José Antonio González Anaya, Managing Director, Mexican Social Security Institute (Instituto Mexicano del Seguro Social, IMSS): Interview

Interview: José Antonio González Anaya

In 2014, Mexico experienced the second-largest increase in formal employment since 1997. What were the main causes of this growth?

JOSÉ ANTONIO GONZÁLEZ ANAYA: This recent growth in formal employment has centred around manufacturing, although construction picked up in the last six months of the year. What is impressive about the increase was that it was not a “comeback” year after an economic crisis, such as in 1996 or 2010. Additionally, October saw the largest increase in formal employment in a single month since monthly records are available. This suggests that Mexico has experienced an interesting phenomenon in the past two years, namely, formal employment is growing almost twice as fast as the economy. There has been an unprecedented process of formalisation of the economy, as a result of structural reforms and the strategy to diminish informality pushed forward by the administration of President Enrique Peña Nieto.

Previous IMSS administrations claimed it was set to run out of money by 2014. Which actions have been taken to reverse this trend?

ANAYA: IMSS is facing formidable financial challenges. The annual cash deficit went from close to MXN300bn ($20.2bn) in 2007 to over MXN24bn ($1.6bn) in 2012. IMSS’s financial challenges are a consequence of external factors, such as the demographic and epidemiological transitions, as well as internal factors, like high administrative costs and operational inefficiencies. For this reason, the administration embarked on a huge effort to stabilise the institutional finances, reducing the deficit from MXN24bn ($1.6bn) in 2012 to less than MXN12bn ($807.6m) in 2014. This is a huge restructuring – equivalent to about half a percentage point of the national collection of value-added tax in a year.

We established two clear objectives: to improve the quality of services and the patient experience, and to improve IMSS’s financial sustainability. At first glance, these objectives seem incompatible, even contradictory, as improving quality and client experience would seem to require increased spending. These objectives can be reconciled by improving productivity and efficiency, strengthening transparency and making sure everybody fulfils their obligations.

What is the future of the public health sector?

ANAYA: The ultimate goal of the federal government’s health sector reform is to ensure effective access to health care. The proposed reform involves major changes for all institutions in the sector and lays the foundation for further integration and service standardisation. Success will depend on the ability to provide these institutions with an incentive framework and the tools that will lead them to use their resources effectively.

Universal health coverage requires greater coordination between public health institutions to make more efficient use of available infrastructure and human resources. We need to build on existing agreements to exchange services between public health institutions, and adopt uniform medical criteria and service standards to improve health outcomes. IMSS has successful agreements in Baja California Sur, Chiapas, Yucatan and Querétaro. IMSS has been key to these efforts by being at the forefront of diagnosisrelated groups. For the most vulnerable groups, especially in rural areas, coordination between IMSS-Prospera and Seguro Popular needs to be strengthened, as in agreements elsewhere.

What is being done to combat chronic diseases?

ANAYA: One of the pillars of improving service quality is to strengthen prevention programmes. We need to continue these efforts and promote healthy lifestyles to reduce risk factors associated with chronic diseases like obesity. We are focused on promoting the PrevenIMSS annual checkup, which served 26m in 2012, 28m in 2013 and targets 30m in 2015.