By Susan Fogel
Health insurance for all the people by 2025. That is the vision of the administration of the Seguro Popular (insurance for the people). Seguro Popular is one of the three major public insurance systems in Mexico. Another is the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSTE). It is reserved for state and federal employees such as teachers. The third system is Instituto Mexicano del Seguro Social (IMSS). This is also called “social security” and also administers pensions. When you pay “social security” for construction workers, this is where your money goes.
According to the IMSS website www.imss.gob.mx, IMSS is the largest social security institution in Latin America and most beloved by the Mexican people. Who is eligible to have IMSS health coverage? Workers. This is the insurance for all working people. IMSS gets its political mandate from article 123 of the Mexican constitution, which provides medical care and other social services to all of the working people and their families in Mexico. Foreigners working for a Mexican company are eligible for IMSS care. Foreigners living in La Paz must apply to be eligible for IMSS insurance. However, it is the policy of IMSS that their services are reserved for Mexican workers, so it is very difficult to be granted IMSS insurance. Few foreigners have been accepted by IMSS.
So, let’s get back to Seguro Popular. Remember this is insurance of or for the people. “The people” is defined as anyone living legally in the Republic of Mexico and has a C.U.R.P. (Clave Unica de Registro de Poblacion). So, if you have renewed your immigration documents recently you have a C.U.R.P. number. Seguro Popular is considered the insurance of last resort for Mexicans. If they have no other coverage, then they are eligible to have this medical insurance. The annual premiums are very low.
Seguro Popular built and runs the brand new Salvatierra Hospital, whose real name is “Nuevo Hospital General con Especialidades Juan Maria de Salvatierra”. It has clinics and hospitals in the five municipalities of B.C.S.―Comondu, Mulege, Loreto, Los Cabos, and La Paz, as well as mobile units. To meet the goal of insurance for all people by 2025, more clinics and hospitals must be built around the country.
Dr. Gerardo J. Rodriguez Guzman, the subdirector of operations for the local Seguro Popular system earned his M.D. at the Universidad Nacional Autónima de México or UNAM in Mexico City. His specialty is public health. He has been in La Paz for five years and was kind enough to explain how the Seguro Popular system works.
Think of it as an HMO. You have a primary care physician. She will handle your bouts of the flu and bumps and scrapes. That is called first level care. If you need a specialist, second level care, your primary care physician will order lab and other tests and request a consultation for you with the specialist. Don’t expect this to happen quickly. You will wait until the specialist has an opening, you will wait for the lab results and x-rays, and if you were prescribed a medication, there is a good chance that the pharmacy will be out. Once second level care has been rendered, the specialist will send you back to your primary care physician for follow up.
Remember, this is the medical plan for everyone and everyone uses it. Bring a book and your lunch and be prepared to wait. And please be polite. Now if your second level care is an emergency, you will be treated immediately. If there is first and second level care, then what follows that is a third level care. This is the care that costs money. Salvatierra has an MRI machine. If you need the diagnostics provided by an MRI, you will pay for it. Cardiovascular care is now covered by Seguro Popular. The Salvatierra hospital is the only one that has an MRI machine. Whether you have ISSTE, IMSS or private insurance you will have to go to Salvatierra for the MRI. IMSS covers the costs of the MRI for its members.
There is a booklet with a list of 275 conditions that are covered under your premium. If the condition is not in the book, it is not covered. All aspects of pregnancy and contraception are covered. Most childhood cancers are covered. The only adult cancers covered are cervical and breast cancer. You are still able to receive treatment, but you must pay.
Have a tooth ache? Are your wisdom teeth impacted? You can have those maladies treated under Seguro Popular. Why aren’t some things covered? Some diseases are costly to treat and have a long treatment period. The scant funds that the agency has must be applied to the majority of the people. Dr. Guzman explained it this way:
“If you have a new car and want to insure it for theft, collision, and liability and have the money, you can have the best coverage. But if you have a car and don’t have a lot of money you will insure it for the basic coverage.” He went on to say, “We are providing the most care for the most people and we cover a lot of illnesses.”
While foreigners are welcome to join Seguro Popular, there are few, if any English speakers on staff and there are no translators available. Salvatierra Hospital is located on Calle Deportes behind Soriana. The Seguro Popular office is on Gomez Farias 852 between Victoria and Salvatierra, up a number of blocks from the Malecon. 612-128-9243 www.saludbcs.gob.mx
Many foreigners will continue to visit their private doctors and pay as they go, but keep the Seguro Popular for the emergencies and hospitalization.
My best advice whether you use IMSS or Seguro Popular:
Bring coffee and water. Pack a lunch, your Kindle and tablet. Don’t just sit there! Get up! Stretch! Walk around! It will keep your old bones from aching, and help you pass the time. Keep your sense of humor.