Hospitality industry consensus: Your model is exhausted

The private hospital sector in Mexico has reached an unequivocal consensus: the current payment-for-service model they operate under is exhausted. This conclusion resonated strongly at the Congress of the National Association of Private Hospitals (ANHP), where hospital CEOs agreed that the approach that prioritizes the volume of procedures over the quality of outcomes is unsustainable.

In a country where 90% of hospitals have fewer than 50 beds and out-of-pocket payments represent half of healthcare spending, there is an urgent need to move toward a value-based management (VBM) model that prioritizes quality, patient experience, and economic efficiency through measurable indicators.

As if in an exercise in self-awareness, the rector of TecSalud, Guillermo Torre Amione, moderator of the panel, challenged his colleagues with a critical question: how can we transform a fragmented system, where all the actors are dissatisfied and distrustful of one another, into one that rewards courage?

Torre described a challenging landscape for private medicine in Mexico. In this model, hospitals are small, with an average of 30 beds, and out-of-pocket payments dominate, with only 10-12 million Mexicans having health insurance. Furthermore, physicians, who perceive themselves as "owners and czars" of care, operate autonomously, making collaboration difficult. This context creates a system where incentives are misaligned: hospitals seek to maximize revenue from procedures, insurers face rising costs, patients, especially older adults, deal with insurance premiums that reach up to 300,000-400,000 pesos annually, and physicians constantly complain about insurers. As a result, all stakeholders—hospitals, physicians, insurers, and patients—are dissatisfied and distrustful of one another. Torre emphasized that this widespread discontent reflects a "broken" system that cannot continue to function without a profound transformation.

The current pay-per-event model encourages practices that prioritize volume over quality. For example, more days in intensive care or more procedures such as radiology or stents generate higher revenue, but not necessarily better patient outcomes. In contrast, the GBV proposes measuring and rewarding quality outcomes, prevention, and efficient management of chronic diseases. Torre emphasized that the public sector, with control over physicians, hospitals, and financing, could implement this model more easily. However, in the private sector, fragmentation, low insurance penetration, and an individualistic medical culture complicate the transition. The central question is: how can hospitals, physicians, and insurers work together to align incentives and prioritize quality in a context where trust is scarce?

The panel proposed solutions. José María Zubiría, general director of the ABC Medical Center, suggested breaking down the problem into three axes: quality, patient experience, and costs. Quality requires transparent indicators, which, it was stated, are already being developed to compare hospital performance. Patient experience, especially during admission and discharge, requires greater integration between stakeholders. Regarding costs, standardizing common procedures, such as the 30 identified by the ABC (childhood heart disease, orthopedics, childbirth), has allowed for pricing in 80-85% of cases with some insurers, although still without including physician fees. Reducing variability, such as surgical times ranging from 1.5 to 4 hours, is key to reducing uncertainty.

The GBV model has been around since the 1990s in the United States, seeking to reward prevention, efficient management of chronic diseases, and population health indicators. In Mexico, with only 10-12 million Mexicans covered by major medical insurance and a medical culture where the doctor acts as the "czar" of care, adopting this model is a challenge, but also a necessity. As Roberto Bonilla of the Dalinde San Angel Inn Group stated, the GBV model is not a fad, but rather a "fundamental necessity" for the viability of the hospital industry in Mexico, given that dependence on insurance companies is "killing" the system. Jesús Ruiz López of the Ángeles Health System Group defended the warmth of the Mexican model, where doctors maintain a close relationship with patients, and proposed integrating it into a sustainable system that measures quality indicators.

For his part, Jorge Azpiri emphasized that TecSalud has been seeking to align doctors and hospitals in collaborative institutes for a decade, although he acknowledged the difficulty of changing a medical culture where doctors are trained to impose themselves and act individually. He also advocated for strengthening primary care to prevent disease and reduce costs, a successful approach in countries like England.

The case of the Spanish Hospital was used as a reference; described by its director, José Testas Antón, it offers a mutual insurance model with 16,000 members who pay affordable fees (less than 30,000 pesos annually) and receive comprehensive care from primary care physicians. This system allows for close monitoring and patient satisfaction, but its scalability would require numerous adjustments to the system. The panel noted that fragmentation and conflicting interests between hospitals (healthcare companies) and insurers (financial entities) prevent these models from being replicated for the 12 million insured patients. The solution, according to Torre Amione, could begin with closed-loop products for two or three key diagnoses, with fixed prices that share risks and reward quality.

Things aren't easy, but there was agreement that the current crisis is an opportunity for innovation. The GBV demands collaboration, transparency, and a willingness to change. It was clear at the ANHP Congress that Mexico can learn from its own examples and from international experiences to build a private healthcare system that prioritizes quality and sustainability, leaving behind an outdated model that no one is convinced by.

Eduardo Clark's contradictions in the drug crisis

Undersecretary Eduardo Clark boasts of significant savings in the purchase of medications and medical supplies, which would be an achievement for the undersecretary of budget at the Treasury Department, not for an official at the Ministry of Health. He ignores that the greatest responsibility in healthcare is to care for patients, not to generate savings at the expense of their well-being. Eight months into the current administration, medication shortages persist, with recurring crises in chemotherapy and neuropsychiatric treatments, echoing the suffering experienced by patients in previous years. Clark also spoke during the morning press conference about the goal of producing more medications through Plan Mexico to reduce imports and costs, but where is the logic if the savings don't translate into access to therapies?

Roche Diagnostics presents its innovations

We're told Roche Diagnostics will present interesting innovations this Wednesday, the 18th, at its Tomorrow Lab 2025, particularly those focused on addressing the long wait times for an accurate diagnosis. For example, the cobas pro integrated 703 platform, which can process up to 2,000 tests per hour from a single blood sample. This means faster results, less workload for laboratories, and, consequently, better patient care. Two other solutions will be: a molecular test that can detect tuberculosis with high precision—already available in Mexico—and a genomic sequencing system for cancer analysis, which could pave the way for more personalized treatment. Diagnostic innovation is advancing; the challenge is for the system to do the same.