Integration Necessary to Strengthen Health System: México Evalúa

Between 2018 and 2024, Mexico’s public health system underwent profound institutional changes that redefined how care is delivered to millions of citizens. The elimination of Seguro Popular, the creation of INSABI, and the later transition to IMSS-Bienestar have reshaped financing, governance and service provision, with impacts still under evaluation on access, quality, and equity, reports México Evalúa.

Mexico’s health sector remains fragmented, divided between contributive systems for formal workers, such as IMSS, ISSSTE, ISSFAM, and PEMEX, and non-contributive services for informal workers through state networks and IMSS-Bienestar. This segmentation, tied to labor status, has left millions with limited or uneven access to health care, despite the 2020 constitutional reform that enshrined universal and free coverage for those without social security.

A recent México Evalúa analysis based on the National Household Income and Expenditure Survey (ENIGH) highlights persistent barriers in access and financial protection. Households continue to face high out-of-pocket spending, while regional and socioeconomic gaps remain significant. The findings underline the need for structural reforms that go beyond affiliation and focus on effective, timely, and equitable access to services.

Policy recommendations emerging from this study point toward building a unified and universal health system. Key measures include integrating subsystems to eliminate fragmentation, shifting to tax-based financing to ensure sustainability, and defining a guaranteed package of basic services accessible to all citizens. Strengthening governance and coordination between federal and state authorities, supported by robust evaluation mechanisms, is also essential to improve efficiency and accountability.

Other proposals focus on addressing inequalities in infrastructure and workforce distribution, reinforcing early detection of chronic diseases, and improving the transparency of the Health Fund for Wellbeing (FONSABI). The study also emphasizes the role of digitalization to support patient-centered care, electronic health records, and more efficient procurement systems.

The creation of a resilient, accessible, and equitable public health system will require political consensus, sustainable financing, and institutional innovation to bridge the gaps that persist in access across the country.