Introduction
Despite institutional reforms and official narratives celebrating progress, universal health coverage remains a distant promise in Mexico. The structural crisis persists as millions remain excluded from medical services, and the federal budget barely addresses 21st-century challenges.
Current State of Healthcare in Mexico
According to the National Household Income and Expenditure Survey (ENIGH) 2024 and INEGI’s 2025 Multi-Dimensional Poverty Report, approximately 30 million people in Mexico lack access to public health services. The majority are outside the social security system, excluded from comprehensive financial protection and healthcare mechanisms.
The transition from Seguro Popular to INSABI and then IMSS-Bienestar has not improved this fundamental indicator. Although overall multidimensional poverty has decreased, 44.5 million Mexicans still lack effective access, and alarmingly, 3.5 million have fallen into extreme poverty due to healthcare expenses, primarily medications and private care.
Budget Analysis
Is the present budget sufficient for transforming access to healthcare?
Comparing the budget proposals from 2024, 2025, and PPEF 2026, adjusting for official GDP deflators (5.2% in 2024, 4.8% in 2025), the real value of the healthcare budget shows nominal growth, and even decreases in real terms for some areas.
- IMSS increases from 504,175 million (2025) to 556,342 million (2026)
- IMSS-Bienestar decreases from 169,716 million (2025) to 167,306 million (2026)
- Secretaría de Salud falls from 59,988 million (2025) to 57,364 million (2026)
This marginal and concentrated allocation to social security appears contradictory, as the 30 million excluded from public medical services are primarily non-right holders. The budget expansion seems to benefit those already within the formal employment system, without ensuring access for the uninsured.
Out-of-Pocket Spending and Private Healthcare
Will out-of-pocket spending and private healthcare decrease or worsen?
Between 2018 and 2024, out-of-pocket healthcare spending grew by 41.3%, twenty times the global growth in family expenditure. Medication purchases, ambulatory consultations, and private care account for over 60% of catastrophic spending. In 2024, 1.11 million households allocated more than a third of their payment capacity to healthcare, and 287,000 households fell into poverty due to this reason.
If the budget does not surpass medical inflation (gross 14%, net 11% for 2025, according to INEGI calculations), out-of-pocket spending will continue to rise, effectively privatizing health protection and turning medication and service purchases into a direct cause of impoverishment.
Hospital and Specialized Care
Will hospital and specialized care see improvements?
The increase allocated to high-specialty hospitals and IMSS-Bienestar barely matches the rise in the minimum professional medical salary (12% in 2025, 20% in 2024), while contractual increases for substitutes and new professionals double these percentages.
The observable result in the first six months of 2025 is a hospitalization rate of only 35%, far below the international standard, and calculated operational cuts for substitutes and rehiring in strategic hospitals like HRAEB.
FONSABI and Social Institutional Empowerment
Will FONSABI lead to institutional and social impoverishment?
The Fondo de Salud para el Bienestar (FONSABI) has become a federal spending black box over the past decade, subject to repeated “remanentes” withdrawals. It fails to meet its original purposes as outlined in the General Health Law and recent decrees.
Unspent money intended for catastrophic illness coverage translates into delayed or nonexistent care for severe conditions (all childhood cancers, transplants, specialized treatments). If high-specialty hospitals like the National Institutes of Cancer and Nutrition are implementing recovery charges for services rendered as a mandatory income source—an expanding measure for 2026—this represents a financial setback impacting those without right holdership and at higher economic risk.
Key Questions and Answers
- Q: What is the current state of universal health coverage in Mexico? A: Universal health coverage remains elusive, with 30 million people lacking access to public health services, and 44.5 million Mexicans without effective access.
- Q: How does the current budget address healthcare challenges? A: The real value of the healthcare budget shows nominal growth, with marginal and concentrated allocation to social security.
- Q: What is the trend in out-of-pocket healthcare spending? A: Out-of-pocket healthcare spending has grown significantly, consolidating health inequity and deepening access gaps.
- Q: Will hospital and specialized care see improvements? A> The current budget allocation barely matches the rise in minimum professional medical salaries, with observable negative impacts on hospitalization rates and operational cuts.
- Q: What are the implications of FONSABI’s current state? A: FONSABI, subject to repeated “remanentes” withdrawals, fails to meet its original purpose of catastrophic illness coverage, impacting those without right holdership and at higher economic risk.
*The author (www.ectorjaime.mx) is a general surgery specialist, certified in public health, doctorate in public health and administration sciences. He is a legislator and advocate for Mexico’s public health, reelected PAN group member in the LXVI Legislature.
