Introduction
The health of a nation is not merely a right or a promise, but a strategic asset. However, in Mexico, managing this vital asset resembles a budgetary labyrinth—a black box where resource allocation, supply planning, and medical protocols operate in parallel universes. A physician might prescribe a treatment based on established medical protocols, only to find that the required medication or equipment is unavailable at the clinic’s pharmacy or institutional inventory. This disconnect, seemingly a logistical issue, is actually the starkest manifestation of structural failure in how Mexico’s state organizes and funds its healthcare system.
The Urgent Need for Reform
The absence of a coherent resource allocation model, both budgetary and technical/human, is the primary obstacle to ensuring equitable and universal healthcare coverage. A system where medical protocols aren’t aligned with actual supply availability or epidemiological data doesn’t translate into specific budgetary allocations is dysfunctional. It’s a resource-consuming machine with inefficient and inequitable outcomes.
The Core Issue: Disconnect Between Theory and Practice
The fundamental problem lies in the disconnect between medical care theory (protocols and clinical guidelines) and practice (what’s genuinely available for doctors and patients). This gap results in erratic, fragmented, and often unjust care. For the same illness, treatment can vary based on pharmacy or hospital equipment stock rather than patient condition. This isn’t merely inefficiency; it’s a significant expression of social inequality, where optimal treatment access becomes a lottery.
The Solution: A New Administrative and Conceptual Framework
The solution isn’t simply injecting more funds into the system but creating a new administrative and conceptual framework linking three key elements: medical protocols, insumos listed in the National Compendium of Health Insumos, and budgetary allocation.
1. Medical Protocols and Clinical Guidelines: The Navigational Tool
A medical protocol is the “user manual” of medicine, detailing the most effective and safe path for diagnosing and treating a disease. Mexico has excellent protocols developed by specialists, but their value is lost if not directly linked to obtainable resources at the care point. For a protocol to be functional, it must include a clear appendix specifying necessary insumos (medications, healing materials, diagnostic equipment) for proper execution. This attachment shouldn’t be a theoretical list but a direct and binding reference to insumos found in the National Compendium.
This seemingly simple step has profound implications. It compels protocol developers to collaborate with logistics and supply experts, preventing the recommendation of treatments using unavailable medications in the public system. It’s the first link in the value chain ensuring care isn’t just an intention but a reality.
The National Compendium of Health Insumos is theoretically the master inventory of what Mexico’s public health system can acquire. It’s the official listing of medications, devices, and materials. For equitable care, this compendium must be an updated, dynamic source fed by epidemiological data and medical protocols. If a high-prevalence disease protocol requires an unavailable medication, the system should have a swift mechanism to assess and adjust demand, incorporate it into the system, and most importantly, ensure its acquisition and distribution.
This is where technological interoperability comes in. The Compendium can’t be a static document. It must evolve into a living, accessible catalog for all institutions, allowing budget planners and institution managers to verify insumo availability and pricing. It’s the link between “what to do” (protocols) and “how to do it” (insumos).
The significant disparity in the Mexican system, perpetuating the budgetary labyrinth, is the lack of precision in linking epidemiological data and medical protocols to financial resource allocation. Health budgets are essentially a general pot from which each institution draws according to needs and political negotiation capacity. This is a reactive, not proactive, model.
To transform this model, introducing necessary budgetary tags is imperative. This concept means funds aren’t allocated generally but are directed to specific treatments based on disease burden. This proactive approach offers benefits like:
- Guaranteeing Coverage: By tagging funds for specific treatments based on disease burden, resources are assured to meet real population needs.
- Empowering Leadership: A Health Secretariat capable of designing and monitoring these budgetary tags exercises genuine leadership over the system. It can direct resources to areas or diseases needing them most, correcting historical inequities. Decision-making shifts from political pressure to data-driven science.
To realize this vision, leadership with foresight and courage to challenge the system’s inertia is required. It’s not just a technical issue but a political one, involving health institutions accepting central resource allocation based on evidence. It means investing in information systems linking Electronic Clinical Records with epidemiological data and inventory management systems.
The ultimate benefit is equity. A healthcare system where protocols, insumos, and budget are perfectly aligned ensures health as a reality for all, regardless of urban or remote location. It’s the difference between an existing system and one that truly functions.
I conclude with a quote often attributed to Russell Ackoff: “When parts of a system are optimized, the system as a whole is not optimized—and often is deoptimized.”
*The author has 25 years of experience in the Mexican and Latin American health sector, is a founding partner of a consultancy focusing on public health policies, digital health, and sustainability analysis.
