Health system challenges towards 2024

Enrique Martinez Moreno, Director General of INEFAM

In the past two months, the Director General of IMSS has been responsible for communicating the progress made on what they called the “Health Plan” that corresponds to the accession process of 23 countries that have signed on to hand over their facilities and equipment for 30 years, as well as how to recruit medical and non-medical staff who urgently need to regularize their jobs. Temporary employment is avoided in the new decentralized public body called IMSS-Wellbeing for the benefit of the population without rights which corresponds largely to its status in informal employment. There are more than 53.2 million people needing care in nearly 14,000 medical units and just over 700 hospitals.

The federalization of its resources aims to achieve universalization of health services, which, in the view of many scholars of the system, is merely centralization as health secretaries will have minimal margins of maneuver to act locally. This requirement is essential for state governors to be aware of possible loopholes and inaccuracies due to lack of standards and operating rules.

Some regulations have been issued recently and lack publication and understanding between the parties, including the statute of the National Office for Democracy issued last September 13 in the Official Gazette of the Federation, which stipulates the integration of its government council with international bodies. The acting secretary, whose primary task is to resolve this situation and determine plans and programmes. This publication indicates that the organization will include four executive units, three coordination and a monitoring body.

The coordination will play an essential role with the states in managing the three tiers of care, including the care of high cost diseases – which with the present government has been absolutely pathetic in its perceived lack of practice and siphoning off huge amounts of money without taking care of the patients. –And, among other things, ensuring the efficient provision of medicines and therapeutic materials, taking into account the good performance of the vaccination programme.

His challenge shows that it will not be possible to strengthen them in 2024, and perhaps they will still be promising again, in contributing to the formation of a better health system than Denmark in March of that year, as López Obrador announced. It won’t be in 2023!

The challenge is even more complex given Guerrero’s bad luck. The impact of Hurricane Otis on Acapulco de Juarez and Coyuca de Benitez left an estimated impact of at least 270 billion pesos, affecting 98% of homes, with

800,000 people live there, and more than 80% of them are hotels (Enki Research estimates). The extent of the destruction is much higher than the budget to be allocated for its reconstruction, which was allocated by the Ministry of Finance and Public Credit on November 1, 61 billion pesos. It is necessary to ensure joint work with private initiative and stimulate investments as soon as possible, given the expected recovery of these municipalities for at least two years.

Such a situation must be taken into account in health spending for the remainder of the year and for 2024. The initiative submitted for the Union Expenditure Budget (PEF) amounts to about 990 billion pesos (mmdp) for next year, which in nominal terms, is 72% higher than the rate set in 2019, with double-digit growth in the last two years and could mean a share of 2.9% in relation to expected GDP in 2024 (Chart 1). On paper, the budget clearly grew very quickly, but in practice it showed notable shortcomings in its practice (Chart 1).

Spending on medicines will be, at a minimum, 102 billion pesos in 2024, to which will be added 13.9 billion pesos from the vaccination program (of this amount, 10 to 12 billion pesos are allocated for procurement), without taking into account the purchase of vaccines against COVID-19 (procurement Abdullah Al-Kubi vaccine is unknown due to the ambiguity surrounding this issue by the federal government). The nominal growth in these expenditures between 2019 and 2024 amounts to more than 36%, which, taking into account the accelerated growth in 2022, the year in which the budget for the purchase of vaccines against Covid-19 was drawn up, the sudden downward adjustment confirms that there is no interest in introducing a vaccination campaign. serious against this new disease in 2023 and not in 2024. This growth, although important, has not been well practiced in recent years, which despite having greater resources, the performance in public procurement has been completely ineffective, as we have indicated on the approximate map (https://inefam.com/mapa-del-desabasto/) and that the general behavior from 2016 to the first half of 2023 is shown in Chart 2, where the year 2023 reflects an index of 50, while the index in the years preceding the current six-year period was about 100. The main milestones that accompany it indicate the presence of a catastrophic reality that has not unprecedented.

In the case of therapeutic materials and medical devices (erroneously called “health supplies”), it may exceed P46.45 billion, a nominal growth of about 40% compared to 2019. This amount should cover comprehensive services, as well as acquisition and maintenance. This sector also faced major problems due to the disruption of public procurement, poor delivery scheduling, and a lack of communication between parties.

Health spending among key institutions is shown in Figure 2, which highlights the nominal growth of more than 15% in the 2024 IMSS budget, and the reduction of the Ministry of Health by more than 56%, transferring its amount to OPD IMSS- Bienestar appeared first in Expenditure Branch 47 with the amount 128.6 billion pesos, to which must be added the federal resources allocated to the states in Section 33, in the amount of 135.6 billion pesos, with which the new OPD we will have 264 million pesos next year, and this, in fact, is less compared to the remainder mentioned at the beginning of this text.

SEDENA and SEMAR achieve the relevant increases, ensuring greater spending for beneficiaries.

During the remainder of the six-year period, a disjointed and fragmented health system will be maintained, with each institution doing everything it can to ensure health services and medicines with marked differences in per capita expenditure (Chart 3) and a long way from ensuring universal access and quality for all. Note the difference between PEMEX beneficiaries compared to IMSS-B OPD + FASSA data of over 79% for 2024.

Health spending among federal entities shows double-digit growth for the most part (Chart 4), linked to the fact that spending not distributed in 2023 is now being distributed in 2024. Guerrero’s government must have more than 17.54 billion pesos and it will not be enough in the face of The urgent need to rebuild its health system. It is the responsibility of the Legislature to make adjustments to access to functional services and access to medications as quickly as possible in light of the unmet needs prior to the hurricane that are now exacerbated by what happened.

The above-mentioned supply map, in a specific consultation on the development of the state of Guerrero, shows that despite a recovery in 2022, it has not been able to sustain itself and even with a noticeable decline in supply so far in 2023 (Chart 3). There are challenges that will undoubtedly be greater, as the Danish dream inexorably declines.