Fellow Since 2009
This description of Paulino Decanini's work was prepared when Paulino Decanini was elected to the Ashoka Fellowship in 2009.
Paulino Decanini created Transparencia Médica, now Primedic, to offer preventive health care services, especially to the most vulnerable social sectors of the Mexican population.
The New Idea
Paulino developed a health care system in which the relationship between the doctor and patient focuses completely on caring and improving the health of the patient. This is achieved due to its procedures and system of incentives. His company, Primedic, offers health care services with a strong preventive focus and quality standards to low-income people. After a careful analysis of both the public and private health systems, Paulino developed Primedic, a health care system whose goal is to return to the basic concept in which the physician s objective is to cure the disease in its early stages of development. Primedic is a health care company oriented to low-income families. This enables them to have unlimited access to primary care consultations and benefit from discounts on medicines, tests, and consultations with specialists. Primedic is a private company with a strong social approach. With six clinics and the support of an important group of investors, the company has begun an aggressive expansion process that will allow it to offer their services nationally.
Paulino is tackling Mexican s lack of access to high-quality preventive health care services for an estimated 40 million Mexicans with limited access. Failing to implement a health care service focused on proactively preventing diseases will seriously affect the health of patients. This issue is rooted in much of the population not having access to public and private preventive health care systems. Additionally, defects in existing health care organizations may damage the patient/doctor relationship. Paulino s professional experience both in the public and private health systems helped him recognize the failures of both. The public system is inefficient when working on prevention, since it focuses more on correction, even if this is more expensive or dangerous for the patient. The private system is riddled with misguided incentives that encourage physicians to prescribe medicines, tests, and even surgeries not appropriate for the patient. Health care services offered by the government are so limited and bureaucratic that even when they do offer preventive health care services, most does not reach the greater part of the population. In theory, everyone must have access to the health care systems offered by the government: The Mexican Institute of Social Security (IMSS), offers health care services to workers in the formal economy sector; the Institute of Security and Social Services for State Workers, offers health care services to governmental employees; and the popular universal health care insurance, offers services to the rest of the population. However, not all Mexicans are protected by these programs, since many do not use them, many others do not know about them or have informal jobs. Additionally, those who do have access to health care services often find that they are not useful. For instance, the IMSS has a deficit of US$60M. As a consequence, it does not have the proper equipment or medicines needed to cover a large number of patients, who find themselves stuck in a highly inefficient system. It is also routine for a patient to wait hours before seeing a doctor. This results in people using the IMSS only when their illness is serious, generally, when it has already become complicated. Only one in three IMSS members uses its services overall, but if you focus in primary care and preventive care 54 percent of the base never use IMSS facilities.Not having a health care system that offers preventive health care services properly brings about serious health consequences and medical costs. If people do not have regular access to a physician, they tend to wait until the problem becomes an emergency. For example, in order to avoid expenses or the inconveniences of visiting a doctor, many people buy generic drugs without consulting a doctor or a preventive health care service. By waiting until their problem turns into an emergency or a chronic disease, the consequences may be catastrophic. Paulino saw that in one clinic, 75 to 80 percent of the 120 kidney transplants done were received by diabetic patients who had not received proper medical services. Many of these serious surgeries could have been avoided with a proper health care service and the opportunity to detect and prevent diseases. For instance, cervical cancer is the number one cause of death among Mexican women, but a simple study can detect the lesion in its early stages. Finally, lack of access to medical coverage can have serious financial effects due to the high costs (i.e. only 2.5 percent of the countrys expenses in health are related with private insurance companies.
