Healthcare in Mexico: Shortage of medicines, deteriorated hospitals, and lack of doctors

It is no news to anyone that for decades the public health system in Mexico has been in a downward spiral, but in recent years the problem of poor medical care has deepened with a huge shortage of medicines, doctors, poor working conditions for health professionals, bureaucracy, and clinics and hospitals falling apart.

President Andrés Manuel López Obrador (AMLO) won the presidency of Mexico with 100 campaign promises. One of them was to have a Mexican public health system like that of Norway or Denmark: where health is a free public right and of very high quality.

“The populists in Denmark and Norway guarantee the right to health. Health in Denmark is free, it is in what they know as the Welfare State; there is protection for the citizen from the time he is born until he dies. We want to create a first-rate and free public health system, because health, like education, healthcare is not a privilege, it’s a right,” assured the president at his morning press conference on January 8, 2020.

But in addition, Seguro Popular was dissolved by the president, which was created with the aim of helping families in the event of a very serious illness, such as cancer or HIV/AIDS. Seguro Popular was created to care for people who didn’t work or for other reasons didn’t qualify for the public healthcare system known as IMSS. The argument was that Seguro Popular “was not useful”, despite the fact that it provided services to millions of Mexicans who lacked social security.

In 2019, the president “created” Insabi (Institute of Health for Well-being) but four years into López Obrador’s six-year term, he never managed to get the system functioning although he had already canceled the infrastructure that his failed bureaucracy was intended to replace. Now the so-called IMSS-Well-Being is the new system that will take care of all those millions of people who do not have social security if the president can manage to have success where he has screwed the pooch so many times before.

Without Seguro Popular, or Insabi, and with health centers lacking in all senses, a private medical service began to emerge, but at very affordable prices, to serve all those people who needed a medical consultation, but who cannot afford the medical services in large private hospitals: Clinics Adjacent to Pharmacies (CAF) .

Clinics Adjacent to Pharmacies emerged in Mexico during the first decade of this century, as a way to promote the prescription of generic drugs. They are regulated and have permits from the Ministry of Health.

After the H1N1 influenza epidemic in Mexico, which occurred in March 2009, the Ministry of Health issued an agreement (2010) to establish the prohibition of the sale of antibiotics without a medical prescription, for which permits were granted for the installation of clinics located next to pharmacies, which are subject to the Official Mexican Standard NOM-005-SSA3-2010, which establishes the minimum infrastructure and equipment requirements for establishments for outpatient medical care. The rule is in force since October 16, 2010.

According to the National Association of Medicine Distributors (ANADIM), it was estimated that in 2020 there were 17,000 CAFs that provided around 325 consultations daily at each of their locations.

In addition, ANADIM highlighted that around seven out of 10 patients in these clinics are affiliated with a public healthcare system, free government healthcare, but they go to these clinics because of their proximity and shorter waiting time with a cost that ranges between 25 to 50 pesos per consultation.

Care in these clinics has become truly important in the midst of the COVID-19 pandemic since, given the saturation in hospitals and the difficulty in obtaining medical care, people went to CAFs for medical attention.

All those patients who suffer from diseases other than COVID-19 were relegated from medical care due to the health emergency, so the doctors in these offices also treated those people.

Despite the high demand for these services, the doctors who attend the consultations in the CAFs have very low salaries, according to Dr. Xavier Tello, a surgeon and health policy analyst, as well as the author of the book “La Tragedia del Shortage”.

The strongest evidence of this situation was established in the 2021 National Health and Nutrition Survey on COVID-19, which shows that seven out of 10 patients in Mexico seek treatment in private medicine, even though they are entitled to free healthcare, such as the Mexican Institute of Social Security (IMSS). Of this total, 18% received treatment at a CAF.

On August 16, the Undersecretary of Health, Hugo López-Gatell spoke out against these clinics, assuring that they “represent a risk to people’s health and lives.”

He even assured that what is important for these pharmacy chains is that the patient leaves their medical consultation with as many prescriptions as they can, even those that are not needed. The Undersecretary concluded by saying the goal was to eventually close clinics at pharmacies.

Due to the controversy that was unleashed, President Andrés Manuel López Obrador (AMLO) himself had to clarify that these clinics would not be closed.

“When they talked about pharmacies, I think it was not nuanced. It is not about closing the pharmacy offices, what it is about is improving the public health system,” said the president in his morning conference on August 31.

