The Mexican Healthcare System: A Perilous Metaparadigm

Mexico’s fragmented public healthcare system is outdated, antiquated, and was designed with a political agenda rather than patient welfare at its core. This analysis explores the current state of the system, its ideological underpinnings, and the consequences of a centralized model that fails to meet the population’s needs.

Fragmentation and Post-Revolutionary Legacy

Mexico’s healthcare system is deeply divided among institutions such as the IMSS, ISSSTE, the two military healthcare systems, PEMEX’s medical services, and the new IMSS-Bienestar program. This fragmentation reflects a post-revolutionary design that centralizes resources and services under a paternalistic state. The notion of a “welfare state” granting services as acts of benevolence to a grateful populace has evolved into a bureaucratic, inefficient, and politicized system.

The ideological heritage of this structure has manifested in insufficient budgets, underutilized resources, and lots of corruption, with decisions driven by political rather than technical considerations. Instead of progressing toward a modern healthcare model, Mexico’s system remains anchored to paradigms of the past, increasingly out of step with international standards.

The Mexican Metaparadigm: The Proprietary State

The concept of a centralized, benefactor state has been hijacked by political interests since the 1970s. Rather than functioning as an effective public health model, the system has become a platform for political careers and a tool for budgetary control. This vision prioritizes a distorted belief that preventing diseases is cheaper than treating them, a rhetoric often used to justify reducing resources for medical care. Ironically, diseases such as obesity, type 2 diabetes, and cancer are not even effectively prevented.

While other countries with economies similar to Mexico’s have successfully integrated hybrid healthcare systems that combine universal access with private sector participation, Mexico’s government insists on monopolizing service provision. By acting as a monopsony—being the sole purchaser setting prices—suppliers face punitive practices that undermine competitiveness and foster extortionary policies. Predictably, this results in structural inefficiencies that compromise the system’s quality, availability, and sustainability.

Countries like Japan, South Korea, Colombia, Costa Rica, Chile, and the European Union members, have proven it is possible to guarantee access to healthcare through public-private partnerships. In these models, the state assumes a regulatory role, ensuring quality standards while services are delivered by private providers.

From dispensing medication at corner pharmacies to providing specialized services like dialysis nutritional care or radiotherapy, these systems excel in efficiency. They also integrate home-based nursing services, transportation, and medical devices like glucometers and wearables, offering benefits that are basically, nonexistent in Mexico such as financial assistance for patients and their families.

Embracing the Metaparadigm

The resistance to radically transforming Mexico’s healthcare system is no accident. With over 80 years of existence, the current model is the only one decision-makers have ever known. Quite literally, all living policymakers are familiar only with this system.

This conformity has perpetuated an underfunded structure where Mexico ranks among the lowest in public healthcare spending within the OECD, while simultaneously having one of the highest levels of out-of-pocket expenses.

Resistance also comes from actors and suppliers within the system, who strive to avoid operational complications at all costs. Yet, the signs of exhaustion are clear. Recent decisions, such as the elimination of the Seguro Popular program and the centralization of medication procurement and healthcare services, have only exacerbated existing problems, leading to shortages and deteriorating quality of care.

The Human Cost of a Failed System

The statist metaparadigm not only limits patient options but forces them to adapt to a system that fails to address their needs. A lack of infrastructure, inefficiency in medication distribution, and centralized decision-making have driven many Mexicans to seek alternatives in the private sector, increasing their personal expenses. An increasing number of people prefer being treated at a corner pharmacy rather than at the public “assigned clinic.”

The COVID-19 pandemic exposed the system’s limitations. Politicized and delayed decisions—such as the initial refusal to procure vaccines—reflected a model more concerned with maintaining control than addressing population needs. Ultimately, the vaccine shortage was resolved by a government ministry unrelated to the problem, amidst internal cabinet disputes.

Today, Mexico’s healthcare system does not serve its patients; in most cases, it is the patients who must conform, comply, and work for the system.

The Metaparadigm Must Disappear

Mexico’s healthcare system has reached a breaking point. After eight decades, it is clear that the centralist, paternalistic model is no longer viable. The country requires a radical rethinking of its system, one that abandons obsolete ideological visions and embraces pragmatic solutions focused on patient care.

The time to act is running out. If Mexico wishes to provide quality, accessible, and efficient healthcare, it must move away from the statist metaparadigm and adopt a more dynamic, modern approach rooted in partnerships and international standards. Only then can the country ensure the right to health in a comprehensive and sustainable manner.