Comparece ante legisladores titular de la Secretaría de Salud

  • Legisladores cuestionan calidad de servicios médicos y señalan desfalcos de dinero público.
  • Un doble crimen desviar recursos de este sector, que ha sido prioridad gubernamental, afirma Narro Robles.

Legisladores de todos los grupos parlamentarios cuestionaron al titular de la Secretaría de Salud, José Narro Robles, sobre recursos públicos desviados en ese sector, deficiencias en la calidad de servicios médicos, Seguro Popular y desabasto de medicamentos.

Al comparecer ante la Comisión de Salud, con motivo del análisis del Sexto Informe de Gobierno, el secretario federal enfatizó la importancia del uso eficiente y transparente del presupuesto del ramo, porque “no se vale desviar dinero público; pero hacerlo en el caso de la salud, es un doble crimen, un doble delito”.

Aseguró que gracias a la estrategia de compras consolidadas para la adquisición de medicamentos, material de curación, vacunas e insumos médicos, se ahorraron más de 17 mil millones de pesos (mdp). “Con menos dinero se ha comprado más en el actual sexenio”, sostuvo.

El presupuesto para las instituciones de salud y seguridad social aumentó de 2013 a 2018, en términos reales, 4.7 por ciento; es decir, 3.3 billones de pesos, de los cuales 68 por ciento se va a las entidades, explicó.

Al iniciar la fase los cuestionamientos, la diputada Carmen Medel Palma (Morena) aseguró que el sector salud se ha convertido en el “botín perfecto” para desviar dinero público. “Vemos el grotesco caso de Veracruz, donde se desviaron dos mil 338 mdp; en el Seguro Popular de Michoacán, 10 mil mdp se destinaron a algo diferente a la salud, o Jalisco, donde no se justificó la compra de medicamentos a sobreprecio, por 107 mdp.

Por lo anterior, pidió saber cuáles han sido las acciones de la Secretaría para denunciar y sancionar a servidores públicos que han malversado recursos. Consideró que el problema de salud va más allá de un cúmulo de cifras, pues basta ver los alarmantes primeros lugares que México ocupa en padecimiento de enfermedades crónico degenerativas. “Hay mujeres pariendo en las banquetas y no se garantiza el cuadro básico de medicamentos”, sostuvo.

En respuesta, José Narro Robles destacó un informe disponible para todo mundo, respecto al muy lamentable caso de niños con cáncer en Veracruz. “No recogimos una sola evidencia de que se hubiera inyectado agua destilada a los pequeños. Encontramos muchos otros problemas que denunciamos, están en proceso y forman parte de las acusaciones para autoridades de ese estado”.

Precisó que “todo lo que hemos encontrado, se ha denunciado. Todo lo que hemos podido hallar de desviaciones, de mal uso, de no comprobación, está señalado frente a la Procuraduría General de la República”.

Por el PAN, la diputada Sonia Rocha Acosta señaló que este gobierno presume que  el sistema de protección social en salud o Seguro Popular alcanzó una afiliación total de 53.3 millones de beneficiarios, “pero sólo fue superior en 0.75 por ciento en relación con la afiliación observada en diciembre de 2012 cuando ya el Seguro Popular beneficiaba a 52.9 millones”.

Mencionó en el 2017, según la Auditoría Superior de la Federación, más de 14 millones de personas no contaron con acceso a la seguridad social y en particular a los servicios de salud. Afirmó que “este gobierno le falló a México y a las millones de familias que hoy viven sin la protección de los derechos de salud. Hoy siguen muriéndose en este país hombres y mujeres por no tener recursos para ir a un servicio privado”.

El funcionario sostuvo que la población asegurada por el IMSS ha crecido en más de 10 millones de personas y que necesariamente dejan de tener el Seguro Popular. Entonces, dijo, es un asunto en donde no se puede ver sólo una de las vertientes. Resaltó que el momento de mayor cantidad de personas afiliadas al Seguro Popular está entre 2014 y 2015; pero si ha habido cuatro millones de empleos formales, prácticamente eso quiere decir: seguridad social. Eso significa, subrayó, que “no se falló”.

