EconomyOffices adjacent to pharmacies, undeniable solution

Offices adjacent to pharmacies, undeniable solution

(Expansión) – Mexico has one of the largest health systems in the world, however it is far from being one of the best, since we rank 62nd as a country according to the RCG Health Index 2021.

Although the reasons for this inefficiency are multifactorial, we will point to three of them in order to propose feasible scenarios for the future of health in Mexico. The rationale behind this analysis assumes an alignment of incentives in the three orders:
1. The budget based on GDP.
2. The coverage rate of physicians per population.
3. The use of the health system by users.

The Public Health System has more than 100 million beneficiaries with a budget amounting to 817,000 million pesos (Public Budget of the Federation 2021-2022). This amount is only equivalent to 3% of GDP, in contrast to the average of 6% of the OECD member countries.

Three institutions (IMSS, ISSSTE and Ministry of Health) take most of the budget, 90% of which is earmarked for health to people (prevention programs and clinical care -including surgeries and medicines), to communities (programs such as vaccination) and generation of human resources (contracts for health personnel). They are good intentions but they are not enough.

Despite the fact that we have more than 350,000 doctors, we only reach a rate of 2.4 doctors per 1,000 inhabitants, contrasting with an average of 3.4 according to the OECD. In addition, there is a brutal asymmetry: while there are cities with a density of doctors greater than 7 professionals per 1,000 inhabitants, there are communities where it does not reach 0.01 doctors per thousand citizens.

To this we add that the 210,000 available general practitioners are not encouraged to pursue a life and career plan as first contact physicians, so the first level of care is unprotected. Although public health institutions have a robust first level of care, the over-demand for services generates deep dissatisfaction in terms of access to appointments and quality.

According to OECD figures, in 2019 only 48% of the population felt satisfied with health services. If we add the post-pandemic effect to this level of dissatisfaction, the use of the private subsystem to solve unmet needs is understood.

According to the National Health and Nutrition Survey (ENSANUT) 2021, of the total number of Mexicans who requested health care, 39% did so at the IMSS and the Ministry of Health and the State Health Systems, contrasting with 50 % who sought care in the private environment. One in five Mexicans was seen in clinics adjacent to pharmacies (CAF)!

The latter is equivalent to 350,000 daily queries that are not made in the public system. In Mexico, out-of-pocket spending reaches a scandalous 48% (ideal 20%). And more notable is that as a consequence of federal policies, among the population that uses public health services there are also levels: while among the beneficiaries of the Pemex health system or the Armed Forces, out-of-pocket spending barely reaches 17%, the same expense for beneficiaries of the IMSS-Well-being exceeds 50%.

Contrary to the official narrative, this use of private sector infrastructure is not the cause of the failure of the system, it is a serious symptom that must be treated urgently, our health system is in intensive care. We cannot imagine the effect that 10 million additional monthly visits could have on the public system from one day to the next.

In Mexico today a proof of concept has been demonstrated: CAFs and private clinics serve thousands of patients who prefer these locations for comfort and efficiency. It is true that the variability of service and infrastructure and level of medical care is significant. The ENSANUT 2021 numbers, however, show us the great opportunity that exists for the public health system to make its operations efficient without having to invest in existing infrastructure.

Today there are already more than 16,000 service points in the country. The centers are already there, the patients already use them. The federal government should seek alliances with experts in the supply chain, warehouses, digital technology and connectivity infrastructure so that, in collaboration with universities, community care nodes/networks could be created, putting the first contact doctor at the center of the clinical operation but with a predictive and preventive approach.

The leading role of the federal government in financing, regulation and accountability with insurmountable anti-corruption systems would be the turnaround that the health system needs.

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Publisher’s Notes:

This column is part of the ‘The Future of Health’ serial .

Fernando Castilleja is an internist and an expert in lifestyle medicine and health innovation. Professor at the Tec de Monterrey School of Medicine for 20 years. Co-founder of NuupHealth and CEO of Genethic Services. Mentor Endeavor, McCombs Business School at UT Austin, HealthIDS and CONACYT Binational Innovation Nodes. Follow him on and/or on .

Juana Ramírez is founder, CEO and Chairwoman of Grupo SOHIN. President of the Warriors Foundation. Entrepreneur Endeavor. President of the Board of Directors of the Association of Entrepreneurs of Mexico. Author of the initiative “Medicine with M for Women”. University professor at UP and IPADE Business School. Follow her on and/or on .

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