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Beyond the Decree: What Mexico’s Universal Health Service Still Needs to Deliver Universal Coverage examines the opportunities and limits of Mexico’s new Universal Health Service (SUS), created by presidential decree in April 2026. The analysis assesses whether executive action can meaningfully integrate a health system whose fragmentation is embedded in its legal framework, financing arrangements, and labor market.
Mexico’s health system remains divided by employment status. Private-sector workers receive care through the Mexican Social Security Institute (IMSS), public employees through the Institute for Social Security and Services for State Workers (ISSSTE), and informal workers, self-employed people, and those without employment rely on IMSS-Bienestar, state health services, or private providers. This division has produced institutions with uneven resources, separate financing systems, and limited mechanisms for coordination. In 2024, 44.5 million people had neither public nor private health coverage, while out-of-pocket spending represented 41.2 percent of current health expenditure.
The SUS is a major step toward integration. Beginning in January 2027, it will expand access to emergency care, high-risk pregnancy services, universal vaccination, primary care consultations, and continuity of treatment for several chronic conditions. “Specialized diagnostics and radiotherapy follow in July 2027. Yet the decree does not merge institutions or resolve the structural barriers that prevent effective coordination across them.
The report identifies the reforms needed to turn the SUS into a genuinely universal service: legally binding governance across health institutions, mandatory and standardized compensation mechanisms, interoperable electronic health records, effective regulation of the private sector, and greater public investment in health.
