The shortage of medicines – El Financiero

In recent years, the shortage of medicines by public health institutions has increased significantly, which has affected large segments of the population in Mexico.

Although there are no official statistics, various sources confirm the phenomenon. The most systematic information comes from the Cero Desabasto collective, which is a member of a large number of social organizations.

Every four months since 2019, this group has published a mapping of the shortage of medicines, vaccines or healing materials, based on the indications that, anonymously, the public makes, mainly, on a digital platform designed for this purpose. Most of the complainants are affected patients and relatives and, to a lesser extent, health workers.

Although the upward trend in the number of complaints received does not necessarily reflect a worsening of reality, since participation has depended, to some degree, on the dissemination of the platform, certain data attracts attention.

The complaints have come from all the states of the country, which suggests that the problem is national and not exclusive to certain localities. As expected due to the size of the beneficiary population, the largest number of reports has involved, in descending order, the IMSS, ISSSTE, Insabi and other institutions.

On an almost regular basis, the main neglected disease has been cancer, followed by diabetes mellitus, high blood pressure, rheumatological diseases, mental health and other conditions.

In order to complement the mappings with “hard” data, this group has prepared a report on the shortage of medicines, corresponding to 2019 and 2020, based on requirements to health institutions in the National Transparency Platform.

Within the content of the report, two unfavorable trajectories stand out. On the one hand, from 2019 to 2020, the number of consultations granted by the system to non-Covid patients decreased 52 percent.

On the other hand, since October 2019, there has been a substantial increase in prescriptions not filled, mainly in the IMSS. The lack of supply of medicines occurred despite the fact that health care contracted.

In general terms, the shortage has been derived from the changes in the processes of acquisition and distribution of medicines and medical supplies that the federal government has implemented since 2019.

The turnaround has been based on the presidential conviction that, in the past, participants in the drug supply chain, including manufacturers and distributors, exercised “monopoly” power to enrich themselves excessively and illegitimately. The government’s orientation has consisted of seeking greater direct participation by the State, eliminating intermediaries, with the aim of fighting corruption and obtaining savings.

Among others, the changes have included the transfer of the centralized procurement function from the IMSS to the SHCP; the closure of the plants of a laboratory that supplied most of the oncological drugs, due to administrative failures; the lower participation of public tenders in favor of direct awards; the coordination of international purchases by Insabi with the support of the UN, and the authorization to the different institutions to obtain, on their own, the medicines in the face of insufficient international purchases.

In addition, the government has disabled and vetoed drug distributors, with the aim of replacing them with its own distribution agency, a function that it assigned to the Birmex laboratories, which are majority state-owned. As of 2022, this company has responsibility for the distribution of medicines nationwide through the armed forces.

The result has been improvisation and disorder in the supply of medicines, at a high cost to society. The shortage has led to the deterioration of health and even the death of many people. The benefits sought are not clear, as the opacity of operations has increased and savings have been confused with containing health spending.

The measures that have given rise to the shortage of medicines reflect the government’s underestimation of the value that individuals contribute in the different segments of the industry. The greatest efficiency in health care is achieved with the elimination of barriers to competition between providers, not with the monopolization of business tasks by the State.

Former deputy governor of the Bank of Mexico and author of Economía Mexicana para Desenchantado (FCE 2006)

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