Childhood cancer patients who paid for their treatments with this trust increased from 2,700 to 300 in the same period. And women with breast cancer, from 8,300 to 2,500.
“A greater number of patients were no longer being treated nor was more budget allocated,” explains Judith Méndez, a specialist in public finance and health at the Center for Economic and Budgetary Research (CIEP).
For this reason, the changes proposed by the reform do not completely surprise him, although he does consider them worrying. In addition, for a few years now, Fonsabi money has no longer been fully used for high-cost diseases.
As of the third quarter of 2021, the fund had 69,902 million pesos. From there, 28,807 million pesos were used to create the Health Institute for Well-being (Insabi), which disappeared in 2023 due to lack of results.
In April of the same year, an additional 33 billion pesos were taken to address the covid pandemic. So this is not the first time that Fonsabi money has been used for other purposes. However, the reform would establish the legality of doing this.
“Yes, it is worrying because, probably, now there will be fewer guarantees,” explains Méndez.
It is also considered whether the limited fiscal space leads to this decision. Without labeling Fonsabi money or assigning distribution percentages, this expense could be used for any government need.
The problem is that the health sector itself is already facing a public budget that does not increase, enough to take away the money it needs.
“If there is already limited fiscal space, eliminating those percentages seems to me like it would take away a guarantee that, at least, resources are being allocated to this fund.”
The “petty cash”
Since this six-year term, Fonsabi has invested less in catastrophic diseases. And some years it has returned up to 80% of its annual resources to the federal Treasury. From there the destination of the money is no longer known.
Other countries, such as Germany, also use trusts to finance the high costs of chronic diseases. The mechanism does not seek to limit care, Méndez assures, but rather to guarantee that of the limited resources that can be spent on health, a portion reaches these conditions, the most present and the ones that impoverish the most.
“If you leave it open, you can miss out on things that are urgent and not necessarily on the most important things or on the population that needs it,” he explains.
The expert considers that establishing a Technical Committee could be beneficial, since it would provide flexibility in the use of resources, especially in health emergencies. The doubt weighs, however: who would make up this body, and will their decisions about money be transparent?
It already happened with Seguro Popular. When it existed, several state governors used that fund to divert resources and Fonsabi no longer reports how many patients it treats for each illness.
For this reason, PAN representative Verónica Pérez proposed shielding 50% of the fund exclusively for catastrophic diseases; prohibit resources from going to the Treasury and transparency in the destination of resources.
“That fund was the last line of defense for those facing diseases such as cancer, heart attacks, HIV or neonatal intensive care,” he declared and added: “That fund was the peace of mind of millions of Mexicans, but this government has turned it into its petty cash.”