Dijo que hay temas que deben ser revisados como el de la cobertura, pero “si uno suma las coberturas del IMSS y del ISSSTE directamente, estamos hablando de 80 millones de mexicanos que tienen seguridad social”.  Reconoció que falta una mayor protección, “pero en el caso del Seguro Popular ha habido un crecimiento”.

La diputada Marcela Guillermina Velasco González (PRI) destacó que, entre las enfermedades crónico-degenerativas, el cáncer es una de las que más muertes causan en nuestro país. Se calculan 160 mil nuevos casos y ocho mil fallecimientos;  la expectativa de vida de quien tiene esta enfermedad es de 65 años. Además, uno de los mayores problemas, es que  cerca  del 70 por ciento de los casos se diagnostican en etapas avanzadas. Preguntó: ¿cuáles son los avances que se han tenido, qué retos persisten y qué está haciendo el gobierno federal para garantizar el abasto de medicamentos contra el cáncer?

De la misma bancada, la diputada Norma Guel Saldívar señaló que el principal reto es unificar acciones y presupuesto, así como fortalecer el sistema de detección precoz de cáncer para identificarlo en etapas tempranas y lograr así una mejor calidad de vida de quienes padecen esta terrible enfermedad. “Está claro que este problema no se puede solucionar en sólo un sexenio; sin embargo, los logros alcanzados sientan las bases para combatirlo más eficientemente”.

El secretario Narro Robles enfatizó que este padecimiento es uno de los graves problemas del ramo salud en México y en el mundo. Según datos actualizados, el número de casos nuevos se incrementaron, ya que México tuvo el año pasado cerca de 190 mil y, de acuerdo con el Inegi, es la tercera causa de muerte, con más de 80 mil defunciones en 2016.

Refirió que en la Legislatura anterior, se logró tener en México un Registro Nacional de Pacientes con Cáncer, el cual era indispensable. Asimismo, el desarrollo del Instituto Nacional de Cancerología, el establecimiento de centros estatales y su fortalecimiento “son también acciones que se han realizado en este gobierno y que conviene mantener”.  Sin embargo, reconoció que los retos son numerosos.

La diputada Elba Lorena Torres Díaz (PES) apuntó que de 2013 a junio de 2018 se realizaron más de 12 millones de mastografías a mujeres de 40 a 69 años y cinco millones de pruebas de papiloma humano a otras de 25 a 64 años de edad, eso nos parece un buen modelo de medicina preventiva, ya que evitarán mayores complicaciones.

La legisladora pidió al secretario de Salud explicar qué acciones de vacunas y medicina preventiva son las más importantes, qué logros se tuvieron y qué tareas deben continuar.

Narro Robles coincidió en que se deben prevenir y anticipar las enfermedades, por lo que consideró fundamental modificar el modelo de organización, no sólo de los servicios, sino del proceso formativo de los recursos humanos, es decir, de las escuelas orientadas a las disciplinas médicas.

Detalló que existe un proyecto piloto entre las secretarías de Educación Pública y de Salud que se denomina “Salud en tu escuela”; este esfuerzo, no sólo debe mantenerse, sino ampliarse con recursos, asimismo tendrán que continuar los programas de vacunación y salud reproductiva.

Por el PT, el diputado Francisco Favela Peñuñuri, mencionó que en el país aproximadamente el 60 por ciento de la población carece de seguridad social, obligándolos a incurrir en gastos catastróficos, es decir, hacen uso de más de dos terceras partes del total para financiar sus gastos médicos

Explicó que la cobertura universal debe garantizar que las personas tengan servicios integrales sin discriminación, adecuados, oportunos, de calidad y que obtengan medicamentos de calidad seguros eficaces y accesibles  para que sus recursos no se vean afectados.

Al respecto, Narro Robles señaló que poco más de la mitad de la población del país ya tiene derecho al IMSS; sin embargo, 16 millones de personas son derechohabientes de dos o más instituciones médicas, lo cual se refleja en una desigualdad en los servicios de salud; de necesita de un esfuerzo por buscar mecanismos que permitan una distribución equitativa del destino per cápita del IMSS, ISSSTE, Seguro Popular e ISSFAM.

