The three years of life of the Health Institute for Wellness (insabi) expose a history of setbacks and simulations in terms of the budget destined to attend with health services to the Mexican population without affiliation to social security institutions. The amount of resources assigned to this item dropped, the quarterly outflows of money from the Health Fund for Welfare (fonsabi); which caused that today it has 30% less resources than there were in 2018. The subsidy for consultations of this financial instrument fell 97.24% and less than 5% of the Fund’s expenses have been dedicated to the care of catastrophic illnesses and construction of infrastructure. All this framed in a strategy of frank simulation in spending, expose specialists.
Created by presidential decree on November 29, 2019 and extinguished by the Congress of the Union last April (it needs to be made official through publication in the Official Gazette of the Federation), the insabi was intended to replace the National Commission for Social Protection in Healthbetter known as Popular insurancethe public policy program implemented by the president vincent fox in 2003, to provide financial protection to the population that lacks social security, with the aim of guaranteeing their access to health services.
In addition to the resources that came directly from the budget, the Popular insurance leaned on him Social Protection System Trustconstituted on November 16, 2004 with the purpose of “creating an agile and transparent mechanism that allows the Federal Government to apply resources to financially support the treatments and medicines associated with them, which are considered catastrophic expenses suffered mainly by the beneficiaries of the Social Protection System in Health”, as established in the Banobras trust agreement that gave rise to it.
With those resources, the Popular insurance It had the mission of attending to 66 high-cost interventions or diseases or those that cause catastrophic expenses; promote the financing of infrastructure in federal entities with greater social marginalization and cover contingencies in the demand for health services.
Low budget as a percentage of GDP for health services to this sector
Judith Senyacen Méndez Méndez, Deputy Director of Research and specialist in health and public finances of the Economic and Budgetary Research Center (CIEP), stressed that what is relevant is to know how much budget was allocated to serve the Mexican population that does not have social security, in which the Popular insurance and then him insabi They had an outstanding task.
He explained that, if the allocations in the different budgetary programs destined to serve this sector of the population are analyzed, both in the past six-year term and in the current one, it is observed that in recent years they have decreased.
In 2016, when the largest amount was allocated, the sum of the resources for Seguro Popular, Seguro 21st century doctor and prosper (in the Health section) and FASSA, was 257,746 million pesos, which represented 1.28% of the national GDP. For 2018, the last of the administration of President Enrique Peña Nieto, the figure stood at 241,562 million pesos, that is, 1.03% of GDP.
By 2020, which is when the Covid-19 pandemic occurred and GDP fell, and where, with the Popular insurance by decision of the president Andres Manuel Lopez Obrador, includes the Insabi budget, Administrative Support Activities, Health Care and Free Medications for the Population without Job Security, as well as those of the Strengthening of Medical Care and AFASSA program, totaled 271,144 million pesos, that is, 1.16 % of GDP. For 2023 the sum is 253,409 million pesos, which is equivalent to 0.81 percent.
The figures show a drop in the amount of resources allocated for this purpose, particularly in 2022 and 2023, where the sum no longer reaches even 1% of GDP.
For her part, Mariana Campos, a researcher from Mexico evaluates, stated that the Social Protection System Trust received each year at least 11% of the total resources allocated to Seguro Popular, which were divided into two funds or sub-accounts: the Fund for Protection against Catastrophic Expenses (FPGC), which received 8% of Seguro Popular resources , and the Budget Provident Fund (FPP), which received 2% for spending on infrastructure and 1% for contingencies.
After the disappearance of Seguro Popular and the implementation of Insabi, just at the beginning of the Covid-19 pandemic, the government transformed the Social Protection System Trust in the Health Fund for Welfare (fonsabi).
Campos mentioned that the objectives of the Social Protection System Trust related to catastrophic expenses and infrastructure, but it was established that the trust resources would serve, from then on, to complement the supply and distribution of medicines and clinical tests. Previously, the objective of covering contingencies allowed any type of current expense, while now it is specified that it will be for medicines and clinical tests. Despite this precision, resources are spent on other purposes, he remarked.