López Obrador acknowledged that these clinics have multiplied due to the lack of medical care that exists. However, he reiterated what López-Gatell had said by assuring that doctors “can induce” drugs to be purchased at the pharmacies where they are located.

He also pointed out that his commitment is that Mexico has the best health system in the world, although in his four years as president, healthcare has gotten worse.

“Let it be heard well. It is a challenge to get all the doctors and specialists, but we are going to have them. Not only in the cities, in remote communities, in rural areas where people suffer a lot from lack of care,” López Obrador emphasized at that same conference.

However, a lack of doctors is just a small part of Mexico’s healthcare issues. Since becoming president, López Obrador has gutted the healthcare system and the way in which Mexico purchased medications, leaving millions of people without their lifesaving medications, including a lack of cancer treatments and HIV medication.

The cuts to the budgets derived from the so-called “republican austerity” and then the emergency due to the COVID-19 pandemic, further reduced the poor conditions in public hospitals and consequently, also in salaries and hospital services, and above all, a shortage of medicines that, according to relatives and the patients themselves, has put the lives of many people in danger.

One of the most combative movements to demand medicines from the government of Andrés Manuel López Obrador is that of the parents of children with cancer, who repeatedly carry out demonstrations to demand medication. Other groups such as people suffering from HIV-AIDS or kidney disease have also held several protests to demand their medicines.

Although the federal government assures that consolidated drug purchases have been made, the only certainty is that patients and their relatives assure that the problem has not been solved and from time to time, drugs become scarce again.

But another serious problem, says the federal government, is the lack of medical specialists. According to the figures provided by the current administration, there are 200,000 doctors lacking in the country, of which 50,000 are specialists.

That is why on May 9, Andrés Manuel López Obrador announced the arrival in Mexico of 500 Cuban doctors to provide services to rural populations, which sparked a strong controversy since the doctors themselves assure that there is a high number of doctors, but the real problem is the lack of opportunities and good jobs.

Through a letter sent to the President of the Republic, the Mexican doctors exposed the situation.

“In our country, there are doctors with capacity endorsed by the universities of the Republic, trained in full knowledge of the needs and idiosyncrasies of our population, some of them unemployed or eventually employed with very low salaries or in areas of extreme insecurity ”, they emphasized.

But the López Obrador government continued to insist that there is a lack of specialists, which is why it signed an agreement with the Cuban regime of Miguel Díaz-Canel, for the hiring of 500 doctors from the island. At the same time, he said that the Mexican Institute of Social Security (IMSS) would open 14,323 vacancies available, which happened on May 24, when the National Hiring and Recruitment Day for medical specialists began.

On June 7, the general director of the Mexican Institute of Social Security (IMSS), Zoé Robledo, indicated that 10,920 doctors had registered at the Conference, which closed on June 3, and of the 14,323 vacancies available, only 6,963 obtained at least one application, while 7,360 did not register any, “no doctor said ‘I am interested in this vacancy,’” he commented.

With that argument, the arrival of Cuban doctors in Mexico began.

At the beginning of August 2022, the journalist Lourdes Mendoza, in her column that she publishes in El Financiero, revealed that she had a copy of the agreement between the government of AMLO and Díaz Canel in which the administration agrees to pay the Comercializadora de Cuban Medical Services SA, $1-million euros per month for the “services” of the doctors of that country in Mexico.

According to the journalist, a total of 610 male and female doctors will cover part of the 5,329 medical vacancies that were not claimed by Mexican health professionals in highly marginalized areas of the national territory.

On Friday, September 9, the president reiterated that he will continue to hire Cuban and foreign doctors, “even if it hurts the conservatives.”

He assured that the purpose is to attend to the health of Mexicans since he insisted that the country does not have the health specialists that are required.

“We are going to continue hiring specialist doctors from Cuba and other countries because we are committed to ensuring that doctors are not lacking, that medicines are not lacking,” he insisted.

A recent investigation has indicated that most of the doctors from Cuba arriving in Mexico lack certifications in their fields, some with three-day crash courses to become ‘specialists’. Cuba fears that qualified doctors may seek asylum in the United States once they reach Mexican soil, so they are sending Mexico undereducated doctors and some of them from the Cuban military, to work in Mexico with pay and benefits better than many Mexican national doctors receive in the country.

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