Mexico’s healthcare system is undergoing a severe decline, according to the study Changes in Public Healthcare in Mexico, 2018-2024, conducted by México Evalúa. The analysis reveals that in just six years, the number of people without access to healthcare services doubled, rising from 20.1 million in 2018 to 44.5 million in 2024, according to official data from Inegi.
Among the main findings of the study, prepared by researcher Jorge Cano of México Evalúa, and presented within the framework of President Claudia Sheinbaum’s first government report:
- Budget cuts. The 2025 economic package reduced by more than 100 billion pesos the resources allocated to healthcare for people without social security, compromising the State’s ability to respond to growing needs.
- Higher out-of-pocket spending. In 2024, Mexican households spent on average 1,605 pesos per quarter on healthcare, an increase of 469.8 pesos compared to 2018. The impact was greater on the poorest households, whose spending rose by over 80%, from 355 pesos per quarter to 651 pesos, while in wealthier households it increased only 34%.
- Rising drug costs. Spending on medicines doubled between 2018 and 2024, with sharp increases in treatments for diabetes (261%), hypertension (242%), and migraines (333%).
- Shift to private care. More than half of Mexicans who sought medical attention in 2024 went to the private sector (55.1%). Only 34% of those with a health problem received care at public institutions.
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Structural factors
The study underscores that the historical fragmentation of the system—with multiple institutions such as IMSS, ISSSTE, Pemex, and the Armed Forces, in addition to services for those without social security—creates inequities.
The elimination of Seguro Popular and its replacement first by INSABI and later IMSS-Bienestar reduced explicit healthcare guarantees and weakened per capita funding. Per-person health spending fell 8% between 2018 and 2024, despite the growth in the target population.
Where public policy should go
Mexico’s health policy in the last six years shifted from a model with proven progress in financial protection—such as Seguro Popular—to institutional schemes that, while promising free and universal coverage, have lacked solid financing and management mechanisms, according to the conclusions of Changes in Public Healthcare in Mexico, 2018-2024.
Seguro Popular succeeded in reducing out-of-pocket spending, catastrophic expenses, and lack of healthcare access, though it maintained territorial inequalities and weak preventive care. Its replacement by INSABI, and later IMSS-Bienestar, expanded the target population and promised coverage for more conditions, but by eliminating affiliation, the benefit catalog, and per capita financing, it undermined budgetary and operational certainty.
The result has been a measurable setback: falling public spending per capita for those without social security, fewer consultations provided, higher out-of-pocket and catastrophic household expenses, and a growing de facto privatization of healthcare, reflected in the rise of private clinics, pharmacy consultations, and self-medication.
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According to México Evalúa researchers, the country will not be able to build an equitable, universal, and sustainable healthcare system unless it addresses the structural roots of segmentation, conditional financing, and governance. The experiences of Brazil, Chile, and Denmark show that institutional integration, solidarity-based financing, smart regulation of the private sector, and explicit guarantees are the pillars of any effective transformation.
Toward a single, universal, non-segmented system:
- Sustained public financing based on general taxation
- Universalize effective access, not just nominal affiliation
- Regulated private-sector participation in drug supply
- Reduce geographic inequality in infrastructure and medical staff
- Strengthen early detection of chronic diseases and cancer
- Public health in Mexico: between cuts and shortages
One year into President Claudia Sheinbaum’s administration, the outlook for Mexico’s healthcare system confirms that the sector is undergoing a structural crisis, according to experts.
“Financial indicators show that a substantial improvement is unlikely with the current budget allocation, casting doubt on health’s priority in the national agenda,” said Jorge Cano of México Evalúa.
The 2025 Economic Package included a cut of more than 100 billion pesos to healthcare services for people without social security, a reduction that alone reflects the sector’s low priority. This, despite 2024 ENIGH data showing an accelerated deterioration: more than 44 million Mexicans lack access to medical services and out-of-pocket spending has risen sharply.
Mariana Campos, director of México Evalúa, said the recently presented study largely reflects the closing of the previous administration and, although it does not measure the performance of the current government, it highlights a structural problem that persists. Researcher Jorge Cano noted that the budget adjustment not only reduces the system’s response capacity but has also reached hospitals and clinics only “in dribs and drabs.”
At the same time, problems in the supply of medicines have become a visible symptom of the crisis. Doctors, nurses, hospital staff, and patient organizations have denounced the lack of basic supplies, which has forced the suspension of services, closure of labs, and even limits on surgeries or imaging studies. Each hospital has had to adjust and reduce the care it offers, deepening inequalities.
Experts agree that “the challenge is enormous”: without sufficient resources and without public policies that guarantee supply and access.
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