Transformations Awaiting the Public Sector

Sat, 09/05/2015 - 13:26

The Mexican public healthcare system is composed of mutually complementary services provided to 1,182 hospitals by both, the Ministry of Health and social security. Total public expenditure on healthcare increased by 127% between 2004 and 2013, from MX$231 billion to MX$524 billion, representing 3.3% of the GDP. The Ministry of Health that includes hospitals, National Institutes of Health, and supports Seguro Popular relies on Federal and State financing. On the other hand, social security includes institutions like IMSS, ISSSTE, PEMEX, SEDENA, and SEMAR, which receive funding from individuals, employers, and workers. In 2014, 57,952,000 people were affiliated with IMSS and 12,753,000 with ISSSTE, while in 2012 PEMEX possessed 755,000 affiliates, SEDENA 832,000 and SEMAR 279,000. Seguro Popular provided cover for over 55.6 million people in 2014.

As part of the National Development Plan 2013 – 2018, The Sectorial Program of Health imposed the guidelines for achieving a universal and integrated national health system. Attempts have been made to integrate public healthcare institutions, such as the unification of the payment system and a move toward consolidated purchases. Dr. Gabriel O’Shea, National Commissioner of Seguro Popular believes “the merger will concern portability and convergence, with the primary goal for convergence being unifying payment scales.” Despite the fact that a consensus has not yet been reached, over 15 different meetings have been held to improve dialogue between IMSS, ISSSTE, Seguro Popular, and the Ministry of Health. Regarding consolidated purchases, IMSS led the major purchase of medicines and medical supplies for 2015 which involved ISSSTE, PEMEX, SEDENA, SEMAR, 21 national institutes of health, and 16 federal states with savings of MX$4.6 billion.

Some of the remaining challenges include improving access to services and avoiding duplicated coverage. For instance, Seguro Popular’s Protection Fund for Catastrophic Expenditure (FPGC) integrated 208 suppliers for medical care - including private and public clinics – located mostly in Mexico City, State of Mexico, Jalisco, Tamaulipas, and Guanajuato, while the other states still have few providers. In addition, the Superior Audit of the Federation (ASF) estimated that nearly four million Mexicans had no access to any healthcare institution this year. Yet 12.7 million people affiliated to Seguro Popular are also covered by IMSS, ISSSTE, PEMEX, and IMSS Oportunidades, therefore, through closer collaboration, institutions could avoid duplicating affiliates in order to allocate adequate resources to those who cannot access healthcare.

Demographic and epidemiological changes are galvanizing the generation of strategic collaborations with the private sector. IMSS spent MX$29 million on private hemodialysis and radiotherapy services in 2014. In addition, it has manifested its intention to subrogate more services, including treatment for 16,000 people with diabetes, a contract for which 16 private companies were interested in participating in tenders. ISSSTE outsources auxiliary services for diagnostics as well as physiotherapy treatments.

Lack of specialists has been particularly problematic, since Mexico has two general physicians and specialists per 1,000 people, while the OECD average is 3.2. According to Dr. Enrique Graue, Director of the Faculty of Medicine of UNAM, the health sector has developed inconsistently, causing an excess of physicians in certain specialties and a shortage in others. Additionally, for some areas of Mexico – mainly large cities – there is a surplus of doctors, while rural areas are facing shortages. Addressing the issue, Dr. Teresa Corona, Director General of the National Institute of Neurology and Neurosurgery (INNN) said, “patients living in different regions do not have access to these resources, obliging them to travel to one of these three cities [Mexico City, Monterrey, and Guadalajara] and representing a burden for the National Institutes of Health.” To solve this, she goes on, “health services in every single state could be consolidated to increase the number of general and specialty hospitals.” As for Dr. David Kershenobich, Director General of the National Institute of Medical Science and Nutrition (INCMNSZ), the problem is not dictated by a shortage of specialists but on a lack of general practitioners. The INCMNSZ has implemented telemedicine solutions to provide support to doctors in several parts of Mexico.

Quality is increasingly becoming prioritized among the Ministry of Health, IMSS, ISSSTE, PEMEX, SEDENA, and ISSEMyM, with 18 hospitals belonging to the institutions accredited by the General Health Council. Generating innovative models is vital in offering more comprehensive medical care. For instance the INCMNSZ implemented a new treatment model that could be easily incorporated into the health system. Dr. Kershenobich explains “in INCMNSZ, patients with diabetes no longer visit the hospital frequently, instead receiving integral care 

from endocrinologists, cardiologists, ophthalmologists, nutritionists, and psychiatrists on a monthly basis, and as they develop better awareness of the implications of their disease and learn how to manage it, they are then given annual appointments.”

In addition to creating innovative models for medical care, research is now at the core of the National Institutes of Health’s strategy. The INNN has developed a research line on neurocysticercosis – a common infectious disease in Mexico – as well as neurodegenerative diseases such as Parkinson’s disease and dementia. The INCMNSZ is establishing a promising research line to elucidate the role of the interaction between intestinal microbiota and human genes in developing chronic diseases. Moreover, the organization collaborates with international institutions such as the Broad Institute of MIT and Harvard to identify Mexican gene variants associated to diabetes.