Health has become the most recent political dispute in Mexico. The start of operations of the National Institute of Health for Welfare (Insabi), the great commitment of the Administration of Andrés Manuel López Obrador to combat the lags in medical care, has unleashed criticism for doubts about its technical feasibility and the absence of rules of operation and secondary legislation. The Insabi replaced the Popular Insurance, created in the Government of Vicente Fox (2000-2006) and continued in two subsequent six-year terms to cover 69 million Mexicans without social security. The Government of Morena defends that Popular Insurance was a fertile field for corruption and abuse against the most vulnerable population, but six former Health secretaries have censored the launch of Insabi, which leaves its beneficiaries in uncertainty. Six opposition governors have refused to implement the new institute in their states.
In Mexico, access to health is a privilege. The country has just 1.7 doctors per 1,000 inhabitants, well below the 3.2 recommended by the Organization for Economic Cooperation and Development (OECD). The health budget is around 5% of GDP, also far from the 9% spent on average by OECD members. There are also major regional differences, aggravated by the centralization of resources and specialists.
The inequalities between the insured population and those without social security are palpable. In a country with more than half of workers in informality, the attention gap between a member of the Armed Forces and a person without coverage is almost three times greater, according to official data. The rural population has access to health similar to that of poor African and Asian countries. "The financial, technical and political obstacles are enormous," warns Laura Flamand, a researcher at the College of Mexico.
That was the context that gave rise to Popular Insurance in 2003. The program charged an annual fee per family according to the income level, which ranged from 240 pesos to 6,000 pesos (approximately 12 to 300 dollars). In return, they were allowed to have access to medical services from a catalog of some 1,600 conditions based on the main needs. Almost 90% of the government subsidy went to the coffers of state governments, which were responsible for hiring doctors and providing care. Over the years, complaints about opacity in money management emerged and criticism for disparities in the health system between rich and poor states grew.
The justification of López Obrador to end the Popular Insurance and launch the Insabi last October was to eradicate corruption and make spending more efficient in line with its austerity policy. But, like many gestures of the Government, it was also a marked line of rupture with the administrations that preceded it. "Politicians selling medicines and doing their August," the president criticized Monday in his morning conference. "That is why the questions also, because it is a transa less, a business that goes away, "he added after announcing the creation of the University of Health to face a deficit of 120,000 doctors.
The opposition has criticized the government's anti-corruption fight. He describes it as demagogic and as a pretext to hide the failure of his policies. A similar discussion took place at the start of its management when it centralized the purchase of medicines, which generated a shortage in some health centers. "There was no hurry to do something right; make a blur and a new account shows a setback," laments Salomón Chertorivski, former Secretary of Health of the Government of Felipe Calderón (2006-2012) and member of the campaign of Ricardo Anaya, former presidential candidate of the PAN.
The promise of Insabi is to achieve universal coverage, recent attention and guarantee treatment by simply presenting an official credential. Some consider this calculation too optimistic. "The Insabi was born without operating rules, without manuals, without a detailed planning of its implementation, without a pilot test phase and without a bigger budget," criticize Chertorivski and Julio Frenk, another former secretary of Health, in a text published in the newspaper Reform, "Insabi: uncertainty that kills". Former officials say the new system has gaps for patients and healthcare workers. "It is said that 'everything' is going to be covered, but under that scheme it is not clear to what extent health can be demanded as a human right," says Flamand.
Six States reject it
"He is doomed to fail," Enrique Alfaro, governor of Jalisco and belonged to the opposition Ciudadano Movement snorted. The States of Aguascalientes, Guanajuato, Tamaulipas, Querétaro and Baja California Sur – governed by the conservative National Action Party – also refuse to adhere to the new framework. The López Obrador Government asks for three months to refine the Insabi operation and trusts that the states will voluntarily adhere. A notable exception is that of the panist Javier Corral, governor of Chihuahua, who said he will join. Another criticism is that the director of Insabi, Juan Ferrer, has no previous experience in the health sector, according to the public version of his curriculum.
"The worrying thing is that health problems cannot be delayed," says Flamand. Two weeks after Insabi started, tens of millions of disaffiliates wonder if they will be treated when they arrive at clinics and hospitals. In the next three months, only former beneficiaries of Popular Insurance with 65 conditions covered by the Protection against Catastrophic Expenses – such as certain types of cancer and cardiovascular diseases in children under 60 years of age – are guaranteed care. The rest is in uncertainty. "We must avoid that there are still people who profit from the desperation of people in the face of a medical emergency, but a broader plan and greater clarity is needed," says the researcher.
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