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EF: In February, the Consortium released a document outlining seven key challenges private healthcare in Mexico faces leading up to 2030. Which are the most pressing on your 2023 agenda, and what measures are you taking to tackle these issues?
JP: It is not easy to pinpoint the most pressing challenge as they are not independent of each other; however, I believe my biggest wish would be a patient-centric model, our first and steepest challenge. We hear much about patient centricity and digital transformation, both difficult to achieve, and we are moving forward in both areas; however, we are still not as effective as we should be.
- To become patient-centric, we must remove other players from the model center. At the center of the model, today is the system per se, the hospitals, the health systems, doctors, insurance, etc.
- Lack of articulation within health systems. We need to strengthen health financing in the private sector to meet patients' needs. Pharma and medical devices already understand that the priority is not to sell but to ensure the patient has the required resources to receive attention, drugs, and devices. The focus is changing from selling health services to the patients and moving into a second phase of finding ways for the patient to have adequate resources. This can only be achieved through articulation and working closely with insurance companies and new financial models.
- Digital transformation is the next natural step, not isolated attempts -hospitals cannot transform in isolation- but as a part of the whole as the industry advances.
- Data analysis: there has already been an evolution in digital procedures, but there is still much to do. The transformation is not transactional but goes deeper into data analysis to have better services and products to meet patients' needs, thus bringing the patient to the center of the model.
- Focus on health over sickness: which changes our work formula. Changing health's central axis from illness and disease to health changes the whole business model as we know it. I believe this to be our biggest challenge because it translates into a huge business change for the industry, as we work and focus on sick patients and not on the patient's health. Achieving this change means understanding what the patient needs -what they need is health- which connects to other health system challenges.
- A social focus on health within the private sector is needed. The paradox is that our present government has left social leanings; however, due to its inefficiencies, there is a patient migration to the private sector. The second and more notable paradox is the private sector should become more socially inclined. Private medicine should be more accessible, patient-centric, and have better financing lines -therefore, more interconnected.
- The private sector should have stronger participation in public policies; this is very relevant to our future. The private sector is aware that Mexican health needs strengthening, as the next ten years will be difficult. We must work more with the government to strengthen public-private collaboration to benefit the Mexican population.
The company's leaders face a huge challenge to bring about change, as it could mean moving their companies from the center. The two most important issues are patient-centricity and the focus on health over disease. We need information analysis, digitalization, and an articulated system to shift the focus from curing patients to keeping them healthy. And ours is an extremely fragmented health system. The information is scattered around; there is no common platform for hospitals, laboratories, or doctors. We urgently need interoperability.
EF: The Consortium represents hospitals in twenty-five Mexican states. How do you assess the level of access across Mexico so a patient in Mexico City, Oaxaca, or Chiapas can have the same access?
JP: According to the insurance sector, only 7% of the Mexican population has private insurance, and we all agree that this is a fairly correct number. But this indicator can be misleading because Mexico City probably has 15 to 20% insured, while in Oaxaca, only 1% of the population has access to second-level private healthcare, including hospitalization. The model is even more negligible in the first level of attention for general and specialized practitioners, laboratories, etc., saved only by the pharmacy consulting rooms, which offer complete access to the first level of attention nationwide. Pharmacy consulting rooms attend more of the population than social security; unfortunately, they are not an articulated part of a system. On the one hand, they offer affordable, fast, easy access, and the quality is not an issue. But the continuity of attention is broken when the patients have to be referred to the next level (specialists, tests, etc.). Mexico has to create integrated models for financial, medical, and diagnostic specialists to make it easier for the patient to access health nationwide. From a hospital standpoint, we have not managed to develop low-cost products. It is possible, but the insurance companies resist the idea due to the existing problems between insurers and hospitals regarding major medical expenses insurance. A challenge for 2030 is health access through financing; financing and health access are currently basic needs for Mexico. Mexico City, Monterey, and Guadalajara are not an issue as insurance coverage is much higher. Still, we must create products for the rest of the country to reduce out-of-pocket expenditures and avoid people risking their assets when they need to access a hospital.
We are a hospital consortium, and many of these subjects should not affect us directly, but we became involved in bigger issues because we believe in efficiency. We started by exchanging information between hospitals, making consolidated purchases and other commercial synergies, which went well but were insufficient. The percentages of private hospital occupation in Mexico are around 55% to 60%, which is very low compared to countries such as Argentina, Chile, or Colombia, which have 99% occupation. Their systems of public-private collaboration make it possible with an average of 80 to 100 beds per hospital. In Mexico, having 55% of occupations over 35 beds is ridiculous, with average billing of USD 3500/4000 per person. In Mexico, there are no products for the population in the middle market. The middle market of the population includes 35 to 40 million Mexicans that cannot afford traditional private medical insurance; they do not want to go to Social Security, so they pay out-of-pocket. The next step is to create a product for that portion of the population, even though it means leaving our comfort zone within the hospital. The whole sector must work on access as many people need designed products to meet their needs. The next ten to fifteen years will be very hard on the public health sector, and there will be a migration of patients coming to the private sector from the public sector. The private sector is very disarticulated; it does not have an interconnected system to receive public sector patients and has no efficient health financing, all of which must be considered to improve access.
