Introduction:

INSABI’s Gone; Now It’s IMSS-Bienestar

After only three short years, the president’s disastrous approach to healthcare, INSABI, has gone the way of the dodo. So what’s next?

As you might recall from our last article, Goodbye Seguro Popular – So What’s Next, Mexican President, Andrés Manuel López Obrador (AMLO), cut the hugely successful social welfare program Seguro Popular in favor of merging it with other health organizations like the IMSS (the Mexican Social Security Institute), ISSSTE (Institute for Social Security and Services for State Workers), and the military’s healthcare: La SEDENA, Mexico’s Ministry of Defense.

Some of these organizations are available for expats with either a work visa or a residency visa, but they are often overloaded with patients, stretched for resources, and using outdated equipment. The best thing you can do to prepare in case of an emergency, is to get expat health insurance so you have medical coverage for yourself and your loved ones. (Click here for a free quote that only takes a minute.)

Catching Up on the Different Programs of the Past

INSABI’s Gone, Now It’s IMSS-Bienestar

– IMSS –

Mexico’s social security institute is the IMSS. It’s an insurance organization and healthcare provider rolled into one organization, and it’s the largest of its type in Latin America. Mexican employers pay into the program. (So can you if you have a temporary or permanent visa, btw). The IMSS has great doctors and it’s very affordable, and it carries a decent supply of medication—if a bit limited. It’s just bare-bones medical care that lacks amenities—like meals with your hospital stay—and you could be barred from joining the IMSS if you have preexisting conditions.

– ISSSTE –

ISSSTE is like the IMSS, but for government employees. The state pays for them to be able to use the ISSSTE. Expats can use the ISSSTE if they have an FM2 or FM3 visa. The facilities are pretty good, and they’re decently stocked. Social protection covers the spouse, children, and even parents of the insured person (if they live with the insured).

– Seguro Popular –

Seguro Popular was nationalized healthcare that did work in the sense that it saved lives. However, Seguro Popular had the most bare-bones, antiquated equipment. You were charged based on what you could afford, and if you could afford nothing, you could apply to be treated for free. It was scrapped in favor of INSABI.

– La SEDENA –

La SEDENA is the Mexican Defense Ministry, which also provides healthcare to veterans. They sometimes partnered with INSABI—especially under AMLO’s administration, which seems to have given so much authority to the Mexican military (from managing the controversial Mayan train to checking travel documents at international airports). La SEDENA administered the covid vaccine in the city where I live. It’s only in these types of circumstances that civilians deal with La SEDENA.

– INSABI –

In 2019, Mexican President Andrés Manuel López Obrador decided to merge the organizations mentioned above all under one banner: the Instituto de Salud para el Bienestar (INSABI). (More on this in the next section.)

Why INSABI Failed

INSABI’s Gone, Now It’s IMSS-Bienestar

Originally, the IMSS—in collaboration with the Secretaría de Salubridad y Asistencia (SSA, Ministry of Health)—was in charge of buying medication for the country. Then, under INSABI, the Secretaría de Hacienda y Crédito Público (SHCP, Mexico’s tax authority) was in charge of purchasing medication, in bulk, in hopes of getting a better price on the country’s medication. This meant that buying medication came under the power of treasurers and politicians—not doctors.

The different organizations tried to find medication as best they could without decent leadership. ISSSTE had some success, but the other organizations suffered. It wasn’t until children started dying of cancer that INSABI’s significant failures became well known.

What’s Next for Mexican Healthcare

INSABI’s Gone, Now It’s IMSS-Bienestar

With 267 votes in favor, 222 against, and one abstention, the Chamber of Deputies approved on Tuesday, April 25, the reform to the General Health Law to terminate the Institute of Health for Wellbeing (INSABI), which was created in 2019. Now, the public health services will pass into the hands of the IMSS-Bienestar, or IMSS-Wellbeing.

In this regard, the Secretary of the Interior, Adán Augusto López Hernández, declared during the morning conference that it’s a reorganization of the functions of the Federal Government's Health Secretary:

It is a reorganization of the functions of the Ministry of Health of the Federal Government so that the operational part and the medical care are consolidated in the IMSS-Wellbeing system, and there is free and universal medical care for all Mexicans.

In accordance with what has been generally endorsed by the Chamber of Deputies, INSABI will disappear and its functions will be integrated into the IMSS-Wellbeing, so that a single decentralized body provides health services throughout the country in concurrence with the state.

In accordance with the transitory regime, in a maximum of 180 calendar days, the Ministry of Health must establish terms and conditions to transfer human, budgetary, financial, and material resources (107.5 billion pesos, or about 6 billion US Dollars, were budgeted for 2023), as well as real estate rights and obligations of the INSABI to the IMSS-Wellbeing.

Since 2022, the provision of medical services has been in charge of the IMSS-Wellbeing, as President López Obrador decided by decree; therefore, the legal framework has now been reformed in accordance with that decree.

INSABI Leaves A Debt of $938.3M Pesos

INSABI’s Gone; Now It’s IMSS-Bienestar

On June 19 of this year, the newspaper 24 Horas published an article entitled "INSABI disappears and leaves a debt of 938.3 million pesos," reporting that, at the end of 2022, the Institute of Health for Wellbeing (INSABI) left debts with suppliers and other services for $938.3 million pesos, according to an independent audit.

