Unbearable Out-Of-Pocket COVID-19 Expenditure

In Mexico, more than 50 percent of the health expenditure comes from the public sector, 40.7 percent is made out of pocket and 7.3 percent is paid by private insurers. In an interview with MBN, Pedro Pacheco, Director General of Prevem Seguros, explained that this reality is unsustainable. “The ability to pay out-of-pocket is limited. An out-of-pocket surgery that costs more than US$5,000 is available only to a small group of people. Even an out-of-pocket expenditure of US$250 is not a reality for many Mexicans.”

AMIS has disclosed the bills of patients with COVID-19 after being hospitalized and they go around MX$920,000 (US$41,902.32) for serious cases and MX$947,000 (US$43,132.06) for severe cases in need of a ventilator. Moreover, the association shared that so far, the average cost for COVID-19 of MX$435,000 (US$19,800) for patients with major medical expenses insurance and MX$222,000 (US$10,111.21) for those with a life insurance. Ambulatory cases can cost private insurers around MX$14,000 (US$637.64).

AMIS has openly said that insurance companies are trying to find ways to reach more people as a result of the pandemic and that most of them have adapted their financing services to increase coverage rates. One example of these efforts is insurance company Plan Seguro, which specializes in health plans. In an interview with MBN, CEO Salvador Arce explained that to respond to the pandemic, the company’s plans include COVID-19 coverage. “(Additionally), we launched a new product specifically for COVID-19, including general information and a phone line for health consultancy on this or any other healthcare subject.”

With a different coverage focus, Assismex, a company behind assistance programs for healthcare, also responded and adapted to the pandemic’s new needs. “We created a membership for prevention and care related to COVID-19, which covers 50 hospital days. We are also selling preventive kits with FDA-approved products and donating all the profits to support the medical staff on the frontlines of the pandemic,” explained Director General Sheila Jasso. She also reflected on the realities that COVID-19 evidenced in Mexico. “The pandemic has brought awareness regarding medical expenses because at any moment, these can represent a very high expenditure for a family.” Family expenditure during COVID-19 can go up to MX$800,000 (US$36,436.80) for a two-week hospital stay depending on the state of the patient. Jasso highlighted that the benefits of being a healthy person on a healthy family and not having a chronic disease was another subject brought to the table during COVID-19.

Experts from Willis Tower Watson (WTW) explained that healthcare coverage plans are key. Regardless, insurance companies and people themselves should be paying more attention to preventive healthcare habits. During an interview with MBN, Omar Viveros, Leader of Health and Benefits at WTW, mentioned that “the challenge now is to transform mindsets, so people can be aware of the importance of a healthy lifestyle. They can then take that knowledge home and share it.” “Minor medical expenses essentially cover this part and while their advances have been significant, there is still a long way to go on both coverage plans and preventive culture,” said Eduardo Hori, Director of Health and Benefits at WTW.