Pablo Escandón Cusi, President, Mexican Health Foundation: Interview

Interview: Pablo Escandón Cusi

What are the main issues facing the health care sector, and what solutions are being offered?

PABLO ESCANDÓN CUSI: Although still young, Mexico’s population is gradually growing older, which makes improving health care services a priority over the long term. The sector represents 5.8% of GDP, with 2.8% originating from the private sector, highlighting the fundamental role non-government actors play in providing services. Demand for medical services has significantly increased among the country’s nearly 125m inhabitants, underscoring the shortage in supply. Even though 55m Mexicans are covered under the general insurance programme, which is part of the federal health structure, Mexico still suffers from a noticeable capacity gap. Efforts are therefore being made to find solutions to increase medical access. The principal underlying obstacle is funding: while the per capita OECD average capital investment in health is around 0.45% of GDP, this is 4.5 times the Mexican average, showing that the country has a long way to go before it reaches the level of capital investment needed to close the gap.

What role should PPPs play in the health sector, and how can private investment be encouraged?

ESCANDÓN: There is a general agreement in the government that the participation of the private sector is needed to boost the country’s health care capacity. With a well-designed public-private collaboration strategy, the authorities can strategically select when and where they would work with the private sector. Increasingly, this means more than just the construction of facilities or the provision of equipment; it also extends to the delivery of primary care services under a model known as integrated services.

Although a few PPPs have already been built to fill the gap, these projects have not been successful enough to generate interest from private investors. If private stakeholders were further incentivised, the need for net public capital investment could decrease, and more funds could be channelled towards improving the quality of and access to health services, training for medical staff and connectivity between institutes.

Investment in services is one thing, but creating a competitive environment is what will ultimately improve access and quality of services, thus harnessing the most positive aspects of supply and demand. This should improve transparency and close the gap in service quality between the public and private sector.

How can preventive medicine be further developed?

ESCANDÓN: Diabetes in Mexico is on the rise, with around 11% of the population identifying as diabetic in 2017, although it is estimated that a much greater percentage is undiagnosed. Mexico already spends the equivalent of 2.25% of GDP on diabetes, including direct and indirect expenses, but this figure needs to increase significantly to boost the preventive capacity of the Mexican Institute of Social Security and the Institute for Security and Social Services for State Workers. Apart from educating the population about healthy nutrition, the country needs to introduce and spread the concept of shared risk among different actors in society – this means that not only the government is responsible for health, but also the local community, corporations, families and the individual.

Everyone needs to be treated as equal partners when it comes to preventing health problems such as diabetes and hepatitis C. Although a number of corporations are already privately funding basic health care, they could go one step further by organising regular screenings for employees. Early-detection programmes might not represent a significant cost for companies, but they can make a difference in both raising awareness and prioritising the prevention agenda in the public and private sector. If the notion of shared risk becomes widely adopted by all key stakeholders in society, medical service costs could drop, and a larger proportion of the population could benefit from improved health care.