Mexico Health Summit 2016 and the concurrent launch of Mexico Health Review 2016 was without a doubt a resounding success. More than 150 guests filled the independence hall at the Sheraton Maria Isabel hotel in Mexico City to hear industry expert views on Mexico's health industry. Furthermore, this event created the perfect opportunity for guests to develop new business relationships with fellow industry members.
Better Regulation for Better Health Access
Improved processes and a speedier regulatory system are allowing Mexico better and more affordable access to medicines and treatments thanks to COFEPRIS, Juan Gallaga, Commissioner for Sanitary Authorization, said at the start of the Mexico Health Summit 2016.
In his opening remarks, Gallaga introduced the role of COFEPRIS in Mexico, explaining that it is present in many sectors of the economy, especially pharmaceuticals. Gallaga emphasized the importance of the pharma business for the Mexican economy. “Certainty in business is important for investment in Mexico,” he said. Products approved by COFEPRIS represent 9.8 percent of GDP while those regulated by the agency are 10.4 percent of exterior commerce.
Gallaga provided an overview of the most vital regulations created and updated by COFEPRIS since its inception in 2001. He explained the areas of pharma the regulatory commission is involved in and the role it has given to authorized third parties, of which there are 19 in Mexico and which have greatly helped in clearing the backlog of pending registrations. “We are going to see in which other ways we can use these to the benefit of the industry and the authorities,” he said.
Although health spending between 2008 and 2012 rose 64 percent, there has been an almost equal reduction in prices. This has been possible thanks to generics and the evolution of their regulation. “The savings have meant we can tend to more patients, especially through social security,” he said, adding that generics have managed to drop prices on average 61 percent. The greatest reductions have been achieved in important areas such as cardiovascular (90 percent), cancer (82 percent) and diabetes (91 percent). “One of the main costs incurred by health systems is in the purchase of medicine.”
Gallaga said this has helped other Central and South American countries who follow COFEPRIS’ register. The institution has agreements with seven countries including Colombia, Ecuador, El Salvador, Chile, Panama, Belize and Costa Rica.
COFEPRIS has also introduced regulations for biotechnological drugs, a sector gaining importance in the pharma industry. The Commissioner said that 35 percent of new drugs registered are biotechnologicals. Regulation in this area began in 2009 and is still evolving. Only last December, NOM 257 was published concerning the regulation of biotechnological medication.
Gallaga reiterated the government is focusing on a policy of innovation and has agreements of equivalence with the US, Canada, Australia, Switzerland and the EU. These mean that devices approved in the US, Canada and Japan will take only 30 days to gain approval in Mexico. The Agreement for the Promotion of Innovation allows new molecules to be approved within 60 days.
Some medical devices and other products have also been deregulated, Gallaga said. COFEPRIS has removed items from its list in two stages, disposing of 1,669 devices in the first phase and 2,242 in the second. “Previously, even toothpaste needed to be registered,” Gallaga said.
COFEPRIS was approved as a regulatory body by WHO in 2014, which entailed a greater production of vaccines in Mexico, mostly those for influenza, diphtheria and tetanus.
The pharma market in Mexico has come a long way, Gallaga concluded, stressing the importance of transparency in the governing health institutions. “There is a link between efficiency and transparency in healthcare,” he said.
Beds for Everyone – Sharing the Burden
A looming lack of access to healthcare is hovering over Mexico even as many public and private hospitals have idle infrastructure, but opportunities will emerge for investment to improve medical care and prevention, according to Mexico Health Summit 2016’s first panel, “Beds for Everyone – Sharing the Burden.” The panel offered differing views on the root cause of the problem. Jaime Cervantes, CEO of Grupo Vitalmex, said that income inequality was to blame but Alejandro Alfonso, CEO of ABC Hospitals, suggested it was the absence of information in medical issues, which causes an inefficient use of services. “The main problem is that Mexico is facing a duplication of infrastructure and services,” he said. Alfonso added that this highlighted the need for better information systems to tackle the problem.
Health authorities must also study today’s problems to find a fix for the future, suggested Guillaume Corpart, Managing Director of Global Health Intelligence. “It is necessary to make a comprehensive analysis of today’s situation and how it will change in the future.” He showed concern about Mexico’s aging population and Mexico’s shifting demographics because “today’s solutions will not help in 30 years.”
A possible strategy to address an aging population and also avoid hospital saturation and increase efficiency is home care, said moderator Antonio Prida, Founding Partner of Curtis Mallet-Prevost Abogados. Corpart agreed. “Addressing an older population through home care is a more efficient solution as hospital infrastructure for all of them is too expensive.” He also suggested Mexico should emulate Brazil, Chile and Colombia, which are making great progress in home care. Cervantes concurred and proposed another example being implemented in India: an app which puts doctors and patients in immediate contact without the need for either to visit a hospital.
