Introduction
The figure “6%” frequently appears in official speeches, international organization reports, and government campaigns. It advocates that countries should invest at least 6% of their Gross Domestic Product (GDP) in healthcare. However, this seemingly fair and unyielding number does not represent the total health expenditure but only the public spending, which is the direct fiscal effort of the state.
The Origin and Ambiguity of the 6%
The origin of the 6% can be traced back to technical reports by the World Health Organization (WHO) and the Pan American Health Organization (PAHO) between 2010 and 2014. These reports observed that countries with “universal systems” and “low out-of-pocket expenses” allocated between 5% and 6% of their GDP to public health spending. It was a statistical observation, not a norm.
The 6%: A Symbolic and Ambiguous Figure
The transition from technical reports to political statements was almost imperceptible. Between 2014 and 2019, the 6% shifted from being an empirical datum to a moral criterion. In this transition, the 6% gained unprecedented power: it became the figure that governs health, a measure of legitimacy rather than effectiveness.
What the Number Doesn’t Tell
The appeal of the 6% lies in its simplicity: it encapsulates the complex task of ensuring access, quality, and equity. It serves to set goals, compare countries, and project commitments. However, this technical utility generates a dangerous illusion: confusing sufficiency with justice.
The 6%: A Political Bet, Not a Technical Goal
Achieving the 6% of GDP in health spending in Mexico would require mobilizing around 1.5 trillion pesos annually, which would necessitate raising the current tax revenue from 16% to at least 20%. This would involve tax reform, reducing evasion, creating new taxes, or reallocating subsidies—all while accepting the political cost of raising taxes.
Beyond the Myth
Reaching the 6% of GDP in health spending is possible but insufficient. It requires three simultaneous transformations:
- Fiscal, to collect sufficiently and progressively;
- Institutional, to use resources transparently and efficiently;
- Political, to prevent increased spending from benefiting corporate interests.
Uruguay and Costa Rica achieved this in less than a decade by combining economic growth, fiscal reforms, and strengthening primary healthcare. Mexico could do the same with a long-term strategy and sustained fiscal consensus. However, this would require acknowledging that health depends not only on the budget but also on political direction and institutional coherence.
Conclusion
The 6% has been a useful but dangerous guide when it becomes a dogma. Its power lies in offering a moral goal without conflict: promising more resources without specifying where they will come from or how they will be used. Breaking the myth does not mean abandoning the ideal of sufficiency but returning political density to it.
The 6% should be a starting point, not an end goal, for equitable public health.
- Desrosières, A. (2004). La política de los grandes números. Ed. Melusina. Barcelona
- Mendez J.S. (2025) Gasto en salud para 2026: Aumentos en hospitales y medicamentos; recortes en salud mental https://ciep.mx/gasto-en-salud-para-2026-aumentos-en-hospitales-y-medicamentos-recortes-en-salud-mental/
- Organización Panamericana de la Salud (OPS). (2014). Financiamiento de la salud en las Américas 2010–2014. Washington, DC: OPS.
- Organización Panamericana de la Salud (OPS). (2019). Compromiso de Montevideo sobre Salud Universal. Montevideo: OPS.
*The author is a Tenured Professor in the Department of Public Health, Faculty of Medicine, UNAM and an Emeritus Professor in the Department of Health Measurement, University of Washington.
The opinions expressed in this article do not represent the position of the institutions where the author works.
[email protected]; [email protected]; @DrRafaelLozano
