Resources, Functions, and Obscurity: Doubts about the Well-Being of IMSS

September 1st is officially created and by decree President of the Republic, Andrés Manuel Lopez Obrador, Decentralized Public Authority (OPD) IMSS- Well-being, A public institution with legal personality (the ability to self-govern) and its own assets.

This means that you will be able to sign agreements and enter into agreements without relying on a higher authority and you will have the infrastructure, personnel and everything you need to serve the target population: Who does not have social security.

In this way a new enterprise is born to replace National Institute of Health for Wellbeing (Insabi)whose main function is only to take care of residents who do not have social security and they are also outpatients, although they are divided into the Ministry of Health.

The problem is that there are two decentralized agencies, one by decree, the other by public health law, with the same mission, explains David Sánchez Mejía, a specialist in law and public health.

The Public Health Act states that it will be Insabi who will take care of the population without social security, and that is unless it is reformed, so, with the decree, it appears that there will be two institutions dedicated to it, agrees Juan Ortiz, public administration specialist and director magnifying glassa digital project to explain to the public what the government does and how it does it.

Health law reform is necessary to avoid duplication and to clarify what Insabi will do and what its scope is. But not only that, says David Sanchez Mejia, but reform of this law will also be necessary because it focuses on federalism and what they want to do now is move to centralization.

To work, IMSS-Well-Welfare will sign agreements with countries that wish to join it (so far 15 have already said they will) and that it will transfer its infrastructure and personnel there. Here is another problem, because so far there are countries that have signed agreements with Insabi, and there are other countries (eight in total), such as Nayarit, Colima and Tlaxcala, that have signed agreements, since February, with regular IMSS and IMSS and now there are others who will sign with them with IMSS- Wellness.

“Here it is unknown and the decree does not say whether the normal IMSS system will transfer to IMSS-Well-being the infrastructure and personnel that countries with which the agreements have already signed agreements have already transferred or what will happen with this,” says Sanchez Mejia.

What the decree says is that caring for the population without social security, the IMSS Welfare will provide them with the financial, material, human, financial and infrastructural resources transferred by the governments of the federated entities, with the resources of the FASSA (the Fund for contributions to health services), as well as with the federal resources to be determined (from Among them, it was not clarified in the decree what it will be and the amount of the amount).

Read more | With insufficient budget, IMSS-Wellness faces the challenge of serving 60 million people

Again the resource problem

And again, as with Insabi, there is no talk of an increase in the budget to serve a larger population than has already been provided and with greater services, says Judith Siniasen-Mendez, health and finance coordinator at the Center for Economic Research and Budget (CIEP).

In addition, the analyst adds, he did not say whether the third level of care, the level provided by highly specialized hospitals and institutes where diseases and more complex health requirements are treated, will be included. Only the first and second level are mentioned, which includes only the basic medical specialties: pediatrics, gynecology, internal medicine, surgery, anesthesiology and emergencies.

A positive part of the ordinance, Siniasen Mendes says, is that IMSS-Well-Well will have a monitoring body appointed by the Ministry of Public Administration (SFP), which, among other tasks, will monitor resource management, which may carry out audits and recommend preventive and corrective measures, which in short That would make the resource transparent and efficient.

But, as the analyst notes, “we must be aware of the 2023 economic package offer to see if the creation of the IMSS-Well-Wellness is accompanied by the necessary budget to do its job.”

And the specialists point out another thing to watch out for, which is what will happen with the Health Welfare Fund (Fonsabi), before (with the popular insurance that dissolved this institute) the fund to protect against catastrophic expenditures.

Alfonsabi is not mentioned anywhere in the decree, so it is not known what will happen to him, as the specialists point out, what is reported is that IMSS-Well-Well will be able to form a (other) credit, should it be necessary, but no further details are provided .

Another aspect that specialists see as problematic is that no diagnosis has been made (which is not part of the decree) as to why Insabi has failed in its task of identifying all this and drawing attention to the population unaffiliated with health institutions, and no mention is made of how IMSS-Well-Well will now work in this task.

“Every time they talk about the progress that’s already been made in states where the IMSS-Well-Well system actually works, the authorities talk about the diagnosis they’ve made in every state, but that’s not public, other than what is said at the president’s morning conferences, we don’t know Whether priority is given to those who need it most, and there is no diagnosis for everyone, which also allows us to know how much budget is required,” says Siniacin Mendez.

With regard to how this new office will operate, the decree states that it will have a Director General, who will be appointed by the President of the Republic, an Administrative Board made up of the President of the Mexican Institute of Social Security, who will head and vote for it, and the heads of the Ministry of Health, the Ministry of Finance and Public Credit and the Ministry of Labor and Welfare Social ; The Welfare Secretariat, the four regulatory bodies of the Mexican Institute of Social Security, appointed by the person in charge of the General Directorate, and a representative of the majority union to which the workers are affiliated.

The Board of Directors must be appointed no later than three calendar days after the decree was published (30 September 2022). The term of the Articles of Association shall be determined within a period not exceeding sixty calendar days from the inauguration of the Board of Directors (November 30, 2022).

This body may enter into cooperation agreements with IMSS in such matters as: planning, management, personnel, financial and legal matters, training and evaluation. Its base of operations will be in Mexico City, but it may have representative offices in states or regions, but as long as this does not increase the budget.

Rules for receiving movable and immovable property from federal entities with which they celebrate coordination agreements must be published within 90 days after the statute was issued (February 28, 2023).