The panelists agreed there was an across-the-board need for better cooperation, which was being hampered by the lack of homogenization. Expanding on the impact of income inequality, Alfonso said that programs public and private institutions are developing, such as “Salud Digna,” are designed to complement the healthcare system but these different projects need to be homogenized.
Lack of homogenization made coordinating efforts difficult, Corpart added, highlighting the deficiencies in coordinating public systems and in cooperation between the public and private sectors. Alfonso agreed on the importance of this collaboration and pointed out a key problem: “Bureaucracy is the great impediment to this collaboration,” he said. Inconsistency is another issue hampering the system. “There are great inconsistencies within the 14 healthcare systems,” Cervantes said. “The government should homologate them to create an equal base for collaboration.” Homologation could have other positive repercussions, Corpart added, pointing out the relevance of homologation to increasing portability across healthcare systems, something that could be improved through electronic means.
In response to an audience member, Prida questioned the role of Public-Private Partnerships (PPPs) to build hospitals. Alfonso said this was not only possible but is already being done, adding that “in my experience these collaborations are not being used appropriately.” While he praised the formula, he suggested the existing model for collaboration needed improving for these partnerships to be truly successful.
The panel concluded with all members in agreement of the size of the challenge. “We need to work on establishing a long-term model,” said Alfonso. He restated the importance of generating solutions for the problem: “We are facing an enormous challenge from an aging population and chronic diseases, which will only worsen in 20 years.”
Delivering Healthcare to the Mexican Megalopolis
Mexico City is the world’s sixth most populated city when considering the metropolitan area in addition to the city proper. There are a staggering 5,920 inhabitants per km2 and the city’s Ministry of Health faces great challenges, including demographics. Life expectancy for Mexicans has increased but many are getting sicker despite wanting a better quality of life. “We want to be fitter for a longer period of time, both physically and mentally,” said Román Rosales, deputy minister of Health of Mexico City at the Mexico Health Summit 2016.
Sedentary routines, alcohol and tobacco consumption all affect Mexican lifestyles and contribute to bad health. Although infectious diseases are still an important cause of illness, Mexico’s main concerns are chronic diseases. Hyperglycemia and obesity are still ranked one and two but hypertension and glaucoma are rising through the ranks. In Mexico City, respiratory diseases are the first cause of illness, which is not a surprise when considering the frequently high levels of air pollution.
Rosales said the city is equipped to deal with this through 210 health centers integrated into its system, of which 100 are at a primary care level, 46 at the secondary and 64 tertiary centers. There are also 33 hospitals in the metropolitan area with a variety of specializations. There are 32,157 people working in the Mexico City health system.
The Médico en tu Casa program is responsible for visiting vulnerable groups in their homes. It has detected many pregnant women that had never been to the hospital for antenatal checkups, many of which are also children and adolescents. The program had visited 2.4 million homes in the populous Iztapalapa neighborhood alone by September 1, 2016.
“We are extremely interested in the participation of the public in looking after their own health,” the deputy minister said. The Ministry is placing a bigger focus on prevention. It has 12 early detection clinics in Metro stations and two more in the Central de Abasto, the city’s main wholesale market. These provide free checkups for people going about their daily business, important as people are reluctant to go for checkups.
The city is campaigning for the reduction of salt in food and has also supported the sugar tax and the traffic light system on food packaging. Diabetes is the affliction that has increased the most since 1985. It is estimated that 76.6 percent of years of life lost in 2013 were caused by this condition.
Added to these issues, 56 percent of the metropolitan population does not have social security and even those who do still opt to pay for private services, according to Rosales. He explained that the city’s Ministry of Health strives to offer healthcare to those who do not have social security, most importantly those considered as the most vulnerable groups of society: children and adolescents, the disabled, mothers as sole breadwinners of families, indigenous populations, the imprisoned population, the elderly, the LGBT population and homeless people.
“Fifty percent of children between the ages of 10-14 do not perform any type of physical activity. sixty seven percent of them spend more than two hours a day watching television,” he said. This contributes to overweight and obese children. “We are approaching 40 percent obesity in adults between 20 and 50,” he added.
The Ministry is also working on the reduction of tobacco use and maintains programs like the weekly Ciclotón and is campaigning to keep children in school full time. It is creating urban gyms and has implemented the Ecobici program to encourage outdoor exercise.
