Reaching the 99%: The Premise Mexico Has Yet to Make a Reality

Last week, at the inaugural Civic Health Forum in New York, I joined a panel on founder-led innovation. The moderator, Logan Plaster of StartUp Health, opened with a deceptively simple question: Tell me about a patient.

He did not want my pitch or my company story. He wanted the room to feel a real person.

The story I told is illustrative, but it is built on patterns we see every day. A cleaning worker in Mexico City. She had been sick with a cough and flu for several days. Going to the doctor, in her reality, does not mean paying for a consultation. It means losing half a shift in a public-system waiting room, and her half-day salary is what feeds her family that week. She cannot.

On her 15-minute break, she picks up her phone. She describes how she feels. A clinical professional asks her questions, triages her, and suggests a treatment. Her medication arrives at the building where she works before her shift ends. She never left the building.

That story, I said on the panel, illustrates something the health system does not want to see. In Mexico, people do not stop taking care of their health because they do not care. They stop because they cannot afford the cost of going to a doctor. And that cost, most of the time, is not money. It is time.

Building for the 99%

The Civic Health Forum is an inaugural event co-organized by Fedcap, StartUp Health, and the Digital Health Hub Foundation. Its thesis is direct. The health system, as it exists today, is built for the 1% who can afford it, navigate it, and use it. The other 99%, which is most of the planet, is left out.

In a previous contribution to this publication, I wrote about why the Mexican employer will be the one to redefine corporate health in the country. That piece was about who pays. The conversation in New York gave me the necessary counterpoint. Even if we solve who pays, we have not solved how we reach the patient. And that "how," in emerging markets, is what will separate the models that scale from those that only look good in a presentation.

Mexico is, by far, one of the countries where this thesis becomes most relevant. And at the same time, one where it is being articulated the least.

The Reality of the 99% in Mexico

The data speaks for itself. Mexico is the second country in the OECD for out-of-pocket health spending. Households contribute 45.4% of total health spending according to INEGI's Health Sector Satellite Account. Between 2018 and 2024, that spending grew 41.4% in real terms. In 2024, 1.11 million households incurred catastrophic health expenses, an increase of 64.5% compared to 2018.

In plain words, people are paying more out of their own pocket and impoverishing themselves in the process.

There is another layer, less visible. Sixty percent of people affiliated with a public health institution end up being treated at pharmacies or private clinics, not at their assigned facility. Not by preference, but because the public system does not respond in time and because the time cost of waiting is prohibitive.

Add mental health. Seventy-two percent of employees in Mexico reported experiencing burnout in the past year, according to Buk's 2025 Burnout Report. Sixty percent of workplace medical consultations correspond to anxiety, stress, depression, and sleep disorders. A wide majority of people living with these conditions never receive formal clinical care.

The picture is clear. The Mexican population gets sicker, spends more out of pocket, sees the doctor less, and when they do, they arrive late. We are not talking about the 1% of vulnerable people. We are talking about the majority of the country's labor force.

Waiting for a Patient Who Doesn't Arrive.

The inherited premise is that the patient will arrive. They will look for a doctor, navigate the appointment, wait, ask permission at work, travel, return for results, refill the prescription. That premise was built for a world where the patient had time, transportation, knowledge, and money to arrive. Most Mexicans do not have those four things at the same time.

The new premise, the one I saw articulated in New York with more clarity than at any other forum I have attended, is the opposite. Health goes to the patient. The system adapts to the person's real behavior, not the other way around. The infrastructure is no longer the clinic, it is the device the person already has in hand.

It sounds obvious when said out loud. And yet, almost all health spending in Mexico is still designed under the old premise. Insurers wait for claims. Pharmaceutical companies design patient support programs assuming the patient will look for the program. Employers buy benefits the employee has to activate. The regulator builds rules for physical infrastructure.

In most of Mexico, that chain breaks at the first link. The patient does not arrive. And so there is no claim, no activated program, no used benefit, no applied rule. Building for the 99% starts by accepting that break and redesigning from there.

Four Ecosystem Implications 

If this new premise is taken seriously, there are concrete implications for four stakeholders in the Mexican system.

For the employer. A health benefit is not justified by its existence, it is justified by its real use. A major medical policy the employee does not understand, or a pharmacy discount they do not remember to activate, are not benefits, they are expense lines. Building for the 99% means health reaches the employee in their language, in their channel, in their time. It also means measuring impact in terms that matter: absenteeism, presenteeism, turnover, control of chronic conditions. The conversation I had last quarter about the employer's role as the engine of transformation holds here. The employer has the incentives and the data to force the change.

For the insurer. The dominant model still makes money when the insured does not use the service. That makes it structurally reactive. In a market where medical inflation in Mexico will reach 14.8% in 2026, according to Aon, and where up to 3 million people could cancel coverage according to AMASFAC, that model will become increasingly expensive to sustain. Insurers that move into the model where health goes to the patient, with real prevention, active management of chronic conditions, and accompaniment between events, will capture value and retain customers in a market that is fragmenting.

For pharma and patient support programs. PSPs in their current form were designed for markets where the patient actively seeks the program. A person who knows their diagnosis, is in treatment, has insurance, and wants to stay adherent. In Mexico, a significant share of patients with chronic conditions has not been diagnosed, is not in treatment, has no insurance, and is not looking for any program. A PSP built for the 99% in Mexico does not wait for the patient. It detects, accompanies, and connects them. This changes the entire economics of the model, and it also changes the conversation the pharmaceutical industry can have with regulators and employers in this country.

For the regulator. Regulation built for physical infrastructure needs to learn how to regulate behavior. The incorporation of telemedicine and digital health into the General Health Law, published in January 2026, was a necessary step but only an initial one. The next, harder step is to regulate the care that takes place outside the clinic, in channels the person already uses, with technologies the regulator did not create. The challenge is not to protect the patient from the change, it is to protect the patient in the change. Doing it well will define whether Mexico leads the regional conversation in the next decade, or follows it.

This Is Just the Beginning

What struck me most at the Civic Health Forum was not the content of the panels. It was realizing, as I listened to founders, investors, and public policymakers from several countries, that the rest of the world is looking for examples of how to build health for the 99%. And that Mexico, by its size, its epidemiological profile, its smartphone penetration, its formal employment structure, and its out-of-pocket spending, is one of the places where this conversation should be most alive.

It is alive only timidly.

At diagnostikare.® we have spent the last years building under this premise, and what we see in operation is consistent with what I heard in New York. When health goes to where the person already is, the most surprising result is not the efficiency metrics. It is that close to 9 out of 10 of our users access a medical or psychological consultation for the first time in their lives through our platform.

This is just the beginning. How employers, insurers, pharma companies, and regulators respond in the next 12 months will determine whether health for the 99% in Mexico is built from within, or built from outside while we watch.