Mexico Bets on Health for All, and the World Is Watching

Mexico launches its Universal Health Service on January 1. The road has bumps, but a country of more than 120 million is attempting what much of the world has yet to finish.

Mexico is about to launch one of the most ambitious public health programs in the Global South. On January 1, 2027, the Servicio Universal de Salud (SUS) will begin guaranteeing free emergency care, treatment for heart attacks and strokes, high-risk pregnancy care, vaccination and primary care to every Mexican, whichever public institution they belong to.

President Claudia Sheinbaum has said the aim is that by the time her government leaves office, anyone can walk into any public health facility with any ailment and be received.

This is a good moment to take stock. The launch is less than two months away. Mexico’s Chamber of Deputies approved the 2027 budget in the early hours of November 11, after a session lasting nearly 20 hours. Registration for the health credential that will open the doors closes on Saturday for the first group, older adults and people with disabilities; roughly 7 million people had registered by late October, about 7% of the 98.5 million first-phase target. It is also a moment of strain: workers at the Mexican Social Security Institute (IMSS), the system’s largest provider, have been protesting over pay since early October. A megamarch was called for November 9. No settlement had been announced as of this writing. How Mexico manages these pressures will show whether universal care can be built on top of existing institutions, a question many countries are asking.

What Mexico Is Building

The decree creating the SUS was published in the Diario Oficial on April 17, 2026. Rather than starting from scratch, it links what already exists: the IMSS, which covers private-sector employees and their families; the ISSSTE, the equivalent institute for government workers; and IMSS-Bienestar, the federal program that provides free care to people without employer coverage, such as informal workers and rural communities. Pemex hospitals, federal reference hospitals, national health institutes and any state that chooses to join complete the network. Each keeps its own budget and staff, but a patient can be treated at any of them, and the patient’s home institution reimburses the cost.

The rollout comes in two stages. The first, on January 1, makes the services described above available across institutions and adds a safeguard: people with cancer, HIV or kidney failure keep their treatment even if they lose their social security affiliation. A second stage on July 1 adds laboratory tests, imaging such as CT scans, and radiotherapy.

The target group is large. In 2024, 44.5 million people, or 34.2% of the population, had no entitlement to a public health institution. The figure counts people without a right to care from a specific institution, not people who never see a doctor. The rise was not gradual. It followed the 2020 abolition of Seguro Popular, a contributory scheme that had enrolled 53.5 million people at its peak, and its replacement with INSABI, a centralized program that collapsed within three years. Affiliation fell by more than 15 million in two years. The share without entitlement climbed from 15.6% in 2016 to 39.1% in 2022 before easing to 34.2% in 2024.

Building at Scale

The ambition shows in the numbers. The government has opened 2,136 registration modules in the 24 states where the federal government operates health services directly, to issue a unified health credential, a physical and digital card that will identify patients across institutions, backed by an investment of 3.5 billion pesos ($190 million). The first phase aims to register about 98.5 million people in those states. The remaining eight states, including Chihuahua, run their own health systems and have not signed on. A home-visit program for older adults has, by government figures, made 18.4 million visits to 11.5 million people and produced more than 11 million electronic clinical files — about 11% of the first-phase population. The shared records the system will need are a head start, not a finished product.

Medicines and staffing are also moving, according to the Health Ministry. A consolidated medicine purchase worth 353 billion pesos ($19 billion) for 2025 and 2026 has been followed by a 2027–28 tender completed five months ahead of schedule. The ministry says 2026 deliveries were 119% higher than in 2025, with cancer drugs up 122%, that 13 hospitals with 1,515 beds opened this year, and that more than 50,000 doctors and 15,000 nurses have been hired since 2024.

Growing Pains

The challenges are real, and Mexico’s leaders do not hide them. The IMSS, which will deliver most SUS services, has seen weeks of protests. Workers began blockades in Mexico City on October 8 and 9, asking for a 10% raise, better medicine supplies and changes in union leadership. In Chihuahua, consultations and daycare services were suspended. A 6.8% package negotiated by the union was voted down on October 14. A new 8% offer on October 21, with 4% on base pay and 4% in housing support, was accepted by the union but rejected by dissident workers, who marched again on October 30 and called another march for November 9. The IMSS says care continues.

