Introduction
The concept of Universal Health Coverage (UHC) has been a cherished ideal for over a decade, promising free access, quality services, and financial protection for all. However, recent financial data and federal budget decisions suggest that this dream is eroding amidst cuts, restructuring, and a lack of tangible improvements in health outcomes.
Current State of UHC in Mexico
Despite triumphalist rhetoric, the reality is stark. In the first half of 2025, federal health spending barely reached a 32% advancement, falling short of the expected 42% based on annual logic. This implies that while bulletins celebrate an alleged expansion of services, funds are not flowing at the required pace or direction to address profound health inequalities.
Vacunation Program
The cornerstone Vaccination Program, crucial for preventing diseases in children, has only exercised 0.2% of the approved budget. Consequently, coverage for BCG and triple viral vaccines remains below 70%, far from the recommended 95% by NOM-036. Preventive measures, vital for reducing hospitalizations and deaths, are being delayed.
Other Essential Programs
Moreover, essential programs like Strengthening State Health Services or Investment in Infrastructure have not spent a single peso this year. How can one expect improved medical care in rural or marginalized communities where the lack of clinics and personnel persists?
IMSS-Bienestar Program
The flagship IMSS-Bienestar program, responsible for attending to 63 million people without social security, has shown a modest financial advancement with only 33% of its budget executed by May. This translates to millions of unfulfilled prescriptions and persistent shortages in medical supplies.
Future Direction of UHC
The concerning aspect is not just the slow spending but the direction the government is taking towards 2026. According to the programmatic structure delivered to Congress, the Secretariat of Health will transition from 27 programs to only 16. Under the guise of “austerity,” essential programs such as epidemiological surveillance, HIV/AIDS attention, obesity and diabetes prevention, and even medical specialist training programs will be eliminated or merged.
This merging of programs into grandiose-sounding entities like the Disease Prevention and Control Policy is merely a black box budgetary loss, diverting focus from pressing health issues. Combating dengue is different from treating chronic conditions like diabetes. Their needs, treatments, and strategies vary.
Impact on Citizens
The impact on citizens is direct: more out-of-pocket expenses, less access to timely services, and growing distrust in the public health system. According to INEGI, household spending on health increased by 30.9% between 2018 and 2022, with the percentage of households experiencing catastrophic health expenses rising from 2.5% to 3.3%. The notion of “free” healthcare becomes a myth when families continue to pay for what the state fails to guarantee.
Key Questions and Answers
- Q: Is it possible to achieve real universal health coverage with fewer programs, less budget, and less trained personnel? A: The concern isn’t just about the efficiency of a model but the health of millions, their right to dignified, timely, and effective care, and the state’s responsibility to use public resources wisely.
- Q: What sense does it make to claim there’s a doctor in every community if there are no medications, tests, or clinical follow-ups? A: Centralizing control without improving quality or correcting disparities in per capita spending between insured and uninsured populations serves no purpose.
- Q: What’s the way forward given the projected institutional dismantling for 2026? A: There’s still time to correct the course, but it requires will, evidence, and empathy. Behind every eliminated program are patients losing care, doctors without tools, and more vulnerable communities.
Universal health coverage is not built on rhetoric; it’s constructed with adequate budgets, stable personnel, indicators measuring real health outcomes, and commitment.
