Is Universal Coverage in the Hands of INSABI or IMSS-Bienestar?

The recent federal announcement to provide universal social security through IMSS-Bienestar aims to guarantee the national right to health, but has also raised concerns as its implementation process is unclear.

Providing health services to those without social security was a task previously given to the Institute of Health for Wellbeing (INSABI), founded in 2020. Thus, the announcement that IMSS-Bienestar will tackle this large task has drawn criticism. The decision was labeled as “a new improvisation, a very serious mistake, mere blind shots,” by Former Minister of Health Salomón Chertorivski.

IMSS-Bienestar has been successful in providing primary care services to those in rural zones. In a 2018 evaluation, when IMSS-Bienestar was IMSS-Prospera, the program was recognized as a national benchmark due to its ability to provide services to entire regions through community actions and personal attention to those who request it in medical units, without conditions. “The program favors the participation of the population in community actions and in the improvement of services,” reads the evaluation.

However, some question the program’s capability to provide services to a much larger population. In a column for Reforma, Julio Frenk, Former Minister of Health and founder of Seguro Popular, said that IMSS-Bienestar will be unable to fulfill its assigned task as its US$98.02 expenditure per capita is the lowest out of all health programs. IMSS-Bienestar’s US$12 billion budget is also insufficient to provide health services to 70 million people. Frenk claimed that the decision “reflects two facts: the lack of a clear health strategy and the failure of INSABI.”

Frenk argues that IMSS-Bienestar might limit itself to ambulatory services and general hospitalization as its infrastructure is insufficient to meet the demand of its targeted population. In 2020, IMSS-Bienestar’s infrastructure included 3,622 beds and 80 second-level rural hospitals. IMSS-Bienestar has the lowest attention rate out of all health systems and it dropped even lower due to the pandemic, found a study by the Center of Economic and Budget Education (CIEP).

Through IMSS-Bienestar, the government has assumed the responsibility to provide health services to everyone. Through this change, IMSS-Bienestar “will continue guaranteeing all citizens the right to health,” said Zoe Robledo, Director General, IMSS. The governments’ plans to increase health access have been welcomed by the industry. For example, Omar Lugo, Country Lead, nPVU and Market Access, Operations Head, UCB Mexico and Latin America, praised the creation of INSABI as a positive step toward the provision of universal health coverage. But it is unclear how the recent changes in the health system will affect care provision in Mexico.