La diputada Martha Angélica Tagle Martínez (MC) destacó que el presupuesto público en salud etiquetado en el anexo 13 para la igualdad entre mujeres y hombres, ha sido menor el ejercido que el aprobado, lo mismo en salud materna, sexual y reproductiva, por lo que preguntó “¿por qué se ha presentado esto en un área tan sensible y de qué manera esta dependencia ha ejercido sus funciones normativas en el área de política pública para corregir esa diferencia?”

En materia del Seguro Popular, resaltó que a pesar de que fue creado como un programa orientado a reducir gastos médicos de bolsillo y fomentar la atención oportuna a la salud, la corrupción, la falta de transparencia y de evaluación lo han ensombrecido, ya que en 2016, la  Auditoría Superior de la Federación detectó malos manejos por 6 mil millones de pesos en el recurso federal asignado a 28 de las 32 entidades federativas. Ante ello, cuestionó “¿qué acciones han realizado para enfrentar la desviación de recursos federales otorgados al seguro popular? ¿Por qué siguen permitiendo que se comenta este tipo de situaciones?”

El funcionario federal señaló que se ha hecho un gran esfuerzo para llegar a la población de adolescentes con programas y acciones que atiendan la salud reproductiva y sexual. México cuenta con 5 mil 800 unidades en todo el país para atender esta situación.

Enfatizó que en materia de corrupción del Seguro Popular, las reformas que se procesaron en 2014 aplicables en 2015, permitieron tener un mejor control de los recursos y asegurar, en un alto porcentaje, que ya no se produzcan irregularidades. “Quiero recordarles que por lo menos dos gobernadores están procesados por haber usado recursos del Seguro Popular y seguiremos hasta el último día haciendo las denuncias correspondientes”.

Por el PRD, el diputado Emmanuel Reyes Carmona, cuestionó sobre el avance y estado de las denuncias por malos manejos del Seguro Popular; ya que “apenas el año pasado usted informó que se presentaron 52 denuncias penales contra funcionarios de la Secretaría de Salud por posibles actos de desvío de recursos públicos por un monto de mil millones de pesos, principalmente por este instituto”.

En materia de desarrollo infantil temprano, preguntó los objetivos que se han logrado a través de programas para su atención. Respecto a desastres catastróficos y naturales, mencionó que los hechos acontecidos por los sismos de 2017 dejaron ver la vulnerabilidad de los servicios de salud, por lo que cuestionó sobre las medidas y programas que la Secretaría tiene estimados en la materia.

Narro Robles comentó que respecto al desvío de recursos, principalmente por parte del Seguro Popular, “desafortunadamente el número de denuncias se incrementó”. “Tenemos presentadas, dijo, 70 de éstas frente a la Procuraduría General de la República y el monto de lo denunciado supera los mil 150 millones de pesos. Hemos estado insistiendo frente a la procuraduría para que nos informen del avance de estas situaciones”.

En materia desarrollo infantil y estimulación temprana, dijo que  México cuenta con 30 centros; “hemos aplicado 2.2 millones de pruebas de Evaluación de Desarrollo Infantil y tomado las acciones conducentes para sacarlos del estado de rezago y evitar que el daño sea irremediable”. En cuanto a los desastres naturales, informó que a pesar de que hubo muertes, “no tuvimos que lamentar la presencia de brotes epidémicos importantes”.

Del PVEM, la diputada Leticia Mariana Gómez Ordaz, calificó como fundamental el abasto suficiente, oportuno y económicamente accesible de medicamentos para la población, a fin de que los pacientes accedan plenamente a la protección de su salud, por lo que reconoció el esfuerzo de la dependencia para ahorrar 14 mil mi millones de pesos entre 2014 y 2017 en las compras consolidadas.

Destacó que al iniciar este sexenio, el desabasto de medicamentos en las clínicas del IMSS y el ISSSTE se convirtió en un impedimento para que miles de pacientes pudieran recuperar su salud. Ante ello, preguntó ¿cuál es actualmente el porcentaje de recetas surtidas de manera completa por ambos institutos y qué tanto se ha logrado reducir el número de quejas por desabasto respecto a otros años?