While allegations of embezzlement swirl, this is false. Indeed, the financial consulting agency Mazars reviewed INSABI's financial statements, corresponding to the years 2021 and 2022. What the 24 Horas newspaper omits is that this consultancy was hired following the guidelines of the Ministry of Public Function (Secretariat de la Función Pública, SFP) for the designation of offices to audit financial statements. This audit helps to check if the use of public resources is carried out efficiently and complies with current legal provisions.

The paragraphs of emphasis mentioned by the Mazars consultancy for the years 2021 and 2022 have been addressed, and as of June 17 of the current year, INSABI has paid $718.8 million pesos of the debt of $938.3 million pesos.

AMLO says the difference of $219.5 million pesos corresponds to invoices that are sanctioned. That is to say that to date, the suppliers have not paid the corresponding penalties for incomplete or late delivery. This is also the line of the Mexican Government Press, but it is still an embarrassment for the current administration.

You cannot pay, as was done in the past, for undelivered goods. When the suppliers submit all their documentation up to date, INSABI will be in a position to settle the debts.

It’s important to clarify that the external auditor's opinion was issued without qualifications. The note in the 24 Horas newspaper highlights the paragraphs of the external auditor's note, which does not change the auditor's opinion. It should be added that the INSABI is in the process of closure, but that does not mean it is leaving commitments unfulfilled.

On June 1, 2023, the agreement issuing the bases for the transfer of resources and disincorporation due to cancelation of the decentralized public body called the Health Institute for Wellbeing was published in the Official Gazette of the Federation (DOF); the fifth section indicates that this unit will continue to enjoy legal status and will be in charge of closing all programs and actions that are in process, including obligations derived from lawsuits and administrative procedures, that is, all pending payments of this institute will be liquidated, as long as the suppliers meet the requirements established in the standard.

The newspaper 24 Horas published unverified information, lacking the rigor of the journalistic exercise, and pointing out non-compliance by the federal government where it does not exist. The Government of Mexico is committed to the health of Mexicans. The Official Gazette of the Federation published this Monday the decree that cancels the Institute of Health for Wellbeing (INSABI), whose functions will be absorbed by the IMSS-Wellbeing,

This body will collaborate with the Ministry of Health regarding the free provision of health services, medicines and other associated inputs required by people without social security. In addition, in the Health System for Wellbeing, the collection of recovery fees for the provision of health services, medicines and other supplies associated with people without social security is prohibited:

The governments of the federal entities will contribute, within the scope of their respective competences and, where appropriate, in the terms of the coordination agreements that they hold with the Ministry of Health, in the operation, functioning and strengthening of the National Health System, for which, they will plan, organize and develop in their respective territorial constituencies, state health systems, seeking their programmatic participation in the National Health System”.

What We Know about the New IMSS-Bienestar

INSABI’s Gone; Now It’s IMSS-Bienestar

The opposition has criticized the speed with which the parties in favor of the president, (Morena, Partido Verde Ecologista de México and Partido de los Trabajadores) have approved the measure. The deputy Margarita Zavala regretted that the INSABI was being integrated into the IMSS-Wellbeing, "without discussion, without dialogue and knowing that the INSABI was a disaster."

Meanwhile, Deputy Salomón Chertorivski has assured that "when the invention they made disappears, they clearly recognize that it failed, but instead of studying and analyzing the errors, what they do is transfer those same failures to another institution."

The coordinator of the Morena deputies, Ignacio Mier, admitted the mistake made with the creation of INSABI. “It is always good to rectify, it is never too late,” admitted the morenista, and added: “The Institute had the resources —we approved it— and the states lacked the infrastructure and resources to operate. I believe that it is a virtuous fusion of cooperation between states and the Federation that materializes in an instrument of Well-being that is the IMSS-Bienestar”.

Morenista deputy Emmanuel Reyes, president of the Health Commission, presented the initiative at the last moment of Tuesday's session. The reform establishes that the decentralized public body IMSS-Bienestar will be the institution in charge of providing free health care to those people who do not have social security, such as people with informal jobs.

The_ IMSS-Bienestar_ health system offers its services in 19 of the country's 32 states, serving approximately 11.6 million people. The institution has 3,983 medical units that provide first-level services and 80 units that attend second-level specialties, such as general surgery, gynecology, internal medicine, or pediatrics. The measure still has to be approved in the Senate, where the pro-government majority that supports the president's party also has a majority.

Looking to the Future

INSABI’s Gone; Now It’s IMSS-Bienestar

Taking into account the failures and shortcomings not only of the now-defunct INSABI, as well as the incorporation of those failed systems into the country’s Social Security Institute, it is more important than ever to look for another option. Standing in stark contrast to these failed systems and the scrambling of public officials to bridge the gaps in coverage, one area of Mexico’s health systems shines like a beacon on the hill: the private health sector. Responding to an increase in medical tourism and surging numbers of expats living in Mexico, private hospitals and clinics have sprung up with modern equipment, sufficient supplies and medicines, and well-trained doctors and nurses that are able to treat complicated and severe health problems. Unsurprisingly, these private facilities come with higher costs. The best way to protect yourself amidst a changing health landscape is with health insurance tailored to expats living abroad.

Click here for a free quote from our experts that only takes a minute.