Low Fonsabi balance, but not for serving Mexicans without social security
In this regard, Judith Senyacen Méndez Méndez said that what happened was that the balance of the fund fell, but that was not reflected in a greater use of resources to care for diseases that generate catastrophic expenses. “On the contrary, what we saw was a reduction,” calculated at 20%, comparing what was exercised when Seguro Popular existed, with what was exercised with the insabi.
“This speaks of less attention in cases of breast cancer, cervical cancer or childhood cancer,” although he clarified that it is not possible to know exactly the cases that were no longer attended to because Insabi no longer made that information public, which it did he Popular insurance.
CIEP analysis indicates that in 2018 they were attended with funds from the Social Protection System Trust 94,400 cases of highly specialized diseases, for an amount of 7,016.55 million pesos and in 2020 (the first year of the Covid-19 pandemic), already with the insabithe figures dropped to 5,642 cases and disbursements for 5,642.34 million pesos, which represents a cut in the exercise of 19.5 percent.
According to the analysis “The decline of Fonsabi”, Prepared by Mariana Campos and Jorge Cano, researchers from México Evalúa, according to information from the Ministry of Health, in the last two years, less than 5% of Fonsabi’s expenses have been dedicated to the care of catastrophic illnesses and construction of infrastructure. “The remaining 95% has been transferred to the insabi for current spending, or to the Federation Treasury (Tesofe), where the trail of money is lost”.
Specialists draw attention to the fact that with the creation of the insabi, the target population was increased from 51 to 66 million people and the number of conditions to be covered, but no new budgetary mechanisms were established, rather the Government’s commitment to financing the institute was weakened. “A total contradiction”, they remark.
If the methodology of the Popular insurancethat is, to contribute a social quota and a federal per capita contribution and, taking into account the new target population of Insabi, the federal government should have granted 87.400 million pesos in subsidies for the provision of public health services in 2022. However, it budgeted only 66,700 million pesos, 24% less (20,600 million), and paid 54,000 million, 38% less (33,600 million) than what it should have contributed with a per capita budget scheme, they indicate.
In another document, Mexico Evaluates It stands out that in 2022 the number of consultations closed at 17.8 million, a drop of 21% (4.7 million) compared to 2021 or 75% (54.7 million) in relation to 2018. According to official estimates, the IMSS-Bienestar increased by 1.7 million their consultations in 2022, an insufficient amount to compensate for the “gap” left by the insabi. That shows him, he emphasizes, “tax errors have consequences.”
Likewise, they highlight that so far this six-year term, quarterly transfers to this trust average 12.9 billion pesos (122% more than the past six-year term) and its outflows 17,000 million (347% more than the last six-year term). However, less than 5% of the expenses of the fonsabi they have dedicated themselves to the care of catastrophic diseases and infrastructure construction. “The remaining 95% has been transferred to the TESORERY of the Federation (Tesofe), where the trail of money is lost. A whole ‘washing machine’ of health spending”, they emphasize.
only in the semi-annual self-assessment report of the general director of Insabicorresponding to January to June 2022, it is reported that 86.37% of the resources in that period were returned to the Treasury of the federation.
In December 2018, the net balance of the fonsabi it was 114,000 million constant pesos of 2022; by June 2022 it dropped to its lowest level since June 2010 at 39.2 billion. At the end of the first quarter of 2023 it is 79,425 million pesos.
Judith Senyacen Méndez Méndez commented that now with the disappearance of the insabiwith the IMSS-Well-being, the resources that are contemplated will be the same ones that were used for the Insabi and, taking resources from the fonsabi, but the problem is that the resources are taken, but they are not executed in health. With the IMSS It is the same, because there is no more talk of a greater investment in resources, since we already have the experience of Insabi not giving more resources and the population ends up having more out-of-pocket spending and less health care.
In addition, he continued, it is important that the budget is executed. He refers that the SIEL analysis “Public Account 2022: public spending in the face of global challenges” points out that by 2022 a historic increase of 14.6% was approved in the health sector, which was concentrated in IMSS-Welfare and in the Ministry of Health. However, in the spending exercise, both suffered the largest sub-exercises: 11,267 million pesos and 22,627 million pesos, respectively. Had it been carried out, this expense would have contributed to the care of the population with the greatest health deficiencies.
