Rethinking the Health Sector

The purpose of health systems extends far beyond ensuring wellbeing in terms of the human body's functioning. Health systems are the single most important foundation for achieving equality and equity in society. By guaranteeing people access to universal hybrid health systems, it is possible to generate stability, wellbeing, and prosperity for nations.

Beyond symbolic declarations, which are useful but insufficient, I propose three concrete actions that could generate a positive multiplier effect on Mexican society. Three areas are particularly complex and politically charged: health supply chains, sector unions, and cutting-edge operations.

The issue of health supplies has commanded the President's attention for the past two years. In short, he found a web of quasi-monopolistic practices that led him to dismantle an inefficient and porous procurement system. Perhaps the iconoclastic approach to those institutions was not the most effective or efficient path, but it was the morally correct one. A line had to be drawn. The question is: how to resolve it going forward? I diverge from many positions here, because without a clear end objective for this systemic restructuring, time is simply wasted. The UNOPS-PAHO approach is a case in point; unfortunately, that organization lacks the necessary scale and experience. PAHO tenders annually what Mexico consumes in a single week, which amounts to less than 1.9% of need.

The near-antiquated understanding of unions has caused people to forget their core purpose: defending those who, due to power asymmetries, cannot obtain fair compensation for the value they create. Public health workers in Mexico are among the best-paid in the sector; any nurse offered a position in the public sector over the private will take it, given the accumulated benefits and perks. This is the legitimate fruit of union struggle on behalf of those who protect us. That said, the role of many health workers needs to be reconsidered. In the United States, a range of procedures are performed by highly trained nurses, whereas in Mexico these same procedures fall to "Doctors," loading them with "minor" tasks. Union struggle has its place, but so does the moral and social responsibility the sector carries toward the population, and how Mexicans in turn compensate that service.

Mexico's public health systems require integration. The duplication and triplication (being generous) of health assets makes the system's operation both inefficient and morally indefensible. Compounding this, there is no digital integration across health systems, and the resistance to it cannot be explained in technical terms; the technology exists to resolve and optimize operations. Moreover, efficient daily operations would provide greater clarity around supplies consumed in real time by population group, as well as staffing and human resource utilization across the national system. What does this enable? An understanding of national health dynamics, which the current system is fundamentally incapable of producing as reliable or accurate demand data for its own sector's needs.

I therefore propose three key actions. The first is the creation of a specialized, fully transparent team to manage consolidated medicine and drug procurement, while allowing a smaller percentage of purchasing to be executed locally by each hospital. Those who practice the art and science of life must always retain the freedom to decide whether alternative treatments are warranted. A proof of concept for this consolidated procurement system was already demonstrated during the 2019 sweep of medicines, from oncologicals to general health supplies, conducted in the middle of the COVID crisis. It is on the record.

The second action involves rebuilding and reinterpreting the labor relationship governing the union's legitimate demands. Benefits now accrued in the health sector should be recognized as victories of union struggle and, at the same time, benchmarked against the private sector. This means giving the union itself the option to develop additional, more flexible schemes that could both increase membership and enable the health apparatus to deliver services more cost-efficiently. The problem is not "there is never enough money," but rather, "we had never realized how important health was."

Finally, on the operational side, what is needed is an information systems integration plan built on full transparency and security. I have no interest in reinventing the wheel: functional systems already exist in Europe and China, while the United States has been unable to harmonize its own national systems. Through a simple national clinical records system (available to both public and private physicians), a healthcare quality measurement tool (rate your doctor), and a real-time epidemiological monitoring system, it is possible to transform how the national health system functions.

These actions demand titanic effort, not technical but political. Only those who can consolidate forces in favor of Mexico and confront powerful economic and political interests will be capable of achieving this reorientation. What COVID has made undeniably clear, however, is that Mexicans do want to rely on their health systems. Who has not lost someone in this pandemic? Humanizing this problem does not mean solving everything at once, but at least demonstrating, step by step, that a functioning system is possible.

Frequently Asked Questions

What are the three key areas for healthcare reform in Mexico?

The author identifies health supply procurement, union labor relations, and digital operational integration as the three complex, politically charged areas requiring structural reform.

Why is PAHO (UNOPS-OPS) an inadequate procurement solution for Mexico?

PAHO tenders annually what Mexico consumes in a single week, representing less than 1.9% of Mexico's actual needs, making it structurally incapable of handling Mexican health procurement at scale.

What digital integration measures does the author propose for Mexico's health system?

A national clinical records system accessible to both public and private physicians, a healthcare quality measurement platform where patients rate their doctors, and a real-time epidemiological monitoring system, drawing on models already implemented in Europe and China.

How does the author view the role of health sector unions?

The author recognizes unions' legitimate historical role in securing fair compensation for workers, but argues that role definitions must be updated: in the United States, trained nurses perform many procedures that in Mexico are reserved for doctors, creating inefficiencies that reform could address without undermining workers' rights.