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Even if the Doctors speak English, the Receptionists often do not. If you know no Spanish it will be helpful to have someone assist you the first time. The word for appointment is 'cita'. Most Doctors work from 10 to 2 and 4 to 8, and Saturdays 10 to 2. The word for receipt is 'nota'.

Pharmacies (Farmacias)

Benavides, ABC, and Farmacia Guadalajara are large pharmacies, but there are pharmacies in supermarkets, and small ones on many corners. Since most medicines are price controlled, the price does not vary much, but be sure to check the expiration dates.

Most medicines are available in Mexico without a prescription, except for narcotics and a few others. If you have a doctor's prescription be sure to have it filled within one month of date shown on prescription. Be careful not to use or mix medicines without the advice of a Physician.

For a full list of interchangeable generics drugs known as GIs in Mexico go to www.ssa.gob.mx

MEXICAN HEALTH CARE INSURANCE

This article is courtesy of The Guadalajara Colony REPORTER, a weekly English-language newspaper covering national, regional and local news in Guadalajara, Jalisco, Mexico. Please visit their online newspaper at:
www.guadalajarareporter.com 

News
IMSS Subscribers can pick up new appointment books beginning October, 2002

Before heading down to your local IMSS (Instituto Mexicano de Seguro Social) health clinic for your next appointment, be sure to take with you two infantill size photographs of yourself and a recent proof of residence (comprobante'de domicilio).

With these items, and your old IMSS appointments card, you can get your new, color-coded IMSS card, or cartilla. Just be sure to visit during your designated turno (turn), either in the morning 
(7 a.m. to 2 p.m.) or in the afternoon (2 p.m. to 8 p.m.). Your turn number should be noted in the old booklets in the space following "Consultorio No.” consultation room number. If your turn is in the morning, it will have a number followed by "T.M." (turno matutino). If it is in the afternoon, it will say "T.V." (turno vespertino).

Doctor Armando Salas, head of the IMSS Community Health Department, said the new booklets are part of a strategy to promote a culture of preventative health care. "We only come to the doctor when we're sick. We want to change this to a culture of health where people come to the doctor when they are not sick," Salas said.

This strategy is made clear in the new appointment booklets. Sections are reserved for vaccinations, nutritional information, re­productive information and cycles and prevention of chronic degenerative diseases.

The booklets are color coded according to age and gender: Green for newborns up to age nine, blue for ages 10 to 19, gray for men aged 20 to 59, red for women of the same age group, and gold for anyone 60 and older.

"The colors will help us quickly identify the group to which the people pertain so we can perform actions from a preventative point of view," said Salas. For more information call or visit your neighborhood IMSS clinic.

What is the IMSS and how does it operate?

The Instituto Mexicano del Seguro Social (IMSS) was set up in 1945 to provide affordable health care to private sector employees.

The IMSS is loosely based on the British and Canadian national health systems. Employers are obliged to register their permanent staff and pay a premium equal to roughly nine percent of the worker’s salary. The employee pays approximately three percent of their salary. Self-employed persons and their families may also sign up for coverage, as may all foreign residents of Mexico.

The IMSS system works on a three-tiered basis. On the first level (primer nivel) there are family care clinics (unidad medicos famillares) where beneficiares must go for consultations with their family doctors (medicos familiars). The quality of these clinics can vary significantly as some are much better equipped than others and are able to do lab testing and x-rays. All include a pharmacy on the premises.

Each local IMSS clinic is assigned a regional hospital, where patients are sent for specialist treatment or hospitalization. For example, the corresponding hospital for the Chapala IMSS clinic is Clinica # 14 in the Tlaquepaque suburb of Guadalajara.

For emergency treatment, beneficiaries can go to any IMSS clinic or hospital, although it is recommended to use the one assigned to them whenever possible. It should be noted that many family care clinics have restricted opening hours and are not equipped for emergencies. The state of Jalisco has 165 family care clinics, 16 second level hospitals, three specialist (third level) hospitals and 39 child-care centers. According to the latest figures, 3.6 million Jalisco citizens are enrolled in the IMSS, a little more than 50 percent of the population. 

Prices shown are as of March 2005

Rates change at the beginning of every year.

PROS & CONS OF JOINING THE IMSS 
Advantages 

Disadvantages 

The following are required to join the IMSS Insurance Plan: 

Please note:

The following are required to renew your IMSS Insurance Plan coverage every year:

 Please note:

If you would like further information or assistance in contacting or using IMSS services please contact:

Lidia Zamudio RN, at the LAKE MED CENTER, 
Constitucion #64, Ajijic, Jalisco.

Telephone (376) 766-8080, Emergency 01-333-156-9080. 
e-mail: andlili@prodigy.net.mx  or  lilinurse297@hotmail.com

IMSS Looks To The Future: Privatization or more public funding? 

Mexico's government-subsidized heath-care system for private sector workers, the Instituto Mexicano de Seguro Social (IMSS), is a contradiction. On the one hand, the institution has some of the best equipped facilities in the country and is responsible for ground breaking medical advances it leads Latin America in the number of successful kidney transplants, for instance; while the other side of the coin reveals a scarcity of hospital beds, medicines in short supply and patients often waiting months to see specialists.

