The Health Director of the Ecuadorian Social Security Institute (IESS) Francisco Mora explains the reasons why the construction of the new Teodoro Maldonado Hospital in Guayaquil, which will cost 489 million dollars, is necessary. It also indicates where the money will come from, despite the fact that the health fund is in the red. Although he admits that in his administration, which is already going through a transition, there will be no public procurement, so that will be the decision of the next government. Among the financing possibilities, it refers to the debt that the Farmers’ Social Security has and what the Ministry of Finance has to pay to IESS. It is emphasized that currently Teodoro Maldonado Carbo does not solve the problem, but gives millions of recommendations to private service providers.

The issue of the new hospital has caused several questions and even criticism. Why did you decide to build the new Teodoro Maldonado Carbo Hospital (HTMC)?

The Teodoro Maldonado Hospital should be the largest in IESS, it is a tertiary hospital and has already reached 53 years of age. It is no longer functional by international standards because it was created for a certain level of population, but populations have varied over the years, as have diseases. I would like to clarify that this is not a hospital only in Guayaquil, but is considered a national hospital that serves 49% of special patients from provinces such as Guayas, Manabí, Santa Elena and Galapagos.

But can it be reinvigorated or is it necessary to build a new one?

The current hospital does not have adequate infrastructure. In 2011, there was already a consultation which, among other things, said that it cannot expand upwards, the bases are no longer resisting. The state infrastructure area has also collected data and says that the infrastructure is not sustainable: neither electrical nor hydrosanitary connections. The current hospital has many inaccessible rooms because they have holes, only 11 of the 21 operating theaters are functional, 300 of the 600 beds are equipped. No matter how much is invested, it cannot continue to work, if it does not have a sustainable infrastructure, it cannot improve.

But the solution you see, how much will the IESS cost and how is that financing obtained if the fund is in the red?

The reference price is 489 million dollars. Beforehand, we have to take into account that the inoperability of the Teodoro hospital costs me 350 million dollars a year in referrals. This is also the reason why I have a large number of private service providers in Guayas. Instead of being the hospital that solves the care, it refers them for $350 million a year. It should also be noted that the Board of Directors has currently prioritized the Teodoro Maldonado Carbo project and its construction is pending approval. It is not a one-day-to-morrow project, it has been worked on for eight months. We updated the documentation and it has two important points: according to the number of inhabitants, it should have 1,087 beds and it should be a cult hospital in major pathology, which is oncology. So, the idea is to equip it with current technology, which already exists all over the world: tomograph, nuclear magnetic resonator and PET scanner. Switch from conventional chemotherapy to other alternatives, such as radiotherapy and proton therapy. The reflection is that if this disease costs me millions and millions of referrals for Solac, which is publicly known, I try to invest in my units. With all these data it was said ‘something must be done’ and this is a new hospital.

The need is justified, but how is it financed?

If the hospital withdraws 300 million dollars, it is an outflow of money in the future that will no longer be realized. As for funding, there are several sources: Rural Social Security owes the Health Department $689 million for health services, whose payments have been piling up. Annually, SSC adds $100 million to its down payment to cover such care as a down payment; if it were required to pay $160 million (usual upfront payments and $60 million for accumulated debt), that would be another source. Additionally, the Ministry of Economy and Finance has a debt with health. It can also come from a percentage, in any case if I have to pay external providers, I can allocate a percentage to the medical unit. Furthermore, historically, 101 IESS hospitals do not complete the execution of their budgets. We could also get from there.

The price of $489 million is the market price, Los Ceibos cost $200 million and was considered expensive…

The $200 million price tag for Los Ceibos was a 450-bed hospital with level two hospital equipment. This is the third level.

Another worrying question is how far you will go, in this administration, with this process, considering that when the Government changes, for example, the president of IESS, Alfredo Ortega, who appointed you…

This is a significant and necessary project. It was approved by three members. We had two votes in favor from the members and abstentions from the employers. Now there is another step, which is the completion of the study for construction approval, and I believe that we will get there. The next Government will decide. We have not reached the public procurement procedure yet.

There are also those who ask why this investment of a tertiary hospital is given as a priority, and not as a priority for the area of ​​level 1, which is preventive medicine.

I am in favor of prevention and health promotion being cheaper than solutions. However, the subject must be taken with a grain of salt. Unfortunately, although we have to promote and prevent, there is a hospital that does not solve me and I have to find a solution for this one.

In terms of the payments that Finance has to make, how has this issue progressed?

There are several ministerial issues that we are dealing with. There is a reality, and that is that IESS for the first time delivered a database to Finance for the $211 million that needs to be collected for services to retirees. The debt is higher, but the values ​​are harmonized so that the ministry can cancel it.

We know that these days Biess bought bonds, can part of that liquidity be returned to IESS?

I have a little information, it would be wrong to tell you. What I can tell you is that we are working on technical tables to reconcile values ​​and concepts, like what is a catastrophic illness. The Minister of Health made a determination of catastrophic and expensive diseases.