Private health services and Covid-19

Once again, INEGI tirelessly provides data on the Mexican health system. On August 23, he made available to the public the results of the statistics that come from private institutions in 2020. Since the private sector in Mexico is not an easy thing, even in times of emergency, having up-to-date statistics allows us to understand the so-called “organized social response” to the health needs of the population . Rightly, on April 13, 2020, the federal government signed an agreement with private hospitals to boost capacity in the Covid-19 pandemic. About 3,200 beds in private hospitals in the country will be used to care for recipients of IMSS, ISSSTE, Pemex, Navy and National Defense, as well as the open residents of the Institute of Health for Wellbeing, while the entire infrastructure of the public sector will be used to treat people infected with Covid-19.

Besides the controversies caused by the non-payment of some of those involved in the repayment, it would be good to resolve them, or not to include the entire private sector in this agreement; The results presented by INEGI allow us to see the private sector’s participation in the epidemic during 2020 from its own point of view. It should be noted that INEGI obtains the data through an electronic format that is applied every six months to special units that have communication and computers. This selection bias is in addition to the bias from capturing consolidated data rather than individual records. The report for the year 2020 comes from 2,862 institutions distributed over 561 municipalities in the country. If there is anything special about the presence of this sector, it is its focus. 25 municipalities and mayors comprise 30% of the institutions, and these municipalities are the least marginalized in the country.

Compared to the previous year, the private sector represented in these statistics reduced its productivity in outpatient consultations and hospitalization, as well as in the laboratory and cabinet. The table shows the impact of disruption caused directly and indirectly by the Covid-19 pandemic. The services contained in the private sector statistics are shown in the thousands. Except for caesarean sections and deliveries that increased from 2019 to 2020, the rest of the selected services declined to a lesser or greater degree. Family planning visits decreased. Surgeries and trainings in pediatric services as well. Some select treatments are significantly reduced such as peritoneal dialysis or rehabilitation therapies.

Although it does not correspond to the service provided, I have included in the last line of the table the huge increase in deaths recorded in private sector facilities. While in 2019, 17,860 cases were reported, in 2020 the number rose to 27,447, which means an increase in deaths by 53.7 percent. If you compare these numbers with those reported by the National Institute of Statistics, but using death certificates in 2019 it was 34,174 and preliminary figures for 2020 indicate that 48,263 cases occurred in private medical units, which represents an increase in deaths by 42.3 percent. This discrepancy in the report is consistent over time, and since 2004 death certificates have recorded 1.7 times the number of deaths compared to the standard six-month report we mention.

The published statistics also include the main causes of death and hospitalizations in 2020 in private medical units. The number one cause of death in hospital was COVID19 with 5,401 deaths, followed by pneumonia, myocardial infarction and diabetes. An increase in deaths was recorded in all cases compared to the previous year. What does not match, however, is the number of deaths from Covid-19 reported in other sources. For example, the health authority reported through the epidemiological surveillance system SISVER that by 2020, 2418 deaths from positive cases were recorded in hospitals and 347 in private sector outpatient clinics. The difference is greater when the number of deaths from Covid-19 reported by INEGI for the year 2020 is initially verified. 7,468 deaths were recorded in the special medical units. The latter is certainly the most accurate, but being preliminary, no definitive conclusions can be made.

Services provided in private health services in 2019 and 2020

The number one cause of hospital discharge in private hospitals, not counting deaths, in men was Covid-19 (30,521) and in women it is very difficult to compete with deliveries and caesarean sections, but remains among the top ten causes of hospitalization with 21,217. Covid-19 is among the top five in terms of its ability to die (10.2%) and average days of hospital stay (8.3).

Based on the above, it is clear that the private sector plays an important role in emergencies, but not what is its contribution to enhancing the resilience of the health system in Mexico. In the span of 20 months, the pandemic has generated tremendous pressure in all countries of the world, putting the resilience of governments, health systems, all national and international institutions, and all people in every country to the test. By definition, health system resilience consists of the ability to prepare, manage (accommodate, adapt, transform) and learn from crises. Having lived through a previous crisis, this system cannot be considered ready, let alone consider that in the absence of a plan that includes all actors, there will be an organized response.

In addition to the experience of the public sector is the experience of the private sector and the community’s resilience. It is the latter that will determine the pattern to be followed in the following health crises. Doubts are still many, but the important thing is the design and operation of measurement and information systems that allow us to understand the dynamic performance of the health system and manage the multiple crises it has faced; Understand the links between social resilience and health system resilience; Analyze the impact of governance on resilience capacity and understand the impact of the private sector on health system resilience. A complete research and development agenda.

* The author is a professor at the University of Washington.

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