translated from Spanish: The ASF warns risk of under-utilization in new public-private hospitals

the audit top of the Federation (ASF) published this Wednesday two reports on the construction of seven general hospitals of the IMSS and the ISSSTE, conceded in 2017 under the public-private partnership scheme, five of which the data show that the companies raised the amount of investment, number of beds, clinics and operating rooms, above which established the national infrastructure program (NIP).
The Agency warned the risk of these medical units to end up not used 100%, so it issued recommendations 2017-1-19GYR-15-0256-01-002 and 2017-1-19GYN-15-0246-01-003, which require both institutes of social security: “(who) implement the” evaluation, operation and control mechanisms that ensure that their projects are aligned with the national infrastructure program, in terms of estimated total investment, attention to dependants and number of beds, in order to prevent under-utilization the installed capacity of hospitals,”said the ASF.
Of the Mexican Institute of Social Security (IMSS), the case presenting greater variation is the construction of a Regional General Hospital in Tepotzotlán, State of Mexico. While in the PNI 2014-2018, an investment of 460 million pesos was projected to have 72 beds and attention to 72 thousand beneficiaries, the APP was per thousand 628 million for 260 beds and attention to 44 million people.
For a Regional General Hospital in García, Nuevo León, investment rose thousand 130 million pesos to thousand 578, 216 to 260 beds, and attend 216 thousand users, to 422 million.
In the case of the General Hospital of zone in Tapachula, Chiapas, investment increased from 798 million to thousand 123 thousand, scheduled beds rose from 144 to 180 and care for dependants, from 144 to 595 thousand.
“The data presented in the analysis of the social profitability of the projects of APP are not aligned with the PNI, all time increments were determined ranging from the 39.6% to the 253.8% in the ‘investment Total estimated’ projects, 20.4% to the 261.1% in number” “beds, and the 313.5% to the 1,349.7% in ‘ care to beneficiaries ‘, with respect to the PNI”, warned the ASF.
There is a hospital APP being built by the IMSS, in Bahia de Banderas, Nayarit, but the audit found that the project was not included in the national infrastructure program.
As for the three new medical units which will be the Institute of security and social workers of the State (ISSSTE) services, the ASF report exposes the differences in two works that began as a proposal not requested (PNS), i.e. to initiative of private companies.
In the project of replacement of the General Hospital of Tepic, Nayarit, the company that proposed it elevated the investment to double, from half a million to a million pesos. It was proposed to build six operating rooms instead of two, i.e. three times more what suggested the national infrastructure Plan; 150 beds instead of 59, and 38 clinics instead of 25.
“It surpassed in all aspects the proposed features in the PNI, which considered the construction of a new clinic hospital in Nayarit for second-level care, whereas the PNS proposed a general hospital,” noted the report of the audit.
In another project, a General Hospital in the delegation South of the city of Mexico, the APP only increased the fixed beds of 180 to 250 and the transient from 30 to 125, while it reduced the number of clinics, established in the PNI to only 36 93 , and lowered the investment of 808 million pesos to 418 million.
Built under the public-private model hospitals already operating have been identified by problems of underutilization even years after having started to operate, as recently documented Mexicans against corruption in the study health impaired on the regional hospitals of high specialty of the Ministry of health.
Hides the IMSS information on contracts and donation of land for hospitals the Superior audit of the Federation noted in its report on hospitals APP of the IMSS, which the Agency did not include in its financial statements of 2017 information on the four projects – Banderas Bay, Garcia, Tapachula and Tepotzotlán – who have an investment of more than 49 billion pesos, and were awarded for 25 years.
The document adds that after presenting the IMSS the results of the audit, the Institute said that in the financial statements of 2018 it would already include information contracts APP, but at the end of the review, last August, had not revealed those details.
“Also, not shown the three properties with a market value, by 72,788.3 thousands of pesos, delivered through the administrative permit temporary developers and by which developers will cover an annual fee for 25 years,” added the ASF.
Therefore, issued the recommendation 2017-1-19GYR-15-0256-01-008 for revealing the IMSS APP contracts, payments to be made and relation to the delivered land, “in order that they have accurate, reliable and timely information, and which contributes in making of” decisions”.

Original source in Spanish