President Claudia Sheinbaum Pardo’s Plan República Sana (Healthy Republic Plan) promises to foreground prevention, technology and equity in Mexico’s health care system. Nearly two years into her presidency, the gap between aspiration and implementation reveals both genuine opportunities and persistent structural constraints.

A major step was announced on April 7, with the presidential decree creating the Servicio Universal de Salud (Universal Health Service [UHS]), which aims to integrate the country’s three main public health institutions — Mexican Social Security Institute (IMSS), Institute of Social Security and Social Services for State Workers (ISSSTE) and IMSS-Bienestar (IMSS-Wellbeing) — so that citizens can receive care at any public facility regardless of their previous affiliation. For implementation, the initiative will rely heavily on digital platforms.

This integration is intended to improve access and reduce fragmentation, but it faces significant logistical and infrastructural hurdles. Out-of-pocket spending currently accounts for approximately 39% of total health expenditure, exposing households to substantial financial risk and catastrophic expenses. In Mexico, such high out-of-pocket costs reflect the limited financial protection offered by the current system and underscore the importance of progressing toward comprehensive coverage.

Historical legacy and policy inheritance

Mexico built its health institutions for a nation that never existed. IMSS, founded in 1943, and ISSSTE, established in 1959, were designed as social security institutions for formal sector industrial and government workers, respectively. The country’s largely informal labor force, as well as individuals from rural and Indigenous communities, have historically remained outside the formal health care system. Successive economic crises, fiscal austerity and the 1990s North American Free Trade Agreement (NAFTA) weakened public infrastructure while the private sector grew rapidly. Earlier attempts at universalization were incomplete.

Achieving effective UHC by 2030 will be extraordinarily challenging. According to the latest Organisation for Economic Co-operation and Development (OECD) data, Mexico spends 5.9% of GDP on health, with primary health care receiving a disproportionately low share, far less than the average for OEDC nations of around 9.3%. Per capita spending stands at just $1,588, compared to the OECD average of $5,967. This underinvestment severely limits the capacity to expand and improve primary and community-based services.

Hospital infrastructure is also critically limited: Mexico has only 1.0 hospital bed per 1,000 inhabitants — one of the lowest (or near-lowest) in the OECD (average 4.2). Life expectancy is 75.5 years, about 5.6 years below the OECD average. Preventable mortality (243 per 100,000) and treatable mortality (175 per 100,000) remain substantially higher than OECD benchmarks (145 and 77, respectively).

Past digital health initiatives have faltered due to incompatibility among data systems, high costs and weak infrastructure, as noted in the OECD comparative analysis of electronic health records. Previous pilot projects to create integrated electronic health records encountered delays and budget overruns, largely because of incompatible platforms and limited connectivity. These challenges highlight the need for robust, interoperable digital systems supported by reliable infrastructure.

Today, chronic conditions predominate in Mexico’s health burden. Overweight and obesity affect approximately 75.2% of the adult population, with obesity affecting approximately 37% of adults (higher among women at around 41%). Diabetes prevalence continues to rise, with many cases undiagnosed and regional disparities persisting, according to the latest ENSANUT data. 

The Healthy Republic Plan and recent advances

The Plan República Sana focuses on five core objectives: strengthening prevention, reducing waiting times, renewing IMSS-Bienestar infrastructure, modernizing drug procurement and digitizing medical records. Yet these are evolutionary steps rather than a complete transformation.

The April 2026 decree for establishing the UHS may add momentum. Phase 1 (starting January 2027) proposes cross-institutional care for key services, including emergencies, high-risk pregnancies, heart attacks, strokes, breast cancer diagnoses and ongoing treatments. A Universal Health Credential is rolling out progressively, beginning with adults aged 85 and older in April 2026. Registration for the general population is scheduled throughout the remainder of 2026, with the goal of broad coverage by the end of the year.

La Clínica es Nuestra (The Clinic Is Ours) was developed as part of Mexico’s new Health Care Model for Wellbeing (MAS-BIENESTAR). It aims to guarantee free, high-quality healthcare for uninsured and underserved populations — specifically people without access to social security institutions such as IMSS or ISSSTE, including in rural areas, indigenous communities, and low-income urban neighborhoods.

Importantly, however, the program’s focus is on improving the physical infrastructure and equipment of the clinics themselves, rather than on the community’s actual health needs. There are no opportunities for broader participatory governance or decision-making in health service planning, monitoring or policy formulation. Ultimately, approval of the community’s funds rests with the health authority. In this context, many residents lack any real sense of participation or ownership in the program. 

New pharmaceutical sovereignty initiatives seek to boost domestic production and reduce import dependence. However, the 2025 reforms to the National Compendium of Health Supplies (CNIS) allow distributors to request product inclusions more easily and removed the requirement to publish maximum unit prices. These changes have raised concerns about reduced transparency and risks of less rigorous oversight, higher prices and more opaque procurement practices.

Other promising elements of the Plan República Sana include expanded telemedicine and digital integration — such as a universal electronic health record, the digital health credential and remote consultation capabilities. However, these efforts face serious challenges in that they lack sustained new funding and clear accountability mechanisms.

Meaningful consultation with frontline workers and communities has also been virtually absent. As a result, the initiatives risk encountering familiar problems: medicine and equipment shortages, staffing gaps and infrastructure deficits. Digital advances may also widen inequalities in regions lacking reliable electricity, internet and basic supplies. 

Persistent challenges: fragmentation, workforce and governance

The vision of a seamless network linking IMSS, ISSSTE and IMSS-Bienestar faces real barriers. Legal, fiscal and operational differences — including incompatible data platforms and longstanding institutional fragmentation — have caused past digital integration attempts to fail. 

Medical training still prioritizes specialization over primary and community care. New public universities have increased enrollment, but curricula remain hospital-centric and few incentives exist for people to become family doctors or community health workers. OECD analysis notes that medical curricula in Mexico continue to emphasize hospital-based specialization, with limited attention to primary care and community health.

According to the 2021 World Health Organization Mexico: health systems review, while efforts are underway to promote primary care roles, the medical education system still faces significant obstacles in fully integrating community-based training and providing incentives for clinicians to practice in rural and other underserved areas.

Policy directions for meaningful progress

Delivering on the Plan República Sana and the new UHS will require three core shifts:

• Make prevention the organizing principle. Balance digital and technological targets with sustained investment in community-based care, public health education and addressing social determinants such as nutrition, environment and inequality. 
• Advance decentralization with transparency. Empower regional and municipal teams with resource control while mandating open procurement data and performance reporting. 
• Strengthen collaboration and accountability. Incorporate frontline workers and citizens into planning, organization and evaluation. Shared governance and transparent, measurable targets will be essential.

The path forward

President Sheinbaum’s administration has linked health policy to broader social welfare goals more explicitly than at any time since the 1940s. Her April 2026 presidential decree establishing the Servicio Universal de Salud is a significant step toward dismantling fragmentation and advancing the constitutional right to health for all.

However, true transformation by 2030 will require more. It demands sustained increases in public health investment, a reorientation of the medical workforce toward prevention and chronic disease management, transparent governance and genuine interoperability of data and services. If these conditions are met, Mexico could move substantially closer to realizing a Healthy Republic — one that delivers equitable, high-quality care while effectively addressing the heavy burden of chronic conditions.

[Casey Herrmann edited this piece]

The views expressed in this article are the author’s own and do not necessarily reflect Fair Observer’s editorial policy.