A Panel Discussion at the Colegio de México Explores the Hybrid Healthcare System
On August 28, 2025, a panel of academic experts at the Colegio de México delved into an uncomfortable reality: Mexico’s healthcare system is a disjointed hybrid, with private services growing silently but lacking integration into the public sector where equity could be ensured.
The Panel: “Public-Private Collaborations in the Mexican Health Sector, a Pathway to Equity?”
As the moderator alongside Laura Flamand from Colmex, I participated in this panel titled “Public-Private Collaborations in the Mexican Health Sector, a Pathway to Equity?” as part of “Diálogos basados en evidencia: sistemas de salud y equidad,” a joint effort by the School of Governance at Tec de Monterrey, the National Institute of Public Health (INSP), the Center for Research in Population, Health and Policy (CIPPS-UNAM), and the Colegio de México.
The panelists were Felicia Knaul (UCLA), Fernanda Cobo-Armijo (Universidad Iberoamericana), and Adolfo Martínez Valle (CIPPS-UNAM). They discussed the ideological stalemate and why reviving public-private collaborations is not only reasonable but essential to harness the full infrastructure.
Alarming Statistics and the Rise of Private Healthcare
According to the National Household Income and Expenditure Survey (ENIGH), between 2018 and 2024, the number of people without access to healthcare services—neither public nor private—jumped from 20.1 million to 44.5 million.
Out-of-pocket spending, an inefficient form of financing that impoverishes families, still accounts for 40% of total healthcare spending, far from the 20% achieved by countries like Colombia or Chile. This is where “silent privatization” comes in, a term coined by Martínez Valle. Six out of ten healthcare services for necessities now occur in private providers, ranging from adjacent clinics to pharmacies (CAFs)—almost 18,000 of them, competing with public health centers—to luxury hospitals or traditional medicine.
This growth was not planned by the state; it emerged reactively, driven by failures in public sector access, quality, and trust. The system is fragmented between those insured and uninsured.
Expert Insights on Public-Private Collaboration
Dr. Knaul, an economist of health and cancer survivor, highlighted opportunities for organizing a system with public funding and diverse provision, leveraging private advantages with proper regulation. She cited examples like Canada, Japan, or Brazil and global institutions such as St. Jude Children’s Research Hospital in Memphis, which consolidates oncology medication purchases through the WHO, benefiting low- and middle-income countries.
The current discourse revolves around supposed universal gratuitousness, which is impossible in any global system. The panelists agreed that privatization is being demonized, and an effective structure like the Seguro Popular is being dismantled in favor of a weakened Insabi (later abolished) and now the IMSS-Bienestar, which faces a significant financial support challenge.
The result? A weakened public health sector.
Short-Term Challenges and Long-Term Solutions
Under Claudia Sheinbaum’s administration, the National Development Plan 2025-2030 emphasizes prevention and attention to vulnerable populations, but it only considers the public sector while ignoring the growing private half of national healthcare spending. Martínez Valle was pessimistic about short-term convergence, stating that recent governments designed policies based on ideology rather than evidence.
However, reality compels us: with private infrastructure already activated and its coverage decreasing to the pyramid’s base, it makes sense to promote it. Cobo proposed legal vehicles like result-based contracts inspired by Estonia or Bulgaria to oversee quality via Cofepris and enforce Mexican official standards.
The key is shifting from ideology to evidence. As a community—academia, journalism, civil society—we must devise a clear plan, as suggested by Flamand: strong public leadership, protocol and cost regulation, tax incentives for non-profits, and technology for cross-sector portability.
Previous Progress and Future Prospects
At the Colmex event, it was noted that despite its limitations, the Seguro Popular reduced catastrophic expenditures by incorporating private elements like effective partnerships with Fucam for breast cancer or clinics in Hidalgo with performance-based payment—an innovative scheme documented by the OECD.
Public support in Colima, derived from Seguro Popular backing, was so effective that private clinics were displaced. Even during the COVID-19 pandemic, collaboration between public and private hospitals was successful, as demonstrated by the temporary hospital in Citibanamex, supported by UNAM and private initiative.
The point is that these achievements were left unfinished in the previous six-year term, and moving forward, collaboration must be revisited.
