Rafael Gual
Director General
National Chamber of the Pharmaceutical Industry – CANIFARMA
/
Expert Contributor

What Can Be Expected From the Changes to the Health System?

By Rafael Gual | Wed, 04/20/2022 - 14:00

Much has been said in various publications about the medicine supply system that prevailed in Mexico until 2018 and the benefits it represented for the National Health System. The changes that were gestated as of 2019 have generated complications that have translated into a generalized shortage of health supplies that had not been experienced in our country before and now has affected millions of people. This brief contribution analyzes the situation in the light of the most recent developments.

Neither the social security institutions IMSS and ISSSTE, in particular nor INSABI have had sufficient and timely access to medicines through the scheme that has been implemented. There are three main causes for such a disaster: a substantial lack of planning, a most ineffective logistics operation, and significant delays in or lack of payment to providers. In addition, the manifest lack of experience and capacity of the purchasing entities have aggravated the problem.

The signing of a multiyear contract between INSABI and UNOPS was intended to guarantee the acquisition of the total requirement of health supplies for the country from 2021 to 2024. The reality to date is a far cry from what was expected and does not seem to be moving in the right direction. It probably is among the worst business deals concluded by this administration. The only winner has been UNOPS, which received the payment in full and well in advance but has not delivered the desired results and has not assumed responsibility for the failure. There have been very serious consequences for governmental institutions, but above all for Mexican patients.

In the first procurement carried out by UNOPS for 2021, already late in June, about 53 percent of the pharmaceutical items[1] tendered were declared unawarded, forcing INSABI to make emergency purchases through direct adjudication, with great opacity in the process, which evidently implied a shortage of therapeutic goods for that year.

With that experience, INSABI launched a call for bids for the 2022 acquisitions, significantly reducing UNOPS’ participation for the second year. However, this process was also carried out late, results were announced on Dec. 22, 2021, and contracts were formalized only in January 2022. The results were far from successful, with more than 45 percent unassigned pharmaceutical items in the bid, which in turn forced new market research processes to try to purchase the products. Currently, INSABI has only awarded 317 pharmaceutical items, it has called for market research for 361 more, and 364 items are yet to be acquired.

For its part, UNOPS issued an invitation to tender in February 2022, which had six modifications in its call and only included 341 pharmaceutical items for the second half of 2022. Only 742 offers were presented for 322 items, with 19 unquoted items initially. The results are yet to be known but given that many quotations are above the prices of reference, it is expected that a greater number of items will not be assigned, which will yet again force the government to carry out new emergency acquisition processes.

In summary, the scenario for 2022 in terms of procurement of medicines and health supplies is as follows[2]:

Pharmaceutical Item

INSABI  (Units)

UNOPS (Units)

24 vaccine items

Unknown

 

361 items (1Q22)

78 million units

E-165, 317 items

398 million units

E-165 unquoted plus complementary, 498 items (in procurement process)

427 million units

258 patented items

18 million units

341 items (2Q22)

 

261 million units

Considering the figures above, even if all these pharmaceutical goods were procured, they would amount to 1.182 billion units, excluding vaccines, a number well below the 1.600 billion units per year on average from 2013 to 2018, which suggests that we will once again face significant shortages of medicines the rest of this year.

The recent modifications that transfer the responsibility of providing healthcare to the population that is not covered by social security, from INSABI to IMSS-Bienestar, do not have a promising future either. Since its creation, INSABI has never been able to fulfill this function. Without operating rules for almost two years, assuming functions that Seguro Popular did not even have and being evidently inexperienced to carry them out, its operation was deficient from the outset in every way: in the provision of healthcare that some states transferred to INSABI itself, as well as in the procurement of the health supplies necessary for such services, and their subsequent shipment to stock hospitals in those states.

The new scheme confirms INSABI’s commission to purchase therapeutic goods. Judging from the outcomes, this function has clearly been inefficient to say the least, and even more so if the agreement with UNOPS is considered, since it has compromised the provision of healthcare and will most likely affect the availability of funds for new acquisitions.

On the other hand, IMSS-Bienestar is only a program, not a health system. It seems quite difficult for it to perform the role of a healthcare provider without any budget allocation for that purpose. It has limited resources, oriented to prevention and education, and providing basic healthcare but meeting the needs of third-level patients is totally out of its reach. In very succinct terms, it is not clear what the destiny, financing scheme and operation of IMSS-Bienestar will be but it seems unlikely to remedy the dire deficiencies and shortcomings of the current system.

Considering the facts, it is certain that difficult times lie ahead. Swift and coordinated action, with the central objective of a timely and effective supply of therapeutic goods for the benefit of Mexican patients, is needed, with adequate planning and an open dialogue among the involved parties, for 2023 not to be once again a lost year for our country.

[1] Pharmaceutical item, “clave” in Spanish, is the classification number given to each product in the Compendio Nacional de Insumos para la Salud (National Formulary): http://www.dof.gob.mx/2020/CSG/CSG_DOF_29042020.pdf

[2] Source: INEFAM.

Photo by:   Rafael Gual