The incorporation of the IMSS-Bienestar to the challenge of caring for and providing health services to the most marginalized classes in the country, essentially the population without social security, will hardly be successful. It is not a question of a lack of vocation of the institution and its workers, but of a lack of resources.
The accounts simply and simply do not come out, many monetary resources are needed and the sources through which they could be obtained are not seen. Under these conditions, the IMSS-Well-being would not be able to cover the functions of the extinct National Institute of Health for Well-being (INSABI). which, by the way, was born without life because it could never be implemented and is a candidate to be one of the great failures in the history of the federal public administration of Mexico.
The Center for Economic and Budgetary Research (CIEP) made an analysis called “IMSS-Wellness. Budget impact estimate“, in which he exposes the resources that the government should inject to promote the operation of the IMSS-Welfare in conditions of relative efficiency.
There is no sustainable source of resources
The CIEP points out that the IMSS-Bienestar was born with greater challenges than the Institute of Health for Well-being (INSABI) but, like it, it lacks a sustainable source of income.
Thus, the CIEP estimates that the IMSS-Bienestar Decentralized Public Organization needs to invest at least 308 thousand 833 million pesos, a figure that is equivalent to one percent of the national GDPin addition to what is currently allocated to this group of the population without social security.
The aforementioned figure is only an estimate of the budgetary needs of the IMSS, but it would not solve its current operational problems. The CIEP warns that in order to ensure that all people have access to health services and expand the package of services for this sector of the population, it is necessary to increase, yes or yes, the current budget for the health sector. In addition to increasing it year after year, according to the needs of the population and, of course, its growth.
The IMSS-Bienestar program registered as beneficiaries until 2022 with medical-preventive and health promotion services more than 11.7 million people from rural communities in 20 states. But, according to CIEP calculations, in Mexico there are about 73.3 million people who are considered among the population without social securityincorporating them all is something close to impossible.
Thus, the analysis issues one of the first warnings: in the absence of a sustainable source that injects the necessary resources into the health services, the IMSS-Bienestar was born with the same deficiencies as its predecessor, the IMSS-Coplamar, whose results As is obvious, it was a health service delivery system that was insufficient for the needs of the Mexican population.
Budget impact, the key
“Thinking of a universal health system requires talking about financing. Beyond the austerity and efficiency measures, the change in the demographic structure and its impact on the epidemiological transition presents significant challenges for the country’s public finances, which will require investing more in the prevention and care of chronic degenerative diseases, in addition to facing the conditions of adaptation in terms of planetary health”, thus warns the CIEP in its analysis.
The budgetary impact for the moderately efficient operation of the IMSS-Bienestar includes expanding health services since, while the INSABI covered 1,807 interventions, the IMSS-Bienestar includes only 50 public health diseasesthis is barely 0.6 percent of the ordinary IMSS package, which means that there is practically no coverage other than for some conditions, a health service such as the one that is claimed cannot operate in this way, nor can it presume that it is an authentic health service for the marginalized population.
Incorporating millions of Mexicans into health services will be a major challenge, which of course will require large amounts of investment or, in other words, more budget.
According to the figures contained in the CIEP analysis, during the last decade, on average, the IMSS-Benestar program has represented 1.9 percent of the health sector budget. For 2022, a historic increase was approved that represented 67.9 percent more than the amount approved for the previous year. However, these resources were not executed in their entirety and there was an under-exercise of 14.8 percent, something incredible to believe in a country with so many needs in the health sector. The additional 308 thousand 833 million pesos that, as a minimum, are required for the moderately efficient operation of the IMSS-Bienestar, would be the beginning, in reality historical investments are required, which we have never seen in Mexico and that we will hardly see in these generations.
deficiencies everywhere
The CIEP analysis indicates that, during the existence of INSABIthe population without social security almost doubled, going from 15 percent to 28 percent. In contrast, care in the public system decreased, coupled with the fact that the budget for care of highly specialized diseases, such as breast, cervical and infant cancer fell 20 percent while family spending for the purchase of medicines and medical care grew 40 percent.
The previous deficiencies and many more would not disappear with the IMSS-Welfare, mainly due to the lack of resources. The CIEP calculates that even if the per capita expenditure of the ordinary IMSS is assigned to the total target population of the IMSS-Well-being, the current deficiencies would be replicated or deepened and point out that one of the great deficiencies is the care rate, which in 2020 was 32 percent; that means 7 out of 10 people affiliated with the IMSS did not receive care at said institution when they had a health problemand even with that, the IMSS is not enough in the attention of the services that are required, nor in the coverage of medicines and other related activities.
The IMSS-Bienestar program faces enormous challenges in serving a growing population with great needs, which is also aging. But, Without a doubt, the great challenge he faces is that of his own survival.it will not be easy to give it the financial viability it requires.
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