In 2002 Paulino and five other physicians created Transparencia Médica, now Primedic, a private company dedicated to offering health care services focused on primary care and preventive medicine. Today, Primedic has six clinics in the metropolitan area of Monterrey. Even though everyone may have access to the services offered by Primedic, they are specially designed for low and middle-class patients. The first product created is a membership for primary care consultations called Primedic. To participate in this program, a person pays US$120 a year, which guarantees direct, unlimited, and free consultations. The physicians, who are highly qualified and rigorously chosen by Primedic, work in the areas of gynecology, family medicine, internal medicine, and pediatrics. A member of Primedic can make appointments to see his/her doctor regularly or, in case of not having an appointment, he/she may go to a clinic and be seen by any doctor. Moreover, as a member of Primedic, patients receive 24/7/365 phone medical assistance. The core idea behind Primedic is that if the patient does not feel well he/she can visit a doctor without worrying about the cost. Patients also have access to laboratories and X-ray services in each clinic. Primedic has agreements with other providers to offer their patients discounts in pharmacies, specialized consultations, and laboratories. For example, if a patient needs to visit a specialist, his/her doctor will explain the reason and recommend a consultation at a preferred fee of US$25. Primedic also offers preventive examinations and laboratory tests at special discounts. For example, a member will pay US$40 for a mammography, approximately 40 percent less than the current costs elsewhere. Primedic is designed to guarantee the well-being of the patient as well as transparent and high-quality health care services. For example, the clinics follow up on different medical needs such as well-child and pregnancy check-ups, chronic diseases, and high blood pressure. In this way it can ensure that these illnesses are treated satisfactorily. Second, to guarantee that physicians recommend the best alternative for diagnosis, a multidisciplinary team of physicians with different specialties is employed. Third, each clinic stores medical records digitally, so patientsmedical history is accessible to all the physicians in case an emergency arises and the family doctor is not available. The system is able to display some alert signals should a patient has a specific problem, and the system is reliable and provides support for the patient. The electronic medical records are reviewed by a doctor s committee if there is a problem. This guarantees that the recommendations made by Primedic doctors conform with standards. Fourth, there are no economic incentives for physicians to prescribe medications or tests the patient does not need. Finally, Transparencia Médica collects patent surveys to monitor the quality of its services. The motivation is to heal the patient, and nothing more. Recently, Harvard Business School published a business case review of Primedic as an innovative model for public health care investments in the base of the social pyramid. Primedic has also drawn the interest of the private sector with the objective of investing in this model. The IGNIA Fund has granted an investment of US$6M, a private Mexican venture capital fund with strong social orientation. Primedic is the very first investment of IGNIA fund.
Paulino was raised and studied in Monterrey. His studies in medicine encouraged him to follow a specialization in surgery. Paulino, a third generation physician in his family, has worked in several areas of the health care system, which has given him a wide knowledge of its different challenges. When working in a public hospital, Siglo 21, Paulino realized several patients had not received proper treatment, since they should have not reached the third-level of their illness. He saw many cases of women suffering from cervical cancer who should have received medical assistance long before the disease became malignant. Paulino also spent several years in the private hospital, ABC and Ángeles in the D.F., as well as at the University of Minnesota the U.S., before returning to Monterrey. When Paulino returned to Monterrey from the U.S. he worked in the largest referral medical center of the IMSS (public hospital), developing his own private practice and private insurance companies. He thought about the well-being of the patient as well as the expenses incurred by this kind of business. Paulino had been part of board advisor for private hospitals and private insurance companies, where he learned about the negative incentives for physicians. These experiences awakened Paulino s quest for less expensive methods to achieve the same results. Being a doctor passionate about peopleswell-being, he was upset by physicians with motivations other than peoples health. These experiences taught Paulino that a good student or practitioner does not necessarily turn into a good physician: The system generates and fosters dreadful incentives. With the collaboration of five other renowned physicians, Transparencia Médica was founded in 2002. The initial investment was Mex$600,000 (US$46,000) and it held 39 patients. Paulino took a great risk, sacrificed his stability as a profitable well-known surgeon, and even mortgaged a property to keep Primedic going. Today, Primedic has a solid financial support with IGNIA fund as a partner, with an excellent leading team and more professional management, Paulino continues his work at Primedic, as Director of Innovation and Medical department.