TBY talks to Salomón Chertorivski Woldenberg, the Secretary of Health, on clinical research, reducing the impact of chronic diseases, and the creation of a universal healthcare system.
TBY Your Vision 2030 aims to create an integrated and universal healthcare system, granting access to all Mexicans. What strategy has been implemented by the Secretariat to achieve the goals expressed in your long-term plan?
SALOMÓN CHERTORIVSKI WOLDENBERG The path toward an integrated healthcare system starts with the consolidation of universal coverage so that all Mexicans have guaranteed equal access to high-quality services, regardless of their labor status. This will become a reality in 2012. Additionally, we have worked with the social security institutions to develop clinical guidelines, a single-cost methodology underpinning exchange prices, electronic files in each institution with common characteristics, and a sectoral framework for exchanging services that facilitate the optimal use of public infrastructure through specific agreements in each of the 32 federal entities. There are also general exchange frameworks in operation, such as one concerning obstetric emergencies. Consolidating these efforts will allow for a comprehensive integration of the healthcare system.
What strengths would you identify in Mexico’s healthcare system, especially in terms of infrastructure and human capital quality?
During this administration, Mexico has made significant efforts to expand and consolidate its infrastructure. We are proud of our human resources and can confirm that a great number of our doctors are considered globally competitive. Additionally, we have regularized over 70,000 workers to guarantee that our staff have the best possible working conditions.
How do you strike a balance between dedication to quality standards, pragmatism, and budgetary concerns?
We are proud that the budget for the healthcare sector has been constantly increasing since 2004, particularly with the introduction of the social protection system, Seguro Popular. As a result, health care currently composes almost 7% of GDP. While this is a historical effort, we are still facing challenges in terms of achieving the best use of our resources. Quality is extremely important to obtain real benefits from these efforts, and it will be constantly improved upon. We are thus developing and implementing clinical guidelines as well as guaranteeing evidence-based medicine.
How significant is nanotechnology in Mexico’s healthcare sector?
Nanotechnology is very relevant for the healthcare sector. Promising results in new molecular diagnostic systems such as nanorays, nanopharmaceuticals, cell therapy and tissue regeneration, and nanobiomimetics are key areas in which to conduct medical R&D in the future.
What are Mexico’s strengths in terms of clinical research?
Mexico has 10 national health institutes devoted to medical education, research, and excellence in health care, which comprises the network of public clinics and hospitals across the country. These institutes contribute to R&D in collaboration with public universities. Over 70% of clinical trials occur in public medical units, which is a direct result of our human resource training.
How has the Secretariat worked to create a legal framework that allows the participation of the private sector in the Mexican health system?
The best use of resources has sometimes meant that public health institutions could provide treatments to more patients if they outsource certain services to the private sector. While the federal and local governments are fully responsible for providing health care to the entire population, a variety of services are sometimes bought from private institutions in order to obtain the best possible results. This is completely acceptable within our current legal framework, and remains a possibility.
Mexico ranks first in obesity globally. How is the Secretariat working to reduce the impact of this chronic disease?
A variety of actions have been taken to reduce obesity and its impact. We are promoting care through specialized health clinics offering a multidisciplinary approach, and consolidating prevention campaigns through public media and focusing on children in an effort to promote healthier nutrition in schools. Our aim for healthier life choices started with the available information regarding chronic diseases and their impact. Significant efforts are being made to consolidate preventive actions with the support of organizations such as Consulta Segura, PrevenIMSS, and PrevenISSSTE, as well as teaching the key skills for healthier life choices.
What are your expectations for the generics market in Mexico, taking into account the current income levels of Mexicans? How is the Secretariat ensuring that access to medicines and medical attention is affordable?
Mexico invests much of its resources in medicines, more than similar income countries or our commercial partners in some cases. This effort is necessary to ensure that the best possible pharmaceutical alternatives reach the population. When this is not the case, we are working hard to promote a strong bioequivalent generic market so that medicines are more affordable. Since October 2011, we have accelerated the process to provide pharmaceutical registration for medicines that compete with those that recently lost their patent. This particular action has resulted in around $76 million worth of savings per year, allowing us to treat more patients with the same budget. The impact of this administrative effort has been fairly surprising, and pushes innovator prices down by 50%. Our key challenge is to decrease our out-of-pocket expenditure through fully accessible public services, including free medical attention and medicines.
What is your specific strategy to ensure healthcare access in remote areas of the country?
We have taken several actions to provide health care in remote areas, including the installation of mobile units that reach even the most isolated communities where over 3.5 million Mexicans live. These small locations would not otherwise have permanent health units due to their size. Additionally, we work together with the Opportunities Program to guarantee that health is a pillar toward social development as a whole in most rural areas.
What structural reforms should be implemented to improve the public healthcare sector in Mexico?
The main long-term structural reform regarding health care is a transition toward general tax funding. This would be the last step of our integration-universalization process, and would imply that all Mexicans have equal access to equal services. Our current effort to guarantee coverage and financing is the first step toward equal spending per capita, but the process will be completed when there are no differences in amount or source.
In which ways can a high-level health system boost the performance of Mexico’s economy as a whole?
It has been proven that over one-third of long-term growth can be associated with better health. We are certain that our current investment and efforts will encourage a healthier and more productive workforce that will contribute to overall economic and social development. However, it is not a matter of performance, but a matter of being committed to a comprehensive, high-quality, and sustainable healthcare system for all Mexicans, regardless of income or labor status.
What is your outlook beyond 2012 for the health sector?
The Mexican health sector will achieve universal coverage and higher quality standards through a better use of resources and a comprehensive understanding of the permanent right to health care. Those are the milestones for the creation of a universal healthcare system, based on a wide social protection approach.
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