“We are working on educating youngsters and adolescents on health instead of waiting for them to become ill,” Rosales said. For this the city’s Ministry of Health is distributing books and leaflets that teach good practices in nutrition and exercise, and providing sexual education to avoid pregnancies in children and adolescents. “To prevent and change lifestyles we need an informed population that has access to healthcare services, no matter through which means,” he concluded.
The road to a healthier Mexico – Tackling the obesity crisis
Mexico has the dubious honor of ranking first in the world for overweight and obesity rates, a preventable but concerning problem for its population that a broad panel of experts discussed at Mexico Health Summit 2016. This is a growing problem that will impact all sectors as hundreds of millions of pesos will be spent to address obesity in upcoming years, said Carlos López, Director General of Productos Medix, while Ricardo Mújica, Executive Director of Fundación Carlos Slim, added the condition can lead to many other diseases, from diabetes to metabolic syndrome.
“What is behind the crisis?” asked Maria Eugenia Méndez, Senior Strategy Manager at Deloitte and moderator of the Road to a Healthier Mexico – Tackling the Obesity Crisis panel at the Mexico Health Summit 2016 López explained the problem has its roots in bad eating habits, as the Mexican diet is based on carbohydrates and fats and is heavily influenced by the US, compounded with a lack of physical activity. Fabián Bifaretti, Director General of Sports World, agreed on the importance of physical activity as a means to reduce obesity. He highlighted the importance of programs that create awareness on the dangers of a sedentary life.
Prevention is paramount and campaigns to create awareness are an essential step to tackle the problem. The sugar tax is another initiative in the battle, which López said was not aimed at reducing soda consumption but, rather, to fund other healthcare programs.
Both public and private institutions are launching initiatives but there is much room for improvement. “Chécate, Mídete, Muévete” is probably the most famous campaign aimed at increasing prevention and private institutions such as Fundación Carlos Slim and Sports World are cooperating.
“It is necessary to increase integration among the public and private sectors to fully address this problem,” Bifaretti said. He also focused on the role of education at universities and at home, especially at a young age.
The main challenge seems to be to change the population’s habits, Méndez said. “The hardest thing to change is behavior and socioeconomic problems complicate this further,” she said, recalling the infamous “Gansito y Coca” (Cake and Soda) diet, popular among low-income children. These habits will have a long-lasting impact. As Mújica explained, today’s parents are facing an unprecedented situation - for the first time this generation’s lifespan will be shorter than the previous one.
While all actors must be involved in the eradication of obesity, “individuals will be the ones who take the final action on their health,” said Mújica. López added that many programs have helped battle the disease, as “Mexico has managed to slow its obesity growth rate to 11 percent between 2006 and 2012, but this condition is still growing and we are still far from a solution.”
The general feeling across the panel was that obesity would only continue to grow unless directly addressed. While they praised existing measures to deal with the issue, they highlighted the need for more action and exhorted the audience to think of solutions. Said López: “Ask yourself, what are you doing to address this fundamental problem?”
Research and prevention to reach a better healthcare service
The Mexican healthcare system is improving through increased research protocols facilitated by regulatory changes and prevention strategies like vaccine production but there is still room for improvement in education, alliances and reducing approval times for medicines and treatments, according to the panel “Improving health through research and prevention strategies” at Mexico Health Summit 2016, Cecilia Moreno, head of Clinical Operations at PPD, told the audience that over the past few years Mexico has grown in the development of vaccines, a basic prevention strategy. “Mexico’smain participation is in dengue fever and HPV prevention,” she said, adding that having Mexican patients participate in clinical trials is important for the country’s private and public industry.
Moreno added that Mexican regulation on research is very well established but regulatory times are too long, which represents an obstacle for the industry. Mexico´s large population is an opportunity to carry out trials and many companies are interested. “We are working on it with the authorities to have more competitive studies,” said Moreno. Companies like Novartis, said Alexis Serlin, President of Novartis Mexico, are working with COFEPRIS to reduce those times.
Gabriela Allard, President of the Mexican Diabetes Association, said education was a primary step for prevention. “Besides having great studies, technology and treatments, it is important to have committed patients, which is only possible with education.” The objective of the Mexican Diabetes Association, she explained, is to create healthy environments in companies, restaurants and institutions. “We need to have an inclusive society. If companies include healthy environments, it is possible to reduce the number of workers who have diseases.” The Association has developed an app that helps patients manage their disease.
Novartis’ Serlin said the drug industry must go beyond just providing medications and partner with the health system to improve patients’ lives. Novartis has started a disease management program that researches the main causes of illnesses. It also helped create “Excellence Centers” in institutions to regulate patient treatments. “We bring in experts from other sectors to spend time with us and get to know what we do and adopt it in their institutions. We have seen that what moves change in the patient is the family and work environment, not only the treatment,” Serlin added.
