High Specialty Regional Hospital: a white elephant for Yucatan Peninsula

Despite being conceived as a hospital with peninsular impact, the High Specialty Regional Hospital of the Yucatan Peninsula (Hraepy) is providing little advanced-level care. What promised to be the most important hospital in southeastern Mexico has become a white elephant that in one year alone had to cancel more than 400 surgeries for lack of medical equipment and supplies.

More than 80 percent of patients are of low socioeconomic status or low income, mainly from Yucatan with more than 74 percent, followed by Quintana Roo and Campeche, mostly from that same socioeconomic status.

Founded in June 2008 with a budget of over one billion pesos (about $50 million USD), the hospital has left little impact on medical attention in the region, as indicated in the Annual Self-Assessment Report of the then-general director of the medical institute, Rafael Antonio Barrera Zoreda, published on 23 March, 2017

In this report Dr. Barrera Zoreda gives account of the limitations and annual budgetary restrictions, the cancellations of operations due to lack of equipment and medical input, amounting to more than 400 a year, as well as the cancellation of scientific programs and the insignificant contribution by the center’s medical research.

This has generated, according to statistics of the report itself, the decrease in the percentage of “satisfaction” on the part of patients, which was due to their social status of marginalization, not having other affordable options.

For example, from 2012 to 2016, the report indicates that there was not a single award, recognition or distinction received, and in that same period, there were only two projects that merited funding.

Of two researchers with recognition in the National System of Researchers (SNI), in those six years, it was reduced to one. The crude hospital mortality rate increased from 7.37 to 7.8 percent.

From 2015 to 2016, the percentage of users with perception of quality satisfaction in hospital care fell from 91.80 percent to 83 percent. The “in-hospital” infection rate, that is to say, the diseases that are contracted while being admitted to the institute, is increasing. From 2015 to 2016, went from 5.3 to 6.6 percentage points.

Although it was possible to reduce the percentage of pneumonia due to mechanical ventilation, which went from 9.1 to 5.8 points, the infection rate of bacteremia associated with catheterization, that is, the intravenous “channelization”, went from 2 to 2.7 points.

Mortality rates due to cerebrovascular event, acute myocardial infarction, are also increasing. The percentage of supply of medicines is down from 94 to 89 percent between 2015 and 2016, of these, more than 72 percent are generic drugs and the remaining 28 percent are patent medicines.

In this regard, Barrera Zoreda made specific observations on the considerable shortcomings of the institute, which although is the only public institute certified by the General Health Council, has serious shortcomings. This recognition was issued during the first four years of the institute’s life, and subsequently it has not received more support.

“The achievements and the response to the social expectations of the Hraepy contrast with a budget that has not evolved in tandem with its development, reflecting for several years that the authorized fiscal resources have been insufficient,” he said.

It also indicates that the aforementioned are added to the budget adjustments of that year 2016, as well as the adverse economic environment of the country, which has accentuated the restrictions on the exercise of expenditure.

“The above takes social relevance, when it is known that more than 80% of the patients that are served are, according to their socioeconomic studies, in a situation of poverty or extreme poverty.”

Despite this harsh reality, from 2008, the year of its foundation, to 2012, it worked with a federal resource lower than that approved. But from 2013 until 2016, it operated with approved federal budgets that exceeded the original budget. Currently it has a federal resource of more than 900 million pesos, (about $45 million USD) of which more than 60 percent goes to salaries.

Additionally, the report finds that the annual budget for research fell from 3.9 million pesos to only 326,288 pesos.

Text: Iván Duarte
Photos: Amílcar Rodríguez

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