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EF: As we shift into the post-pandemic era, how are your priorities and agenda evolving? What does 2023 have in store for FUNSALUD?
HM: As we worked through the pandemic, we never lost sight of the key things happening in healthcare. We have to work to close the gap in access. This lack of access is due to three things. The first issue with access is related to personnel. This refers to the physicians, lab technicians, nurses, and all the other people that work in the healthcare system. We need to think about whether we have the right physicians at the right time and place. Over the years and throughout the pandemic, we learned that Mexico has a lack of skilled physicians. We do not have the right specialists. We have too many paediatricians in a country that does not really need that many paediatricians. We do not have enough oncologists, cardiologists, psychiatrists, and geriatricians.
We need to rethink the distribution of the right physicians with the right specialties. In essence, we need to determine the number of physicians that we require and ensure that they have the right specialties. Thirdly, we need to have these specialized physicians inside the country. Our physicians are currently concentrated in the key capitals of the states. We have physicians in some geographies, but when you look into the state, you find a lack of specialist physicians within the country. That generates an inequality where people have to move into the big cities to access healthcare. That is the first of our many concerns as FUNSALUD.
Our second concern revolves around infrastructure. When you compare the Mexican health infrastructure with that of other OECD countries, there is a noticeable gap. This is seen through indicators such as the number of beds, mammograms, or different equipment that is required throughout the country. We also have inequities in the time it takes to market new drugs and medical devices that enter the market. With regard to the launch of a new pharmaceutical product in Europe or the US, it typically takes about two years for it to enter the market from the moment they submit it to the FDA or the regulatory agency. In Mexico, that process takes around four years. That difference generates some inequalities caused by our lack of investment in the healthcare sector. We typically underinvest by about three percentage points of GDP when we compare that to the OECD's investment in healthcare. That lack of three points for a period of 30 years generates the three issues I mentioned earlier. We do not have the right personnel, infrastructure, pharmaceuticals, and medical devices as required.
We are working to find ways to close those gaps. The only way to close them is to go into new technologies. We really have to work on producing the right physicians and specialists. We then have to connect them to the rest of the country, and that's where things like telemedicine are key. We have to quickly adopt those technologies to try to make a better diagnosis and make sure that we do not move people from the countryside to the cities. We have to do healthcare completely differently. We have to work with people while they are still healthy and without illness. We need to focus on wellness and prevention by making sure people exercise, eat properly, and do the right things. We need to look into the "Four Ps." This means that we need to look into predictive healthcare, preventive healthcare, and personalized medicine and do it in a participatory way.
Everyone needs to know what they are susceptible to base on how they exercise, feed themselves, and, finally, when they need pharmaceuticals, they use the one that is right for them. Everyone has to ensure that they are responsible for their healthcare and recognize that nobody will do it for them. We are trying to improve the pharmaceutical offerings to cope with demand and find ways to reduce the demand, and that is why we have to work a lot more on making sure people have healthier habits.
EF: In your opinion, what can be done to align the goals of the various stakeholders in the pharmaceutical sector?
HM: There needs to be a redesign of the health system. When you look at how the system works, you see that the main provider of healthcare in the country and several countries is the IMSS. The IMSS is an institution that is responsible for too many things. Apart from health, it is also responsible for pension funds. On closer inspection, IMSS and ISSSTE report to the presidency. All the institutions that provide healthcare services report to the president's office. The Ministry of Health has no leverage in making decisions that would align with the goals of all stakeholders. It is very difficult to align individual needs when you have too many providers that are not under the responsibility of the Minister of Health.
The challenge for the system is in how it is designed. We are trying to align the system so that there is one provider of healthcare. This is a big task. We need to review what we are investing in healthcare and understand how we want the system to be designed in order to have a system that is more optimal in the way we deliver and provide healthcare. There is a lot of work to be done in the years to come, and FUNSALUD has started to work on the plan for 2024–2030. Whenever we have a change in the house, we bring in a new project or program about how we foresee the next six years. We are currently working on that. We are concentrating on how we should work to make sure that we recover life expectancy. If we do not change things by the end of 2030, Mexico will have a gap versus Japan of potentially 12 to 15 years. We have to work hard to make sure we do the right things to reduce that gap and get back on track to getting a better life expectancy.
EF: How would you ensure that the public sector adopts the latest technologies?
HM: We have to work to ensure that the regulatory agency, COFEPRIS, has the right people to track and approve new technologies. For example, if we look at CAR T-cell therapy, we have room to improve the people who are reviewing technologies like that and all the things that have to do with the new technologies in communication, the use of AI images, and biomarkers. We have not solved the personnel or regulatory issues yet. We also do not have the regulatory framework to make sure that goes through. We have to work from a regulatory perspective, and then we have to work on the training of the people. Those two things are critical.
There is a lot of work to be done in making sure that the physicians or the local hospitals get accustomed to the technology. Sometimes we forget to focus on the training of our healthcare workers in the use of new technology. Our physicians need to be trained and educated prior to the introduction of new technology.
In summary, the regulatory framework has to be solved by staffing COFEPRIS with the right people who are able to evaluate innovations as soon as the framework is ready. We then need to go into making sure that the physicians and researchers are happy with what they are seeing and the resources that are coming into the industry.
