State of the Mexican Health Industry in 2022By Miriam Bello | Mon, 09/05/2022 - 12:24
The López Obrador administration has been marked by a plethora of changes in health processes and regulations. Experts have questioned the clarity and sufficiency of some of these measures to meet the government’s ambitious and transformational goals for the sector.
Among the main projects set by the federal administration was the reform of the Federal Acquisition Law for medicine and medical supplies. All acquisitions of health supplies in Mexico are now handled directly with manufacturers, either through bidding processes or direct sales. The acquisition process was broken down into two parts, with some products acquired directly from manufacturers and others acquired through a contract with the UN Office for Project Services (UNOPS).
UNOPS coordinates a bidding process to boost the number of participants by reaching out to companies that were not operating in Mexico but could offer their products to the Mexican government. In retrospect, diversification was not achieved, says Juan Luis Serrano Leets, Partner of Life Sciences at Sanchez Devanny. “Over 90 percent of the products acquired were bought from the same Mexican companies that have had operations or plants in Mexico for several years,” he explains.
Distribution of medicines has also been a challenge. By July 2022, INSABI, the body in charge of handling this process, had only distributed 40.8 percent of the medicines requested. Performance has been poor since 2019. According to findings from Nosotrxs collective Cero Desabasto, before López Obrador’s administration, the year with the largest number of unfilled prescriptions was 2017, with about 3.5 million. However, unfilled prescriptions started to accumulate after the Acquisition Law was changed. In 2019, unfilled prescriptions climbed to 7.5 million and in 2020 to 18.3 million. 2021 was the worst year so far, with Cero Desabasto reporting 24 million prescriptions went unfulfilled at public health institutions.
“We can see that the results (of the changes to the Acquisition Law) have been frankly bad. The processes carried out by UNOPS have not been positive. Lack of planning has led to these shortages,” says Rafael Gual, Director General of CANIFARMA. “We have an enviable industry in Mexico, with the capacity to supply the entire market,” he adds.
A second large change came with the termination of Seguro Popular as a universal care provider. In its place, INSABI was created to play a similar role. “The decision to eliminate Seguro Popular led to significant changes. Seguro Popular was an insurer that funded health services at all public institutions of the National Health Systems. INSABI, on the other hand, uses a model that is similar to IMSS but its rules are also not very clear,” explains Serrano Leets.
By definition, the purpose of INSABI is to provide and guarantee the free provision of health services, medicines and other supplies associated with those who have no social security, as well as to promote, in coordination with the Ministry of Health in its capacity as governing body, actions aimed at achieving an adequate integration and articulation of the public institutions of the National Health System. Earlier this year, the duty of providing universal healthcare was given to IMSS-Bienestar. The latter is a federal government program that is aimed at those who seek free access to medicines and medical care but who do not have social security.
“IMSS-Bienestar is an attractive alternative from a universal health perspective because its functionality is better established than INSABI’s,” says Andrés Castañeda, Health and Wellness Coordinator for Nosotrxs. “But the mechanisms for its services to reach people are still unclear, as is the way its funds will be divided in the provision of healthcare. The future of IMSS-Bienestar’s regular funds, its own projects and its power to redirect patients to other institutions are also in question.”
Through a transparency request to IMSS, Animal Político found that the transition of responsibilities between INSABI and IMSS-Bienestar were applied without a predesigned strategy or evaluation with indicators, deadlines or times. “States were even chosen where governors volunteered to go through this process and were asked to follow a list of steps. However, it is neither necessary to follow these steps in order nor to apply them all,” shares the news outlet.
A third change and current priority for the Mexican health system is resuming care for essential non-related COVID-19 ailments. A study by BMJ Global Health used health data from January 2019 to December 2020 from IMSS to determine the disruption in essential health services in Mexico during COVID-19. Results of the study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included breast and cervical cancer screenings (79 percent and 68 percent, respectively) and over half of diabetes, hypertension and prenatal care consultations. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22 percent and 17 percent, respectively.
To close the care gap brought on by the pandemic, IMSS implemented National Days of Recovery of Ordinary Medical Services, which recently concluded an 11th round and exceeded its service goal, reaching 129 percent. A total of 1.69 million services have been provided, of which 244,117 were specialty consultations, 31,125 were surgeries, 610,120 detections, 749,054 family medicine consultations, 53,509 diagnosis and treatment auxiliary studies and 218 transplants.
Lastly, regulation has also been under the spotlight in 2022. Regarding tech, both among public and private providers, the interest in digitizing the health sector is vast and efforts are starting to permeate the industry. The sector has recently introduced a Digital Health Law initiative to the Chamber of Deputies that “would provide certainty and support the development of digital health solutions in the country,” explains Héctor Valle, Executive President of Funsalud. This law would set the tone for COFEPRIS to quickly respond with regulatory frameworks for this type of innovation in healthcare, benefiting the market and patients by providing guidelines to ensure safety.
There is also a need to accelerate the market’s access to innovation. Serrano Leets explains that COFEPRIS should ideally approve the drugs and devices that prove to be safe and effective in the most efficient and least bureaucratic way possible, undergoing the greatest controls allowed by law to correct any situation that may generate a health risk. “In an ideal scenario, the authority would be efficient and fast on approvals, engaging in continuous communication with the industry, patient associations and other important players,” he says. However, there have been significant delays in drug approval processes in the country as a result of several administrative changes in the commission’s operations. “Just this year, COFEPRIS has undergone several personnel changes. Delays have led to accusations of corruption within the agency, which further delays COFEPRIS’ operations, generating a bottleneck that only harms the population,” says Serrano Leets.