Rogelio Villareal, Director General of the Centro de Oftalmología de Monterrey, mentioned the importance of establishing alliances to offer better services. That is the case of the project he is developing with Monterrey’s ITESM, the government, social organizations and the private sector. Together they are looking for prevention strategies for eye diseases. “Through these we have found an interesting relation between research, innovation and prevalence,” he said.
Allard mentioned that there is a challenge when patients ask about the newest medical innovations and best treatments. “For us the patient has the right to the best education and information and that is our responsibility,” she said.
The conversation was moderated by Christian López, partner and head of Life and Science at Baker and McKenzie.
Prioritizing Healthcare on the Economic Agenda
Life expectancy in Mexico has increased drastically due to many advances and programs. “Simple schemes like vaccination programs have had a drastic impact,” said Miguel Lombera, President of the Mexican Society of Public Healthcare and moderator of the fourth panel of Mexico Health Summit 2016, Prioritizing Healthcare on the Economic Agenda. But longer lives are beset by degenerative chronic diseases.
Mexico invests less of its GDP in healthcare than most other OECD countries, showing up third from last on the list. Xavier Valdéz, Director General of IMS Health, said that Mexico “needs to invest more or optimize resources,” and emphasized the importance of choosing drugs for their effectiveness over their cost. “We should be talking more and more profoundly about access to medicine,” he said.
The country’s healthcare system is also important for promoting Mexico internationally, said Blanca Mendoza, Health Director at ProMéxico, “The health sector is a priority for the Ministry of Economy and ProMéxico,” she said. “The organization and the government are aware of the importance of the health sector in promoting Mexico abroad.” She stressed the importance of communication between different areas to optimize care. The healthcare sector is aided by the agreements spearheaded by ProMéxico with other countries as they enable Mexico to export its medical devices and pharmaceutical products.
Lombera asked José Alarcón Lead Healthcare Partner of PwC Mexico to give his opinion on optimization of public resources. “There are PPPs in which the private sector gives a service that corresponds to the public sector. These agreements allow the two to share risks, with the private sector taking on the financial risk while the public sector operates the hospital,” he said. Alarcón explained that in 2014 there were 296 PPP hospitals operating worldwide. Of these, the UK had the most with 113, Canada came in second place with 56 and Australia in third with 16. On this list, Mexico is in joint fifth place with the US at six PPP-operated hospitals. Those six hospitals have an accumulated CAPEX of US$455million. Alarcón added that there are six further PPP hospitals authorized, which will bring Mexico’s total to 12.
PPPs in social infrastructure are increasingly a topic of conversation as the health sector has not been immune to widespread federal budget cuts. Cristóbal Thompson, Executive Director of AMIIF, said that “there were MX$9 billion in cuts to the healthcare budget last year, in addition to being third worst in investment in health in terms of GDP.” Efficiencies are needed to improve healthcare in the short term, which would also counteract budget cuts, he said.
“It is clear that health is vital for Mexico’s competitiveness,” he added. A study AMIIF participated in, carried out by the US Chamber of Commerce, measured the productivity cost tied to health issues. It determined that in 2013 it was 6.3 percent of GDP. “It is important to have a system that gives the results needed.”
Lombera also emphasized the inexpensiveness of prevention over cure. “We need to mitigate the cost of hospital and tertiary healthcare through improving primary care and prevention,” he said.
A member from the audience pointed out that it is not the amount of money spent on healthcare that matters but the structure of the spending. “We all have an important role to play in this sector and we are all responsible,” ProMéxico’s Mendoza added. “We need to be more efficient and innovating.”
Alarcón pointed out the need to maintain efforts. “In Mexico in 2008, 228 clinical trials were carried out. By 2014 this number had dropped to 129.” He added that Puerto Rico has managed to increase its income in R&D and is a model to follow.
Data and technology at the service of healthcare
The benefits of technology are numerous for physicians and patients alike and the Mexican healthcare system is no different. “New technological developments are empowering doctors, nurses and patients,” said Angela Spatharou, Partner at McKinsey & Company, during the Data and Technology at the Service of Healthcare panel at Mexico Health Summit 2016.
Technological developments in the healthcare system can be grouped into areas like data analytics and digital engagement, which allows doctors to connect with patients remotely and in real time. “Remote care” is also empowering patients to take control of their own healthcare through features like mobile apps to monitor diabetes, among other conditions, while the cloud has allowed medical institutions to share real-time data allowing physicians to make better and faster decisions.
