Is Mexican universal healthcare coverage too ambitious to work?
Exactly 10 years ago Mexico realized that its public healthcare provision was inadequate as it was based on a system of employment benefits. This left over 50 million Mexicans without healthcare coverage because they were largely employed by the country’s widespread informal economy. The implementation of the Seguro Popular transformed access to healthcare into a right rather than a privilege, and today it has succeeded in registering all those who were excluded under the original national healthcare plan, the Mexican Institute of Social Security (IMSS) created in 1943.
More than just the social aspect of covering the whole country without leaving anyone behind, Seguro Popular is also interesting for the pharmaceutical and medical device industry as a whole despite the low prices, as it brings new consumers into the market on a massive scale. Even more interestingly for the government, if Seguro Popular currently represents huge spending to cover the most citizens under its umbrella, it should in the long term allow savings through preventive medicine rather than expensive treatment.
Unfortunately, the more Seguro Popular grows, the more it exaggerates the fragmentation of the healthcare system, as the states are now responsible for the implementation of the program and the management of the infrastructure. Each state manages its network of general hospitals and a smaller group of high specialty hospitals. To meet the huge demand of such an attracting new coverage system, both the federal and state governments had to build their own primary care and hospital facilities in a short amount of time but it has not been accompanied by a similar growth in terms of human resources, making it very difficult to deliver a quality and efficient care. This is a direct consequence of the lack of strict national requirements and standards expectations that would encourage most hospitals to homogenize the care provided, whether it is through IMSS, ISSSTE, Pemex or the National Institutes.
This disparate mosaic of so many different institutions is the main source for varying services and quality offered at health clinics. If the GDP spending for healthcare is still below Latin American average and far behind OECD countries, some state that Mexico has the resources to create a better healthcare system, if only it was more united. Jaime Cervantes, President of Vitalmex, a company providing integrated healthcare services, explains that “there is clearly enough money for healthcare in the country. However the issue is infrastructure and the articulation of the fragmented elements of the system: it is too complex and not efficient.”
Echoing the views of many general managers of the industry, Carlos Jimenez, Director General of B. Braun Aesculap de México contends that “it is difficult to view the Mexican healthcare market as one single entity. Indeed, the healthcare market is Mexico is composed of 4 to 5 different segments. There is the highest standards segment, which would be the private sector and the “5 star hospitals”, followed by the National Institutes at the government level, which are every much focusing on quality. I would then classify IMSS and ISSSTE as the third segment and finally the decentralized parts with the “Secretarias de Salud”. Each of these different segments act with their own mechanisms, their particular processes, using different technologies for treatments. That is why the Mexican market is not very clear and difficult to classify as developed or not, given the fact that it has so many different layers.”
Roman Rosales, general manager of medical services and ER for Mexico City, Health Department, adds that “as long as our health institutions remain financially independent, it will be difficult to obtain a performing healthcare system. Universal coverage is the best solution to homogenize medical practices in the country, provide equal services to the patients, display high technology equipment, and insure equal professional medical attendance to all patients.”
Indeed, the notion of a cohesive healthcare system was one of the propositions of incoming President Peña Nieto who included healthcare as one of his main pillars for reform. The idea was a central part of his ‘Pact for Mexico’ reform proposal that rallied all political parties together under a single cause. That cause is the assurance to transform Mexico into a country with enviable living standards and robust economy that is recognized globally.
Gonzalez Pier, former Finance Director of IMSS, and current President of Fundación Mexicana para la Salud (Funsalud) concludes that “the healthcare system in Mexico is at a crossroads. We are working on turning a system that is very fragmented and inefficient into something that is more appropriate to the needs of the population. There is a lot of consensus regarding universalizing healthcare coverage, but we need to be more precise on what exactly universal healthcare entails.”
“There are two hot topics on the core agenda: what will be the benefits and the population groups covered. We need to include those who are not covered yet, and provide more interventions currently not being delivered. It will be a tough challenge because it is difficult to deliver the same level of care throughout the whole healthcare sector. We also need to define and work on the new tools required to deliver this brand new health system. Beyond defining a common view of healthcare, the real challenge will lie in implementing the system in an efficient and sustainable manner.”