Introduction
The narrative of universal and free access to medications and healthcare for all Mexicans crumbles under the reality of austerity and shortages. Despite the promise of free healthcare, it has exacerbated inequalities rather than strengthening the public system. The most representative case lies within the network of National Health Institutes (INS) under the CCINSHAE, which provide high-specialty care. These institutes suffer from diminished operational and financial capabilities, reducing access to them to a luxury for those who can navigate long waiting lists or have privileged referrals from influential individuals.
The Pre-Universal Free Model
Prior to the implementation of universal free healthcare in 2020, INS operated under an equitable quota recovery model adjusted to each patient’s socioeconomic level. This system was fair: those with more resources contributed more, while low-income patients paid little or nothing, ensuring that access did not solely depend on public funding. From these quotas, INS retained up to 35%, a crucial budgetary supplement that financed supplies, maintenance, and infrastructure improvements. This income represented a significant portion of their operation, allowing flexibility within limited federal budgets.
The Impact of Mandatory Free Healthcare
However, with mandatory free healthcare, the government eliminated these quotas, arguing that the state would cover all costs. The issue is that the state cannot fulfill this promise of increased coverage without significantly raising the budget allocated to healthcare, which, according to CIEP, is only 2.7% of the GDP—less than half of the internationally recommended 6%.
Financial Strangulation and Systematic Cuts
The result has been financial strangulation and systematic cuts. By 2025, budgetary impacts on INS directly affected the Institutes of Pediatrics, Nutrition, and Oncology. Per-person spending without social security dropped 24.9%, from 5,625 pesos in 2024 to insufficient levels.
Loss of Financial Autonomy
This loss of financial autonomy has transformed INS into shadows of their former selves. Doctors could previously request patients or families to purchase missing supplies to expedite procedures; now, this practice is prohibited, closing doors to timely care.
Case Study: Instituto Nacional de Cardiología Ignacio Chávez
Austerity has led to critical situations at the Instituto Nacional de Cardiología Ignacio Chávez. Recently, the institute’s leadership informed doctors about the severe budget crisis, even considering closing the emergency area due to a lack of essential supplies like anticoagulants, diuretics, insulin, and others. Without these supplies, how can they manage cardiac emergencies? The institute, which serves patients nationwide, has limited services: in April 2025, it ran out of cultures for patients due to a lack of resources, prioritizing only urgent surgeries. With a 6% budget cut for 2025 (from 228 million pesos), the institution struggles to maintain its level of care, previously distinguished internationally.
Austerity Leads to Legal Vulnerability of Physicians
The impact extends beyond patients to physicians in INS. With the professional responsibility of saving lives, they face growing legal vulnerability due to a lack of supplies. Unable to document real causes for patient discharges—fearing administrative reprisals—physicians become exposed to lawsuits. Patients informed about the situation can directly hold doctors accountable, and such cases have significantly increased within the public system.
Key Questions and Answers
- What was the previous model for INS financing? The previous model was an equitable quota recovery system adjusted to each patient’s socioeconomic level, with up to 35% of the revenue retained by INS for supplies, maintenance, and infrastructure improvements.
- How has the mandatory free healthcare affected INS financially? The mandatory free healthcare has led to financial strangulation and systematic cuts, with per-person spending without social security dropping significantly.
- What are the consequences of losing financial autonomy for INS? The loss of financial autonomy has transformed INS into shadows of their former selves, closing doors to timely care as doctors can no longer request patients or families to purchase missing supplies.
- What are the challenges faced by physicians in INS due to austerity? Physicians face growing legal vulnerability due to a lack of supplies, unable to document real causes for patient discharges and exposed to lawsuits. Patients informed about the situation can directly hold doctors accountable.
