Healthcare in Mexico

Mexico’s healthcare system is underfunded and inadequately organized to meet the needs of its population. The healthcare system has not changed substantially since the Health Ministry was established in 1943. Coverage has been expanded since that time and now all Mexicans have access to basic healthcare services, at least on paper. However, the quality of the services, and in some cases access at all, varies considerably. Those who can do so rely on private services to augment, if not replace, services provided by the state. Mexico has a mix of public health insurance programs, employer-provided health insurance and private out-of-pocket care and a number of disconnected social security institutes that provide care. 

Since its start, coverage under Mexico’s public healthcare system has been based on employment status. Salaried or formal-sector workers are covered under one of two programs. The Mexican Social Security Institute (Instituto Mexicano del Seguro Social, or IMSS) was created in 1943 to provide healthcare coverage to private-sector, formal and salaried workers and their families. In 1959 the Institute of Social Services and Security for Civil Servants (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, or ISSSTE) was established to provide coverage for government employees and their families. Non-salaried and informal-sector workers were excluded from formal social insurance schemes and the healthcare needs of this group were addressed by the Ministry of Health. The Seguro Popular, or Popular Health Insurance, was created in 2003. It was neither secure nor popular, and was plagued with corruption. It was replaced by the Institute of Health for Welfare (INSABI) in 2020, making true for the first time the constitutional mandate to ensure free access to healthcare to anyone regardless of income or race.  

INSABI provides unemployed and poor Mexicans with access to preventative healthcare services such as diabetes screening and vaccinations, as well as treatment for chronic and severe illnesses. Enrollees don’t have to pay a fee at the time of the doctor visit. The program is supported by a mix of federal and state funds. The poorest families pay nothing to join. The rest pay a premium based on their income. The program currently has over 57 million people and covers all conditions, services and medicine free of charge. This public insurance scheme, coupled with Social Security, represents 95% of the insured population in Mexico. Funding for INSABI is derived from the federal government, the Secretariat of Health, and the individuals who form a part of this system. However, approximately 20% of individuals in this system, representing the poorest covered sector, are exempt from this.  

Those who are Employed and their dependents can use the program administered and operated by the IMSS. The IMSS program is funded equally by the employee, the private employer, and the federal government. There are more than 65 million people covered through IMSS and its programs. Further, within IMSS a program which is specifically targeted towards aiding the poorest in the country and is funded by the government. The IMSS does not provide service to public employees, who instead are serviced by the ISSSTE which sees to the health and social care needs of government employees at the local, state, and federal levels. Nearly 9 million people are covered by the ISSSTE. 

Private healthcare makes up a substantial portion of the Mexican healthcare system with both spending and activity. Overall spending to the private institutions accounts for around 52% of total health spending in the country. The services provided by private institutions and private physicians in their offices are afforded by a part of the population, either by contracting a private insurance or by paying directly for the services. It is estimated that around 6.9% of the Mexican population has private insurance coverage, mainly paid as an out-of-pocket expenditure. Generally, the use of private healthcare is limited to Mexicans of higher socioeconomic status. 

Cost of healthcare in Mexico is dependent on the nature of the service and the institution utilized. Generally, health costs associated with use of the public healthcare sector are higher than their private counterparts. Also, people not insured under any current health insurance scheme most often utilize private doctors instead of public institutions. There are a decent number of people internationally, especially from the U.S., who go to Mexico to medical procedures done. The out-of-pocket costs are usually cheaper than their insurance premiums. There can be issues quality and access wise, for people in rural communities. Another issue can be that people can only be seen by providers in-network, sometimes even in emergency cases. Despite the issues with healthcare in Mexico, they are continuing to try and improve it.