Spatharou praised these advances but regretted that they have not reached Mexico. While technology is important in every sector, there needs to be a special focus on healthcare, said Francisco Morales, Healthcare Division Director at 3M. “An aging, sicker population will lead to the rupture of any healthcare system,” added Gonzalo Maroto, National Account Manager at GE Healthcare. Alejandro Paolini, Managing Director at Siemens Healthineers Mesoamerica, agreed. “Without innovation, the healthcare system will collapse in 10 years.”
Another problem is the healthcare system’s existing priorities. Martín Ferrari del Sel, Director General at Dräger, mentioned a recent discussion with IMSS’ representatives where he felt that the institution was looking for short-term solutions while “it is necessary to start planning for the next 10 years.”
Still, there has been progress and data and technology have already brought benefits to many Mexicans.
Maroto mentioned the evolution of tomography to detect breast cancer as an example. This tool has advanced significantly, allowing diagnosis at a much earlier stage and leading to less invasive and less expensive therapies and a higher life expectancy for patients. But Mexico needs innovative strategies to allow greater access to healthcare and technology. “Digitalization increases quality and efficiency of healthcare” by providing instant access to large amounts of real-time information which can help doctors make better decisions and reduce decision-making times, Maroto said.
The country still has a long road ahead for both the implementation of these systems and the acquisition of medical devices, said Ferrari. Challenges range from the financial to the technical. Economic hurdles include a limited healthcare budget, which is not exclusive to Mexico. “All healthcare systems across the world face budget restraints,” said Morales. All panel members agreed that new equipment must improve clinically and operationally without ignoring the financial aspect. While new technologies may be more expensive it is necessary to demonstrate to healthcare systems that they will bring savings in operations, even after considering their cost, said Morales.
In Mexico, data collection systems have evolved at an uneven rate and were developed by different organizations so data is not stored in the same place or in a similar format, complicating the introduction of new technologies and making this process more expensive. Maroto highlighted the importance of reaching a consensus among technology developers so information can be easily communicated across different hardware and software. Ferrari agreed. Communication failure across different pieces of equipment brings about economic loss and can endanger a patient, he said. “By digitalizing information to the cloud, the danger is reduced.”
Good communication among systems can even protect patients by predicting potential vulnerability, said Maroto.
A year of innovation at IMSS
2016 has been a year of challenges but also change and innovation for IMSS, Mexico’s largest health provider. The Institute has gone through several adjustments to improve services to workers, families and employers. José Arriaga, Director of Medical Operations at IMSS, closed Mexico Health Summit 2016 by sharing the most recent efforts made by IMSS to improve process digitalization, treatment of chronic diseases and quality of care.
Arriaga said the institution serves 18.3 million insured workers and supports the program Prospera, for daily expenditures of MX$1.2 billion.
There are three levels of care offered through 1,500 Medical Family Units, 350 hospitals, of which 79 are rural hospitals and 25 are specialty medical centers. Also, IMSS runs service centers like daycares and gyms.
According to Arriaga there are two main challenges facing IMSS. First is a changing demographic. “There are more people above the age of 65, which represents more healthcare expenditure,” he said. Second are chronic diseases like diabetes “which represent 80 percent of health expenditure.”
Besides these challenges, IMSS is changing its service offerings. There has been an improvement in digitalization through changes to the Institute’s website and simplification of processes. Back in 2012, most processes had to be done in person but now they are mainly digital and remote. This benefits many IMSS affiliates, especially pensioners and pregnant women.
Today, 76 percent of consultations are in family clinics and it is possible for a patient to be in front of a healthcare professional within two hours. Another 20.5 percent of consultations are hospitalized. Triage processes have been implemented and patients are classified by their level of urgency so they are treated in the shortest possible time through a program called Unifila. So far the initiative has been applied to 142 clinics.
Bed availability has been improved as well as heart attack treatments with the Código Infarto program, which has helped reduce mortality rates by 57 percent in cases of heart attacks. Before, a patient having a heart attack had to pass through six filters to reach their first medical contact. Now, thanks to the new system, staff is qualified to recognize symptoms and the patient can reach a medical professional at first contact.
Other improvements by the IMSS include the simplification of prescription refills with the program Tu receta es tu vale, a more efficient use of surgical theaters and an increase of 9 percent of transplant procedures in the last year. Training has also been improved
with the “SER IMSS” program, a series of training sessions for its workers aimed at offering better service, which has been implemented in 80 percent of its centers.
Going forward, IMSS expects to keep improving its digitalization process and to improve the quality of its service. Arriaga said there was MX$19.4 billion for infrastructure investment until 2018.
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