The federal government is determined to cancel in the coming months 35 Official Mexican Standards (NOMs) that regulate quality, and various standards that must be followed in all health services provided in Mexico, both in public and private institutions, with which -in general terms- it is not ruled out that there could be a greater deterioration in this sector .
The NOMs are legal provisions of a technical nature, of obligatory observance, whose objective is to regulate the way in which certain processes or services must be carried out. When it comes to the rules that govern the health system, these guarantee homogeneous criteria for disease care.
In this case, the regulations that the Ministry of Health intends to cancel, as announced in the Official Gazette of the Federation (DOF) on June 1, are those that establish how medical care should be provided for conditions such as diabetes, high blood pressure, prostate cancer, osteoporosis, cervical cancer, breast cancer, cholera, and sexually transmitted infectionsamong other ailments.
In interview with HIGH LEVEL, the doctor and lawyer Angel Gutierrez considers that the problem itself is not the elimination of these standards, which are even outdated, but the secrecy shown by the authority, since the Ministry of Health has not justified whether the NOMs will be replaced.
“The fact that they are going to be eliminated like this per sewithout any plan, it’s wrong, but if they are going to be eliminated by providing for other mechanisms to guarantee health care, then that’s fine, the problem I see is that the situation in this sense is not entirely clear, its elimination is simply proposed without saying how certain regulatory details are going to be corrected ”, emphasizes.
found positions
Most of the Mexican Medical Colleges and Academies, as well as health policy experts, have warned that These rules are necessary. because the NOMs that they want to cancel ensure that all patients in the country have the same type of diagnosis and treatment, regardless of whether the person goes to the public sector or private medicine.
The doctor and analyst Xavier Tello He pointed out that the current federal government wants to move from evidence-based medicine to one that is based on stocks. That is to say, “They want to institutionalize this, that medicine be done with what there is, and that by taking what is there, there is no regulation for which someone can have a responsibility”.
“Without standards of care, the diagnosis and treatment that patients receive will be what (the Undersecretary of Health Hugo López Gatell) decides,” since these NOMs, by establishing a minimum obligation, due to costs, public health institutions “do not they are able to offer at this time”, lamented Tello.
Certainly, if only the content of the 35 NOMs whose cancellation was announced last month is taken into account, when the elimination process is completed, people who have no possibility of receiving care outside of public health could be affected, by ceasing to there are minimum guidelines for diagnosing and treating serious illnesses.
For example, the rule on breast cancer addresses everything from detection methods to the treatments that must be applied according to the type of tumor that occurs due to this condition that, in 2021, caused the death of 7,973 Mexican women, according to data from the National Institute of Statistics and Geography (INEGI).
It should be clarified that This does not mean that institutions and/or doctors will stop having a legal responsibility in terms of the services they provide, nor that they cannot be sued in case of negligence, since the General Health Law, which -hierarchically- is superior to any Official Mexican Standard, as well as article 4 of the Constitution, will continue to be the foundations for demanding quality health care.
Companies vs public policy
The 35 official standards that are trying to be suppressed “are the ones that regulate around 90% of the burden of disease that exists” in our country, explained the doctor and legislator. Ector Jaime Ramirez Barba, Secretary of the Health Commission of the Chamber of Deputies.
“With this measure The López Obrador government will shake off the obligation to provide regulated care to patients who suffer from the main diseases, such as diabetes, cancer, hypertension or obesity”, added the deputy of the National Action Party.
When the Undersecretary of Health was asked, Hugo Lopez Gatell, Regarding the government’s rationale for canceling these NOMs, the official said that “it is not necessary to have Official Norms or the equivalent to regulate the prescription, the therapeutics, (and) the diagnosis of each one of the diseases.”
According to López Gatell, in Mexico “comprehensive medical care has always been provided to cover these 35 or more diseases, and to provide comprehensive care to people.”
The Undersecretary of Health added, in one of the president’s morning conferences, that the cancellation of the regulations “is an issue that they have wanted to make big.” the medicine merchants, there are true mafias in everything related to the medical sector, Not only in Mexico, in the world, those of the laboratories are very powerful interests, those that traffic with the diseases and with the pain of the people”.
For his part, in a recent virtual conference organized by the National Academy of Medicine, the doctor of law Carlos Fernando Matute González He pointed out that there is “an evident contempt” on the part of the current federal administration to apply the regulations that are not necessarily made 100% by the government.
As they are technical regulations, the NOMs of the health sector require not only the intervention of the authorities, but also the contributions and consensus of other actors, including scientists and companies.
Unlike the general laws that are made abstractly in the Legislative powers, the technical norms -such as the NOMs- are elaborated from the experience and professional opinions of the sector they regulate, and from the practical application of scientific knowledge in specific sociodemographic contexts. For this reason, the NOMs must be reviewed periodically.
In fact, its cancellation, on some occasions, is not entirely negative, reiterated Ángel Gutiérrez, who as a practicing doctor ensures that doctors in the public sector comply with their obligation to diagnose and treat conditions, regardless of whether or not Official Standards exist.
“Overregulation is not positive either, since we see people and not diseases, and each patient must be treated according to their particular conditions,” concluded Gutiérrez.
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surya palaces Journalist and lawyer, specialist in legal analysis and human rights. She has been a reporter, radio host and editor.