Commission of the Senate- Sen. Maki Esther Ortiz Dominguez, President – Mexico
The president of the Health Commission at the Senate and former vice minister for integration and development for the 2006-2011 administration talks about the importance of ensuring high-quality healthcare services and the initiative to create a national integrated healthcare system in Mexico.
On which topics have you been working since you became president of the Health Commission?
There are some initiatives that are really important for us; we have to consider which are worth pursuing. The most fundamental are those that deal with the health of Mexican society. First of all, we are currently reviewing the lag in political initiatives from the past tenure; then, we will develop a strategy to create proposals for new laws that can contribute to the healthcare sector. Our objective is to develop the commission into a diverse but unified platform to discuss health-related issues among all stakeholders. Communication is crucial, so we always try to keep extensive dialogue with the Ministry of Health, the local governments and universities. All of those efforts will eventually create a strong foundation for Mexican healthcare services.
What have been some of your latest achievements?
One of the latest achievements of the Senate of Mexico was a unified effort to improve accountability of the Seguro Popular, the public institution providing health service coverage to people not affiliated to any social security institution. One of the main points of this initiative was the application of sanctions for the misuse of public resources, which range from fines to a jail sentence.
Another initiative we promoted regards prescriptions; with this new reform, when a patient gets a prescription, they should also be presented the option of the generic equivalent. In this way everyone can have the choice between patented and generic drugs according their economic status. Today, the use of generic drugs represents 15 percent of the total market; our goal is to reach 40 percent within the next few years. Of course, we have to consider the quality of generic drugs before taking any step forward; this is why bioequivalence analysis is very important before issuing any laws related to expanding the spread of generic products.
A further victory came with the creation of preventive medical support that takes into consideration factors such as age, gender and geographical area. Another initiative we have been encouraging is the incorporation of information technology in the public healthcare system, such as electronic clinical records to access the medical history of a patient and the electronic birth register.
What are the major challenges the Mexican public healthcare sector faces currently and what should be done to overcome them?
Reaching the highest quality standards is one of the most important challenges we face. Everything we do should gravitate towards providing high-quality healthcare services. We must be able to offer a larger number of medical consultations and waiting times should decrease. Last but not least, we need more specialized medical staff and better drug quality.
We need new legislation to fulfill the promises we have made to millions of Mexicans. The executive and legislative powers must join forces to strengthen public health institutions, and eventually work in particular areas with public-private partnerships to deliver better healthcare services. This alliance must be mutually beneficial and transparent.
Chronic degenerative diseases related to obesity cost the Mexican healthcare system more than USD 4.5 billion. What measures have been implemented to correct this trend?
One of the most concerning issues in our country is obesity. We are encouraging awareness campaigns and programs that start from childhood to make people aware of their eating habits and the need for a balanced, healthy and active lifestyle.
Sales of counterfeit drugs in Mexico are estimated to account for 10 percent of the market. What are priorities to counteract this illicit activity?
We want to get rid of the so-called productos milagro, products promoted with unrealistic medical effects. We are also working very hard to sanction the selling of medical samples, a major problem in Mexico. An important initiative to reduce sales of counterfeit drugs is the implementation of the bi-dimensional holograms, to give a clear idea about the origin and expiration date of a drug.
As vice minister for integration and development in the past government you pushed the functional integration of public institutions to create a universal health system. What was the vision behind this initiative?
Our vision back then was to ensure Mexicans healthcare coverage even if they were not affiliated to an institution. When speaking with the former president of Mexico, Felipe Calderón, we agreed that the only way to reach this objective for the entire population in the long term was to funnel more resources into healthcare. Since the current Mexican healthcare system is fragmented among different institutions (IMSS, ISSSTE and Seguro Popular, amongst others), we proposed the concept of “portability of healthcare services”: any Mexican – employed or unemployed – could go anywhere in the country and get quality healthcare at any institution. Indeed, to make this happen, services throughout the country should be consistent and all institutions need to have access to the patient’s clinical history – that’s why the electronic clinical record plays such an important role. This past October I presented in the Senate a project to reform our Constitution, to create an integrated national healthcare system in Mexico.
How do you think the integration and a more patient-oriented healthcare system can be achieved?
We can reach a high level of efficiency through the outsourcing of medical services to third parties and providers from the private sector. Also, we need to ensure the supply of essential medications, taking advantage of the benefits of generic drugs but without forgetting that R&D is also crucial. We want Mexico to become a leading country in terms of development in the field of medical care. We need efficient drug procurement programs, patent research and supply chains. We must think about every step of the value chain, as every step is as important as the other. And above all, the most important aspect is the final beneficiary: the patient. To make all this happen, we will certainly need a healthcare reform in Mexico.
What are the current priorities on the agenda of the Health Commission?
Our main goal is to have homogeneous clinical practices in all 32 Mexican states, so all diseases can be treated with the same level of expertise. To do so we developed more than 380 guides on good clinical practices and update them on a regular basis. Another priority we have is quantifying the resources of the healthcare sector; we need to ask ourselves questions such as: “How many hospitals do we have?” “What technology do we have available?” “What human resources do we have at our disposal?’”, “What is the bed-occupancy in this or that hospital?” and “How many operations are performed in this or that hospital?” Once we know this, we will be able to know our strengths and our weaknesses, and act accordingly.
What is your vision for the Mexican healthcare sector in the coming five years?
We have learned a lot over the years and we must spare no efforts to give Mexico a world-class healthcare system. But we must not forget the reality of our country; otherwise, we will lose perspective on our capacities and limitations.
I see great opportunities coming from the integration of our health system. Private investment in the sector will be key to help fill infrastructure gaps in the National Health System, provided that everything is regulated by the government. We want to see resources allocated to healthcare to grow between 8-12 percent by 2020. It won’t be easy, but we will work very hard in the coming years to make this a reality.
Mexico has transformed into a country that exports a number of products in healthcare – today we are Latin America’s largest exporter. We are also a cost-competitive manufacturing country – pharmaceutical manufacturing in Mexico is 18.6 percent cheaper than in the US. This is the reason why many companies are coming to Mexico: they know the quality and cost-competitiveness of our manufacturing.
Any personal objective you are working on?
My personal goal is to improve the health of the Mexican population. To get there, we must integrate the whole healthcare system into a coordinated converging force. Everything should be done at a reasonable price and within our own economic boundaries. Everything starts with and derives from good health. In my opinion, health transcends everything else. Yet, as a doctor also specialized in economics, I have learnt to always seek a cost-benefit relationship and this is why we need to focus on every single detail if we want a prosperous future.
Fortunately, our country has understood that health is one of the most important areas you have to invest in to become a better country. We are trying to change the way we approach the healthcare. It is not always a matter of money and resources but a philosophy, a mentality and the willingness to change for the better and evolve into a healthy country.