EF: How do you assess the future of hospitals, and what is the Consortium's role in their evolution?
JP: Currently, technology is not an issue; telemedicine, for example, has been around for the last ten years. The problems reside in the health and hospital models. Once we have the model, we can adapt the technology, but it is very hard to implement if the business model is unclear. These circumstances have delayed technology implementation; for example, electronic health records have been around for about 15 years; however, implementing them in Mexico has taken forever. Mexico has not understood the reason for having EHRs. We have gone from documenting on paper to a computer or cloud, with the data kept the same way as on paper. There is no sharing of the information or using it to benefit patient attention. I believe the future of hospitals will mean reformulating the operative models of the health sector. Based on the tools technology provides the hospitals and the health systems of the future depend on clearly defining the business model, operations model, and technology implementation. We urgently need data, better-designed services and products based on the population's needs, and improved communications, all of which technology can provide. There was a boom in telemedicine during the pandemic, but it has faded out with the pandemic over. It was a great tool when face-to-face was not feasible, but we could not provide an efficient attention model for it to be more effective, making it a poor example of implementation. Mexico does not have an integrated application with all systems, and health services, another example of Mexico's lack of articulation in health services and making technology less effective. The tools exist, and we must work hospital by hospital; financing and resources must be found to move forward with technology implementation, creating virtuous circles for the patients.
Attention continuity exists when the patient is integrated into a system of continued attention and is another area that needs work. Health systems should have interoperability; when a patient goes to the doctor and is referred to a specialist or a diagnosis center for tests, the personal data and financial model travels with the patient. Eventually, the information goes into a cloud where the data is analyzed for market ends, and certain conclusions are drawn around patients to improve the attention and benefits. That happens in countries with interoperability but not in Mexico. Usually, when someone does not feel well in Mexico, they go to the pharmacy. Then the patients wander from place to place within the system without their electronic health records, and the feeling is that we have learned nothing from past experiences. We must quickly create strategic and operative mechanisms within the private sector to better prepare for the future. In Colombia, they have created "liquid" hospitals, referring to their non-rigid walls; these liquid hospitals go into homes, workplaces, and schools and look beyond hospital attention to grow the bed numbers assisted by technology. We have to think strategically, out of the box. We live in a period of great opportunity in the private sector to influence reforms within healthcare. It is more than an opportunity; it is our social duty to the Mexicans and their future.
EF: To what do you attribute Mexico's increasing popularity as a medical tourism destination? Is it due to the quality standards?
JP: There is no doubt that the quality standards in Mexico are high. Since 2006/2008, the hospital quality certification criteria between Mexico and the United States have been homologated. Mexico invests in its private hospitals, and they have a good level of attention. The existing medical tourism is a natural activity we have had for a long time, but I do not think it is such a big industry. People from the US choose to come for certain medical reasons and are always related to out-of-pocket expenses, looking for cheaper medical attention. They are generally for plastic or bariatric surgery, where the cost is important. They are not insured American patients that choose to be attended in Mexico. Medical tourism still has a long way to go in Mexico, and to progress, we must position ourselves as the operating theatre for the United States. We have the opportunity, capacity, and quality to do this, but the certification alone is not enough. We must create positioning mechanisms in the US and Canada, so when a patient leaves a consulting room after being told he needs an operation that will cost 40 thousand dollars, he will immediately consider Mexico as an option for his operation. Currently, this does not happen. We need campaigns showing Mexico as having excellent hospitals, quality, and attention. Then we must follow up with finding patient recruiters in the US, preferably doctors or hospitals, to generate patient volume to Mexico. Medical tourism has two main components besides clinical: cost and accessibility to the places we want to develop medical tourism. The proximity of the US to Mexico helps, but that alone is not enough; success lies in promotion, recruitment, and showing our medical excellence, not necessarily in high-complexity surgeries.
EF: Our feature is called "Road Map to the Future," so if you had to create a road map for the healthcare industry in Mexico, what would be your three base pillars?
JP: My first pillar would be articulation (interoperability). There is a dialogue between all the main players; we all agree on the importance of working together. A second pillar would be social participation, as we cannot depend on the government for interoperability and Mexican health services. Sector players have been waiting for four years to see what this administration will do. By now, we have all concluded that we cannot wait for the government to act. As a sector, we can move ahead and work on articulation and public policies to improve the private health system. My final pillar would have to be digital transformation: once we have integrally advanced on the first two steps, technology must be brought in based on a health business model with good data analysis that allows for prevention, improved attention to the patient, and the population's benefit.
EF: Is there any final message you would like to share?
JP: My final message is a call to integration with all the sectors players working to reach our final objective: the patients, and new health models for the Mexican private sector, to be a reference in health for the upcoming generation.
