Background and Relevance of IMSS-Bienestar
The IMSS-Bienestar program, established by Mexican President Andrés Manuel López Obrador in August 2022, aims to provide comprehensive medical care, including hospitalization and medications, free of charge to individuals without social security affiliation. The program centralizes healthcare delivery by signing agreements with states, allowing it to directly operate health units using their infrastructure, personnel, and resources from the Fondo de Aportaciones para los Servicios de Salud (FASSA).
Currently, 23 states have signed agreements with IMSS-Bienestar. This program’s objective is to ensure universal access to healthcare services, but it has resulted in financial challenges for participating states.
Reduction in FASSA Allocations and Its Impact
According to Moody’s, a leading credit rating agency, the centralization of healthcare spending through IMSS-Bienestar has led to a decrease in federal resources transferred to states. This reduction limits the operational margins of entities that have joined this policy instrument, designed to serve the population without social security coverage.
States that opted for the IMSS-Bienestar agreement have experienced a 0.7% additional gap in healthcare spending as a proportion of their projected operating income by 2025. This gap, though manageable, adds to other financial pressures such as pensions, salary increases, federal debts, and public works spending.
- Q: What is the additional spending gap for states with IMSS-Bienestar agreement by 2025? A: 0.7% of their projected operating income.
- Q: What other financial pressures do these states face? A: Pensions, salary increases, federal debts, and public works spending.
FASSA Resource Growth and Its Redistribution
From 2020 to 2023, FASSA resources for all states grew annually by an average of 6.5%. However, states integrated into the IMSS-Bienestar program transferred their agreed-upon FASSA resources during this period.
Since 2024, following a presidential decree modifying the Fiscal Coordination Law, the Secretaría de Hacienda y Crédito Público (SHCP) has directly subtracted the agreed-upon portion of FASSA to transfer it to IMSS-Bienestar.
This subtraction caused a 23% drop in resources distributed to states from FASSA in 2024. States with agreements experienced an average reduction of 34%, equivalent to 38,000 million pesos, while states without agreements saw a 7.0% growth.
- Q: How did the FASSA resources change for states with and without IMSS-Bienestar agreements after 2024? A: States with agreements experienced a 34% reduction, while those without saw a 7.0% growth.
Healthcare Spending Adjustments and Future Implications
Since the program’s inception, states have adjusted their health departments’ spending. States with IMSS-Bienestar agreements saw an average reduction of -13% in spending, while those without agreements increased their spending by 9.0%. By 2025, the reductions are projected to be -12% for states with agreements and -1.0% for those without.
The spending adjustments haven’t been proportionate to the FASSA reduction, indicating rigidity in healthcare spending. Consequently, states will need to cover their health departments’ operations with more self-funding as IMSS-Bienestar centralizes healthcare units.
- Q: How have states adjusted their health department spending since the program’s inception? A: States with IMSS-Bienestar agreements reduced spending by -13%, while those without increased it by 9.0%.
- Q: How will states manage healthcare department operations in the future? A: States will rely more on self-funding as IMSS-Bienestar centralizes healthcare units, with limited FASSA resources available for them.
FASSA Coverage and Its Impact on State Finances
Moody’s highlights that the reduced FASSA coverage forces states with IMSS-Bienestar agreements to utilize more self-funding and participations to cover the healthcare spending gap. The Mexican government aims to ensure universal access to medical care through this program, but it has created financial challenges for participating states.