El titular de Salud precisó que en el caso de las instituciones de seguridad social, a través de una estrategia integral que tiene que ver con la compra consolidada y la distribución de los medicamentos a las diversas delegaciones del IMSS y del ISSTE, se tiene el compromiso de otorgar un vale cuando no se pueda surtir el medicamento, que ha tenido un gran avance. De tal forma que el abasto está muy cercano al 95 por ciento en el caso del IMSS y 94 por ciento en el ISSSTE.

A pesar de ello, reconoció que existen problemas en los servicios estatales de salud, particularmente en el primer nivel de atención en los centros de salud de los estados. Pero, abundó, a partir de las reformas aprobadas por el Congreso en materia de salud, hoy permiten que tengamos un mejor control de los recursos, principalmente, en el Seguro Popular, aunque aún hay problemas.

En su intervención inicial, José Narro aseguró que la salud es un derecho e igualador social, un componente de inclusión y estabilidad, y aunque reconoció que el sistema nació fragmentado y dependiente de condición laboral, cuenta con instituciones públicas que otorgan movilidad, cobertura y calidad en sus servicios.

Puntualizó que el sector salud tiene una enorme capacidad de respuesta y muestra de ello es que existen 23 mil unidades de atención ambulatoria, mil 400 hospitales y “un ejército” de médicos y enfermeras, que suman más de medio millón.

Todos los días, más de un millón de mexicanos se atienden a través de servicios públicos; se otorgan 100 mil urgencias, 10 mil cirugías, se asisten 4 mil 300 nacimientos y hay más de 16 mil hospitalizaciones.

Además, el Consejo Nacional de Evaluación de la Política de Desarrollo Social (Coneval) refiere que el indicador de acceso a los servicios de salud, es el de mejor comportamiento entre 2012 y 2016.

Precisó que durante la actual administración se han incorporado intervenciones al Seguro Popular. Hoy se atienden mil 800 enfermedades y 330 eventos que representan gastos catastróficos, que ha beneficiado a 680 mil pacientes con enorme necesidad, con una inversión superior a 38 mil 500 mdp.

El sexenio muestra avances, aunque modestos; la mortalidad infantil disminuyó 12 por ciento y se alcanzaron 270 salas de lactancia y de 3 a 27 bancos de leche humana.

Asimismo, la transmisión de VIH bajó 34 por ciento, respecto al sexenio anterior y el embarazo infantil 11 puntos porcentuales en niñas, y 16.8 en adolescentes; los números más bajos en los últimos 30 años.

Se aplicarán 600 millones de dosis en la próxima semana de vacunación, con una inversión de 38 mil mdp en la compra del biológico.

El titular de Salud subrayó que los principales retos epidemiológicos son el sobrepeso y la obesidad. En México, padecen alguna de las dos 7 de cada 10 adultos; 3 de cada 4 mujeres en zonas rurales; 4 de cada 10 adolescentes y 1 de cada 3 niños.

La diabetes es otro grave problema. Entre 1980 y 2017, cifras preliminares señalan que las muertes por esa enfermedad se elevaron más de 7 veces; tres de cada 20 decesos que ocurren en el país, corresponden a ese padecimiento, además es la principal causa de años de vida con discapacidad.

Añadió que también hay desafíos inevitables como la transición demográfica, porque se requerirá atención geriátrica y de enfermedades del corazón, tumores, insuficiencia renal, salud mental y adicciones.

Para el gobierno actual, aseguró, la salud ha sido prioridad, sin importar el momento, México ha avanzado en esta materia y prueba de ello es que la esperanza de vida al nacimiento ha incrementado, y ha disminuido la mortalidad infantil y materna.

“Claro que tenemos problemas y claro que hay situaciones que urge remediar en el país”, pero la salud es central, porque influye en muchos aspectos de la vida de las personas; por ello, la necesidad de transitar hacia un sistema preventivo y fortalecer el sector con una cobertura universal efectiva, concluyó.

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