Consolidate IMSS-Bienestar

Transferring health services from 23 states to the new IMSS-Bienestar organization in political, administrative and labor terms has been a great first step in a process that still has challenges ahead to guarantee the operation of medical services and the certainty that people will receive quality and free medical care. The first thing, says Zoé Robledo Aburto, is that each doctor’s office and pharmacy have a computer, which is practically non-existent at present, and to complete the staff of specialist doctors in hospitals. The latter will soon be resolved with the Cuban doctors who have begun to arrive in the country as part of the expansion of the agreement between Mexico and Cuba to have 3,800 additional to the 1,200 who already work in health centers and hospitals destined to care for people without social security.

In an interview with La Jornada, after Claudia Sheinbaum, virtual president-elect, announced her ratification as director of the Mexican Social Security Institute (IMSS) and responsible for the consolidation of IMSS-Bienestar, Robledo gives an account of what has been done, the challenges and how, despite omens and criticisms of the new scheme, it is possible to offer a new health model that reverses the medicalization and hyper-hospitalization that occurred for more than 40 years, as well as the silent privatization with Seguro Popular.

An example of this is the lack of categories of hygiene, cleaning and laundry workers, vital services in any hospital, which are in private hands.

After two years of working with the entities that agreed to join IMSS-Bienestar, the official has full knowledge of the situation of health services and inevitably of the differences with social security.

The talk follows.

–What is missing from IMSS-Bienestar?

–The first big step was the political, administrative and labour part. Next comes the installation of the computer system and ensuring that the quality of care is the same in all states. Any attempt at universalisation should have started with this.

“There are nine states left, although the governor-elect of Yucatan, Joaquin Diaz Mena, has already announced that the state will join IMSS-Bienestar. We will see with Guanajuato and Jalisco, where there will be new governors. We have been in talks with Aguascalientes, Coahuila and Durango.

“IMSS-Bienestar will complete two years as a decentralized public organization and we are in 23 states with 11,900 health centers, 635 general hospitals and 66 specialty hospitals. The adaptation of the IMSS computer platform has already begun to have the clinical records, the inventories of warehouses and pharmacies and the level of prescription filling.

The most important thing is that the staff adopt the technology for their work. That will cost money, as it happened at IMSS. You can have the computer and the system, but if the doctor doesn’t use it, it’s useless. So there is a huge training task ahead.

Robledo highlights the advantages of the IMSS computer system being its property. It does not have to pay for licenses for use, nor does it depend on individuals to ensure the operation of the services and now engineers can develop a specific platform for IMSS-Bienestar.

He shows the advantages that his experience at the IMSS has given him to transfer to the new organization. Another element that will be copied are the family doctors, who do not exist in the health centers of the states.

These units have been staffed by general practitioners at best. There were 700 in rural areas that lacked such staff. At best, there were nursing staff or medical interns.

–When will Mexico have quality medical services for people without social security?

–Services must be considered in three dimensions: quality linked to coverage, timeliness of services and free of charge, as in Denmark, a public service focused on prevention, without interference from private individuals. In Mexico we are moving towards having a single catalog of medicines. With consolidated purchases there will be the same supplies everywhere and in the volumes needed to ensure timely access to treatments. The third element is free of charge, which previously, with Seguro Popular, did not exist and even less so in hemodialysis therapies for people with chronic kidney disease; nor for cardiac interventions performed in hemodynamics rooms. Patients also did not have access to radiotherapy to combat any type of cancer. With IMSS-Bienestar all types of therapies will be available.

The head of the Social Security during the interview. Photo Maria Luisa Severiano

–What happened with the hiring of doctors?

–There is a 30 percent shortage of specialists in the workforce and the need for family doctors in health centers, like in the IMSS. That is one of the big differences with social security. They are specialists to see all stages of a person’s life. In health centers, general doctors make a great effort, but they do not have sufficient tools and this is important, because 80 percent of the illnesses can be resolved there. In the states, only 5 percent are family doctors.

“We are also trying to get health centres to operate from Monday to Sunday. This is already the case in 5,000 out of 8,000 clinic units. There were 700 in the most remote areas, which did not even have a general practitioner.

“The calls for applications have already filled all the places at the first level.

Three thousand general practitioners were hired for two years; they will then be able to apply for a permanent position and in the meantime, they can prepare and earn a point in the National Medical Residency Exam.

–Is this lag related to the fact that rural areas have always been at the back of the pack when it comes to health policy?

–We did it backwards, starting from the periphery towards the center in hiring, even for specialists, because we found 282 hospitals in rural areas that had, on average, four doctors from the six core specialties that should not be missing: surgeon, anesthesiologist, pediatrician, gynecologist, internal medicine and emergency medicine.

“These comprehensive community hospitals were built during the Seguro Popular (Popular Insurance) regime. They have an operating room, but they do not perform surgeries; they have an outpatient area, but without doctors.

“We proposed to President López Obrador to provide them with specialist doctors or to convert them into health centers with expanded services. They are in areas of very high marginalization, where doctors do not want to go. It was decided to hire and offer permanent positions with a bonus of 10 thousand pesos. The response was good, but there were vacant positions. That is where the Cubans came in, with whom 70 percent of the total staff of the 282 hospitals was completed.

–How will the missing 30 percent of doctors be covered?

–With the Cuban doctors who are already arriving as part of the agreement with the island. If there is a proposal from Mexican doctors, we take it immediately, but the reality is that there is no one who wants to go to those hospitals that have, on average, 20 beds, an expulsion room, five consulting rooms and a small emergency area.

“Cuban doctors have helped with this, around 600; another 600 are in general hospitals and 3,800 more are coming.

We assume that the building is needed and must function as a hospital, although there are also situations such as in San José del Rincón, state of Mexico, where two hospitals for the general population were built on the same street almost at the same time.

–Regarding the computer system, it took several years for IMSS to achieve this. How will it be done in IMSS-Bienestar?

–By September we will have 50 thousand units operating in most of the 38 thousand health center clinics and pharmacies. Also in warehouses and hospitals in a system interconnected with state coordination and the central level of IMSS-Bienestar. It is the only way to have control of the inflow and outflow of medicines –which does not exist today– and to see how the supply moves so that all prescriptions are filled. The next challenge is the adoption of the system by the staff; that will take more time.