, obesity or diabetes – a situation that proves decisions made in the insurance sector are not made by health professionals. Without the input of public health practitioners, it is not possible to meet new challenges. Therefore, we are working to create a product for geriatrics that will be launched in the second half of 2018. It is time to free healthcare from the General Insurance Act.
Q: How are you working to include these products?
A: Three years ago, we designed the first cancer policy in Mexico and we had to overcome many regulatory problems. In Mexico, when someone wants to innovate, the law throws up many barriers. Institutions are learning with us and we are learning with them. To provide a license for a new product, the National Commission of Banking and Insurance (CNBS) needs a historical report that proves the efficacy of the product.
Q: Which products are most helpful for increasing access to healthcare?
A: It is not about the products, it is about the programs. For example, our minor medical expenses product is offered with a wellness program. These programs provide access to first-level service. Without a program, there is no medical follow-up, no patient adherence and a disorganized service.
Q: Where do you see the niche of opportunity in healthcare?
A: The key is at the first level of care. Mexico does not need more hospitals; the country needs more primary- care centers. Despite the existence of formal institutions that provide health services, we have charitable and private initiatives dedicated to providing diagnoses. Many, such as pharmacy consultancies, are impossible to suppress because this type of services are supporting the capacity of IMSS.