EF: How do you assess the potential of the Mexican healthcare industry to become an innovation hub on a Latin American level?
HM: Mexico is on its way to becoming an innovation hub. I know the region very well and have worked throughout it. I have headed the region several times for several companies, and I have done consulting for the healthcare environment all throughout the region. Mexico has one thing that is a clear advantage, and that is its geopolitical position. Being so close to the US has its benefits and risks. The benefits outweigh the risks when we think of Mexico as an innovation hub. For example, Jalisco has a hub that is moving in that direction. We are seeing some good things at some of the production sites around Toluca and Leon. We can also look at what is coming in Chihuahua and the north as we get closer to the US.
Yes, we have an advantage in that we have good researchers. We have great schools and universities. Many people from Latin America come to Mexico to study medicine and other healthcare-related programs. We have the right things to make Mexico an innovation hub. We also need to continue investing. Today, we have a legal framework that gives certainty to investors to make things happen in Mexico, and we are constantly seeing a lot of investment coming in from the outside. We have a lot of Asian companies and groups looking to invest in Mexico. Over the last few years, I have been working with many universities, and I have seen a very good group of researchers working all around the country. We are on the right track and should keep investing in that.
EF: How do you assess the progress of mental health awareness and treatment in Mexico, and what is your role in this?
HM: As a society, we are all working on raising mental health awareness. One of the positive things that came out of the pandemic is that the people of Mexico became more open about mental health issues. Previously, Mexicans would not be very open about going to a psychiatrist or a psychologist, and that has to do with the cultural issue where we are a little shy about saying that. It is different in Argentina, where they are more open. People are comfortable talking about their psychiatrist visits. If you are working at the office, it would be very easy for someone to discuss their doctor's visit for cardiology or oncology, but people would not say they were going for psychiatric needs. It is a cultural thing. The pandemic helped us open that door, making it easy to talk about depression and other mental health issues.
When we were reviewing the distribution of specialists throughout the country, one of the things we were lacking was psychiatrists and psychologists in Mexico. This is a big challenge in terms of how we are going to deal with it. There is a lot of work being done to make sure that the biomarkers in voices can now be helpful in detecting depression in society. Over the last few years, I have seen one or two companies use biomarkers in voices to detect depression and anxiety. Those are the kinds of things where we want to see new technologies being used. We acknowledge the lack of psychiatrists and other resources, but we need to figure out how we can blend these things together and get the support of new technologies to be able to handle the challenges of today and the future. There is a lot of work to be done, and mental health is a clear space to see how we can incorporate new technologies.
EF: How are you leveraging different partnerships for the advancement of innovations in the industry?
HM: We are all working together to try and close the gap. As I mentioned earlier, we have to work on the personnel, physicians, nurses, infrastructure, and access to medical services in order to close that gap. One of the most critical things is that we need to reduce the demand for health services. Closing the demand gap means you have to work with people and their particular habits. That will help us close that demand gap and bring up new offerings. It is basic economics if you want to reduce demand and improve the offerings you have. We work based on what we call "councils." There is one council that is working on habits and another that is working on mental health and wellness. There is a council that is working on the quality that the system is delivering, and that is where we do the hospital's private ranking. There is another council that works on the system and the framework of the system. That is where we make the plans for the future of the healthcare system at the state level. We make the plans for the ministries of health within each state. This is another council that works with new technologies. One of the things we have recently done is write the proposal that is being discussed in the Chamber of Deputies and Senators regarding digital health.
Each of these councils has its own agenda and priorities. We then work from the agendas of each of the councils to make sure that we move things forward and bring their plans to fruition. We do a lot of research and analysis in order to write public policy. We are currently working in the field of genomics. This involves all the regulations governing genomics, although Mexico has no regulations on genomics.
The councils are comprised of people that come from the research arena, the private sector, the government, and public and private institutions. We take all their visions and try to create something that makes sense out of them.
EF: When you look back at this period of your career, how would you like to be remembered as a leader?
HM: I think we have worked on having a very clear agenda for how to close the gap. I would like to be remembered for making sure that during this period, we really managed to close the gap and improve access to healthcare within the country.
EF: If you had to create a road map for the future of the healthcare industry in Mexico, what would your three main pillars be?
HM: Firstly, I would say we need to improve our habits. Second, we have to accelerate the inclusion of new technologies. For those two things to happen, we have to keep on working to make sure that we get extra budgets for the healthcare system as a whole. We need more resources to improve our habits and to include new technologies to close the gaps.
Again, it is basic economics. The demand will continue to grow, and we are not going to be able to supply that demand for healthcare services as a whole. We have a graph that specifically shows the gap. As we become an older population, the demand for healthcare services is going to increase. If you have people going to the physician earlier because they have different diseases, then you have an issue. This is seen, for example, with diabetes, obesity, or things that have to do with all the things we are seeing today in the system. If you do not work on taking control of the demand, you are going to see an increase in demand and no supply to be able to meet it because the amount of money that we're going to require to meet that demand is going to be enormous and we, as a country, don't have it. We are underinvested not only in healthcare but also in security, education, and all across the crucial sectors. We need to work with people who are already ill and ensure that they do not get worse because as soon as things get worse, it is also very difficult for the system to cope with it.