Primary Care 2.0: Redesigning Care for a More Human Health System

Since its inception, primary care has been defined as the first point of contact between individuals and health systems. According to the Alma-Ata Declaration, its purpose is to be accessible, comprehensive, continuous, and close to the population, offering guidance and support in one of the most important aspects of our lives: health. (It’s important to note that primary care should not be confused with the first level of care, which refers to the physical or hierarchical structure of the system. Primary care is a broader and more transversal model, focused on prevention, comprehensive follow-up, and a wider understanding of the patient’s social environment.)

Countries with strong primary care models, such as the United Kingdom, Canada, and Norway, have shown that well-coordinated systems are not only more efficient but also deliver better population outcomes. This becomes even more relevant in contexts with a high burden of chronic diseases, such as in Mexico. Currently, Mexico continues to record one of the highest rates of type 2 diabetes among OECD countries, with an estimated adult prevalence of 17%, well above the organization’s average. This is coupled with sustained increases in mental health conditions and cardiovascular diseases — the latter responsible for approximately 22.5% of deaths in the country, making them the leading cause of mortality.

In Mexico, over 10% of the adult population lives with diabetes. A significant percentage is unaware of their condition, and an even larger group is at risk of developing it, considering that over 70% of the population is overweight or obese. These conditions require constant management from the first level of care, ideally under a modern primary care approach. However, public health expenditure — representing only about 5% of GDP — remains focused on hospital levels, with little structural investment in this level, limiting its effectiveness as a preventive model.

At its founding, the IMSS (Mexican Social Security Institute) embraced this vision through family clinics designed to serve a growing urban-industrial population. However, demographic changes, population growth, accelerated digitalization, and the current epidemiological profile mean that the model no longer adequately meets today’s needs and often can only serve a few.

Most health systems in Latin America still operate under an episodic, reactive, and fragmented approach. Primary care, which should be the closest level to people, frequently becomes a blind spot. It’s often limited to brief consultations, with little or no follow-up, disconnected from the social, cultural, and economic factors that largely determine patients' health.

The pandemic accelerated the digitization of care but also delivered a clear lesson: digital access alone does not guarantee effective care. If we don’t understand the context in which a person lives, works, and eats, we will struggle to make a clinical impact or influence behaviors. Modern primary care must consider not only symptoms but also the structural barriers that shape the experience of receiving care — even before people fall ill.

What does Primary Care 2.0 entail?

Based on my experience developing digital care models that have served thousands of patients with high satisfaction levels, and from numerous conversations with national and international experts in public health, digital health, and the realities of emerging countries, I would highlight five essential pillars to rethink and strengthen primary care:

1. Continuity, Not Just Contact

Primary care must stop being just a point of entry and become a permanent bridge. This requires longitudinal follow-up enabled by technology, structured data, and coordinated clinical teams.

2. Omnichannel Access and Digital Closeness

Smartphones, instant messaging, video calls, automated reminders, and increasingly intelligent algorithms are already part of our daily lives. The key isn’t just to offer multiple channels but to organize them coherently to generate real — not fictional — closeness.

Some care models already show improved adherence when tools like personalized messages, automated reminders, and asynchronous communication are integrated. These technology-supported interventions strengthen the patient-system bond, even in high-demand or geographically dispersed contexts.

3. Data to Guide, Not Just Record

A 2.0 model must be fueled by clinical, behavioral, and contextual data, including the social determinants of health. Only then can we anticipate risks, adapt interventions, and personalize support.

This includes traditional information like electronic medical records or e-prescriptions, topics that, in my view, have spurred wide debate and progress in some areas. Yet, we remain stuck in discussion, without clear decisions or progress. Meanwhile, we leave out elements that could immediately impact prevention and personalized care, such as sleep patterns, perceived stress levels, absenteeism, or eating habits.

These data, collected securely and ethically, allow early detection of physical or mental health deterioration.

4. Prevention and Behavior as a Priority

It’s not enough to treat hypertension or diabetes. We must address habits, treatment adherence, stress, nutrition, and environment. The first level should take a leading role in education, prevention, and active health promotion. Countries like Finland and Cuba have integrated these approaches with good results.

5. Trust, the Most Valuable Intangible

Nothing works in health without trust. It doesn’t matter how accessible or sophisticated a service is, if the patient doesn’t trust it, they won’t engage. And if the system doesn’t inspire trust, it won’t transform.

Trust is built every day. Not just from what’s visible — like the interaction with medical staff — but also from what’s invisible: solid clinical processes, feedback mechanisms, quality certifications, secure data management, and scientific validation of the tech tools in use.

In digital environments, where there is no immediate physical contact, trust is built through consistency, transparency, and user experience. Every interaction matters. A delayed response, a system error, or an impersonal message can erode that relationship. And rebuilding it without physical presence is far harder.

These five elements come with their own challenges and require the active participation of various ecosystem stakeholders: public institutions, private sector, insurers, regulators, and the medical and scientific communities. But if I had to highlight one as indispensable, it would be trust. Without it, none of the other pillars stand.

Beyond technical and operational changes, Mexico faces a deeper structural challenge: the need to transform its regulatory, financial, and cultural frameworks so the health system can respond to today’s demands. We need rules that enable digital innovation in health without compromising clinical safety, as well as payment models that incentivize medical follow-up, prevention, and health outcomes, instead of replicating traditional assistance schemes whose main incentive is low service use, offering “coupon books” designed not to be used or resolving care needs in a purely transactional way.

Changing perception is also key. Primary care shouldn’t be seen as a filter for access but as the backbone of the system: a bridge rather than a door.

Since the pandemic, we’ve seen rapid shifts in service offerings. Some models have proven robust. Others haven’t. Some have endured. Others have disappeared. What’s clear is that we’ll continue to see new proposals, from digital solutions to hybrid models and next-gen insurance, and that’s a good thing.

This evolution isn’t just driven by technological change but also by a new way of conceiving health care. It’s no longer about seeing the patient as the end-user of a service, but as a person who must be actively supported across different moments, channels, and levels of complexity.

Talking about innovation in health involves a wide spectrum, with various levels of application and impact. And while not everything must revolve around primary care, any solution aiming to transform the system should incorporate — more or less, depending on its nature — these five pillars as part of its value proposition to the real stakeholder: the patient. Among them, trust stands out as a non-negotiable component.

A modern primary care model must prioritize building trust from multiple angles — clinical, technological, operational, and ethical. Because ultimately, patients don’t trust an app or algorithm. They trust that a system is caring for them responsibly, continuously, and humanely.

Redefining primary care may be the greatest opportunity for health system transformation in Mexico and much of Latin America. It’s not just about adding technology, it’s about changing our collective mindset. About believing that collaboration, coordination, and a shared vision can build a closer, more human, and more trustworthy system for all.

Achieving this will require political will, private sector innovation, clear regulation, sustained financing, and collaboration between academia, industry, and governments. Because health isn’t transformed from one front alone, it takes everyone moving in the same direction.

Because in health, what’s most strategic must also be what’s most human and closest to us.