According to the analysis presented by the Federation’s Senior Audit (ASF) to the Trust of the Social Protection System in Health (FSPSS), in 2019, the Mexican federal government channeled only 10 billion pesos to the Catastrophic Expenditure Protection Fund (FPGC) when 13 billion pesos were transferred to it. The 3 billion 599 million 803 thousand pesos that were not transferred could mean the realization of 21,759 breast cancer surgeries.
In recent days, this trust and its main fund, the Catastrophic Expenditure Trust, have been in the focus of the debate, since the Chamber of Deputies approved taking away 33 billion pesos, which will go to the Federation Treasury, to pay for COVID-19 vaccines, as argued by the legislators of Morena and the federal government.
Now as part of the audits presented to the 2019 public account, the ASF documents that not only were fewer resources channeled to it, but that the trust has deficiencies in its rules of operation and in the system for managing validated, authorized and paid interventions.
Read: Welfare Health Fund: How will the 33,000 mdp be spent now?
It was on November 16, 2004, that this trust was established, with the aim of creating an agile and transparent mechanism that would allow the federal government to apply resources to financially support beneficiaries of the Social Health Protection System with associated treatments and medicines, which are considered catastrophic expenses.
At the start of its operation, in 2004, the trust covered five conditions, which increased to 66 in 2018.
On November 29, 2019, the decree to create the Institute of Health for Welfare (Insabi) was published, which assumed all the rights and obligations of the defunc National Commission for Social Protection in Health. This decree foresees the formation of the Health Fund for Welfare, replacing the FSPSS.
The tasks assigned to it were to pay attention to diseases that cause catastrophic expenditure and infrastructure needs, as well as to complement resources for the supply and distribution of medicines and inputs. The fund’s resources came before the federal government, state governments, and beneficiary families, which will now no longer make any contributions.
Last year, federal contributions to the FSPSS were included in the budget of the U005 «People’s Insurance» program, by the National Commission for Social Protection in Health (CNPSS), now institute of health for welfare (Insabi).
Of the 69 thousand 887 million 720 thousand 400 pesos exercised in this program, notes the ASF, 15 thousand 405 million 666 thousand 800 pesos (22.0%) were transferred to the trust, through 24 transfers for federal contributions.
Of these 15 billion, 67.5% (10 billion 195 thousand 700 pesos) went to the Catastrophic Expenditure Protection Fund and 32.5% (5 billion 005 million 471 thousand 100 pesos) for the Budget Forecast Fund (FPP), another bag, but for infrastructure in the most marginalized entities.
In order to verify that the federal contributions to the FSPSS in 2019 corresponded to the percentages established in the General Health Act (LGS), of 8.0%, for the FPGC and 3.0% for the FPP, the calculation basis for the determination of the amounts was revised and found to differ from those reported in the 2019 Public Account.
Only 10 billion 400 million 195 thousand 700 pesos were transferred to the FPGC, when 13,999 million 999 billion pesos were transferred, with which 21,759 breast cancer surgeries could have been performed.
In addition, of the 64,568 medical care validated by hospital units to be supported by the FPGC, in 2019 the FSPSS Technical Committee authorized 59.2% (38,213 care), amounting to 964 million 346 thousand pesos, representing 64% of the 3 billion 068 million 969 thousand 600 pesos that covered medical units in the care of beneficiaries. As long as 40.8% (22,919 attentions) were pending authorization, and 0.7% (440 attentions) were not authorized.
Regarding the FPP, in 2019, 5 billion 471 thousand 100 pesos were transferred to it, down 0.1 percentage points to 3.0% established in the LGS, with about 249 million less.
For the care of infrastructure needs for primary care and basic specialties in the most socially marginalized federal entities, 2.1% (3 billion 705 million 446 thousand 400 pesos) was earmarked, higher by 0.1 percentage points than 2.0% established (3 billion 499 million 999 thousand 800 pesyou).
While to address unforeseen differences in demand for services (because of an epidemic, for example) 0.7% (749 million 999 thousand 900 pesos) is targeted, or 0.3 percentage points less than 1.0% (449 million 975 thousand 400 pesos) provided for in the General Health Act, without INSABI explaining the causes and effects.
Regarding the development of high-specialty infrastructure and new technologies, in 2019, the Technical Committee of the Health Social Protection System Trust did not authorize financial support for these projects, although the Master Infrastructure Plan recorded eight projects in hospital units that provide high-specialty medical services.
In 2019, under the «Physical Infrastructure» sub-account of the FPP, 76 projects were financed, 3 thousand 661 million 621 thousand 900 pesos, authorized during the period 2011-2019, of which 40.8% (31 projects) were not located in federal entities, municipalities or localities of high or very high social marginalization, according to the criteria of the Conapo, nor was it foreseen in the PMI of 2019 , so it was not established that these projects focused on streamlining public investment in infrastructure and ensuring sustainable operation.
With regard to the payment of unforeseen differences in demand for health services, it was found that the sub-account «Differences in Demand and Payment Guarantees» had an amount of one billion 024 thousand 500 pesos at the end of 2019. Insabi reported that no state regime requested financial support, so resources were transferred to the sub-account «High Specialty».
With regard to the monitoring of the FSPSS operation, the Ministry of Health did not carry out such activity to verify the fulfilment of the purposes, nor the implementation of the financial support of the trust in 2019.
No robust rules
The ASF assessment, which aimed to control the efficiency, effectiveness and economy of the FSPSS, covered: its design; the integration and operation of its Technical Committee; financial performance; authorization, implementation and coverage of support for the care of interventions and medicines associated with diseases that cause catastrophic expenditure, as well as for the development of infrastructure and acquisition of high-tech equipment.
The review focused on the 2019 financial year, and covered the period 2013-2018 in comparing the eeroged budget, as well as on the results related to the coverage of the Catastrophic Expenditure Protection Fund.
The audit notes that the FSPSS had operating rules, approved by the Technical Committee of that trust, in sessions held on 22 May and 28 June 2019, which had the right purpose of regulating the operation of the trust and establishing the bases, requirements and modalities for access to the FPGC and the FPP.
The ASF identified deficiencies in these rules that affected implementation, since the target population was not precisely defined; mechanisms were not included to enable the collection of information and the assessment of economic and social benefits; no criteria were established for those responsible to adjust the modalities of the operation or to decide on its cancellation.
In addition, since the Social Health Protection System in Health System (SPF) Trust was amended by the Health Fund for Welfare (FONSABI) on 29 November 2019, it was indicated that the rules of operation of the new fund would be issued in the opinion of the SHCP, and would establish how the resources of the fund will be exercised.
The second transitional decree created by Insabi and amended all the structures mentioned indicated that the Federal Executive should issue the regulatory provisions to provide in the administrative sphere the provisions of the decree, within 180 days of its entry into force, so that the rules of operation of the Health Fund for Welfare should have been issued on 29 June 2020; however, as of October 16, 2020, they had not been published.
In view of this, the ASF recommends that they are already issued and include: the precise definition of the target population; mechanisms for obtaining information and assessing economic and social benefits; criteria that allow those responsible to adjust the modalities of their operation or cancel it.
The results, observations and actions contained in the audit shall be communicated to the audited entity, in terms of articles 79 of the Political Constitution of the United Mexican States and 39 of the Federation’s Audit and Accountability Act, so that within 30 working days it may present(e) the information and make any considerations it deems relevant.
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