Like many subsidized healthcare systems around the world, the IMSS finds itself strapped for cash and at a crossroads. Reducing the number of people covered by easing them into the private healthcare sector is the option currently being studied by the Canadian and British governments and, no doubt, by their Mexican counterpart. But anyone who mentions the word IMSS and privatization in the same breath in this country is entering a political minefield. And fixing the IMSS is not just a simple matter of privatization. Many Mexican analysts point out that moving the highest paid 25 percent of workers into private health care and allowing employers to "contract out" of contributions could mean that the IMSS loses as much as 50 percent of its funding.

The IMSS was founded in 1945 to provide affordable health care to private sector employees. There are currently 55 million people throughout Mexico registered in the institution, 3.7 million in the state of Jalisco. Financial problems within the IMSS have surfaced over the past 15-20 years, and in step with the nation's general economic decline. Most significantly, as life expectancy for Mexicans has increased so has the burden on the IMSS. The amount of chronic degenerative ailments IMSS physicians now attend to is much higher than 25 years ago.

The last ten years have been especially tough, with the number of new patients with IMSS insurance increasing dramatically, as job creation lags far behind. In fact, since 1998, the IMSS has been slashing jobs to increase efficiency and productivity. Hiring new doc­tors and nurses has virtually stalled, and hospitals and family medical centers built at the end of the Zedillo administration remain empty due to lack of staff.

Nevertheless, there are still 370,000 employees in the IMSS – far too many for some critics of the Institution. The payroll burden on the IMSS is enormous and eats up a huge portion of its budget (it costs the IMSS approximately $157,000 pesos a year for each worker). Although wage increases in recent years have been kept to the minimum allowed by law, the hikes have added around four percent a year to the IMSS budget.

On the positive side, a bloated "senior management" bureaucracy has been slimmed, although 46 percent of IMSS employees still work in administrative areas. Stricter timekeeping controls have been enforced and absenteeism, once a whopping 34 percent, has been checked.

Despite efforts by the IMSS to clean house, critics say there is much to be done. Jalisco Federal Deputy Jorge Urdapilleta has promised to launch a new initiative that he says will strengthen the medical part of the institution by channeling resources more effec­tively. The plan includes reducing many of the fringe benefits enjoyed by employees. "It's fine that we have soccer and baseball stadiums, theaters, stores, vacations centers [for employees], but it doesn't make sense when medicines are short and hospitals can't receive sick people," Urdapilleta said.

The Jalisco politician can expect fierce opposition from the IMSS labor union, which has accumulated immense powers in defending the rights of workers over the years (up until recently it was almost impossible to layoff an IMSS worker for anything short of a serious criminal offense). Union leaders deny their actions have contributed to IMSS problems, and argue that the malaise in the institution is the result of the "unspoken agenda" of successive governments, which they say have run down the IMSS on purpose in order to force its eventual privatization. Nevertheless, the unions can find support from some unlikely quarters. Former IMSS Director Ricardo Garcia Sainz says lack of investment, slashing of jobs and poor salaries is the main reason why morale in the IMSS is Iow.

While additional government funding seems a remote possibility in the short term, the lMSS has tried to raise cash through other means. One has been the way it charges for its "Seguro de Salud para la Familia" for workers, which are now levied per person instead of per family. And the IMSS has started a program to assist employers who have fallen behind with their contributions for insured staff members. The institute has also stepped up its preventative medicine program, in an effort to identify ailments before they become chronic and thus save money. But these efforts are bandaids that cannot cover up the institution's major wounds. Research shows that a hospital bed is needed for every 1,000 patients, meaning there is a shortfall of 10,000 IMSS beds in Mexico. And although IMSS provides free medicines, shortages are common place, with patients often ending up having to payout of their own pockets for expensive drugs. Medicines for diabetes and hypertension, widespread ailments in Mexico, are commonly out of stock, most frequently at the beginning of the year when IMSS contracts with pharmaceutical companies expire.

Another possible way to find extra funding for the IMSS is to ask employers to contribute more; the premium is currently around nine percent of a worker's salary. But there seems little likelihood of this idea gaining acceptance among leaders of Mexico's industrial and business chambers, who are already upset at the increase in payroll tax included in the recent fiscal reform package.

Despite its structural problems, the IMSS has managed to maintain its medical standards, most experts agree. Doctors and staff, while frequently under pressure, are usually dedicated and attentive. Service is improving, although more cases of negligence are being reported, possibly as a result of the creation of the National Medical Arbitration Commission. While several highly publicized cases have surfaced in Jalisco, including the suicide of a 52 year old man who was refused admission to hospital after complaining of severe pains in the abdomen (he had a tumor restricting blood flow to his intestines), IMSS Delegate Maria Guadalupe Marin points out that the institution employs 28,000 people in the state, attends some 33,000 patients a day and that "there will always be areas in which we can improve service."

Exactly how the IMSS moves forward into the new century is a question that Mexico's politicians will have to tackle soon. It's likely that President Vicente Fox and his National Action Party (PAN) believe progressive privatization is the only way to keep IMSS solvent and improve overall standards. What's unlikely is that they can convince the main political opposition, the Institutional Revolutionary Party (PRI), which is closely tied to the IMSS labor union, that such a move is in the best interests of the nation and the health of its citizens.

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