Money is the other test. The 2027 budget puts health spending at about 1.14 trillion pesos ($61 billion), a 10.6% real increase, though still around 2.9% of GDP against the 6% often cited as a benchmark. Mexican households pay 39% to 48% of health costs out of pocket, well above the regional average of 32%, a financial burden the SUS is meant to lift. Gaps between institutions persist: per beneficiary, IMSS-Bienestar spends roughly 4,400 pesos ($237) a year against about 10,000 ($540) at the IMSS and 11,400 ($610) at the ISSSTE, although its budget rises 21.1% in the 2027 package. The reimbursement rule — the patient’s home institution pays the treating institution — has no dedicated fund behind it. The 2027 budget earmarks 500 million pesos ($27 million) specifically for expanding universality, a figure the opposition called “totally insufficient.” As one El Financiero column put it, the compensation box “is still missing.” Not every state is on board. Chihuahua is not applying the framework, at least at the start, and others outside IMSS-Bienestar are yet to be brought in.

A Question of Legal Footing

The SUS was created by presidential decree rather than by law, which raises the question of durability. Sheinbaum has said she will seek legal reforms and that there is no turning back, and an opposition initiative filed in October would write parts of the system into the General Health Law. Brazil’s universal system, rooted in its 1988 constitution, shows the value of that kind of anchoring. Mexican lawyers differ on how far a decree can reach, and the next government takes office in 2030.

Why the World Is Watching

Universal health coverage remains one of global health’s unfinished goals. The World Health Organization and the World Bank estimate that 4.6 billion people were not fully covered by essential health services in 2023, and progress has slowed from 1.5% a year between 2000 and 2015 to 0.5% since. Wealthy countries are not exempt: the United States counted 27.1 million uninsured people in 2024, the only OECD member without universal coverage for its working-age population. India covers roughly 500 million of its poorest through Ayushman Bharat, but out-of-pocket spending still accounts for about 48% of total health expenditure. China has enrolled 95% of its population in some form of public insurance, though coverage depth varies enormously between urban and rural areas. Mexico was one of 15 countries that presented national health compacts at a World Bank-backed forum in Tokyo in December 2025.

Most middle-income countries face a version of Mexico’s problem: several parallel institutions, each serving a different slice of the population, none serving everyone well. Mexico’s approach of connecting existing institutions instead of replacing them offers a path for those countries. It also shows that “universal” is a spectrum, with coverage on paper needing medicines, staff and short waits behind it. Even established systems face trade-offs: a survey by Canada’s Fraser Institute, a think tank, put the median wait from referral to treatment there at 28.6 weeks (a physician survey with a 13.1% response rate), while cost keeps many Americans from care. No model is risk-free; the test is whether a system keeps improving.

Mexico’s Neighbours

Latin America has particular reason to follow closely. Many of its health systems share Mexico’s fragmentation, and households pay about 32% of health spending out of pocket across the region, against 20% in OECD countries, according to the 2026 report by the OECD, the Inter-American Development Bank and the World Bank. Unmet health needs average 25%, from 3.2% in Costa Rica to 73% in Peru. Brazil’s decades-old public system and Costa Rica’s unified social insurance show what is possible. A success in Mexico, one of the region’s two largest economies, would give its neighbours a fresh template.

What It Means

For Mexico, January 1 is a beginning rather than a finish line. The first test will be simple and human: whether someone arriving at any public emergency room is treated without a charge or a question about affiliation, and whether the medicine is on the shelf. The reimbursement system, shared records and a settlement with health workers will help decide whether the July stage arrives on time.

For the world, the lesson is already visible. A middle-income country has decided that dividing citizens by institution is no longer acceptable and has set a date. If it succeeds, it will show that universal care can start by connecting what exists. If it stumbles, it will still have mapped the obstacles others must plan for. Either way, Mexico has chosen to try.

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References

Sources are listed in the order they appear in the article. Dollar figures are approximate conversions at about 18.6 pesos per dollar. Figures from the Health Ministry and other officials are government claims and are attributed as such in the text.

1. Crónica, “Sheinbaum firmará decreto para crear el Servicio Universal de Salud,” April 7, 2026. https://www.cronica.com.mx/nacional/2026/04/07/sheinbaum-firmara-decreto-para-crear-el-servicio-universal-de-salud/

2. Infobae, “Tras casi 20 horas, Cámara de Diputados aprueba Presupuesto 2027 y pasa al Ejecutivo,” November 11, 2026. https://www.infobae.com/mexico/2026/11/11/tras-casi-20-horas-camara-de-diputados-aprueba-presupuesto-2027-y-pasa-al-ejecutivo/

3. UnoTV, “Credencial del Servicio Universal de Salud: ¿quiénes pueden registrarse hasta el 14 de noviembre?,” 2026. https://www.unotv.com/nacional/credencial-del-servicio-universal-de-salud-quienes-pueden-registrarse-hasta-el-14-de-noviembre/

4. UnoTV, “Bloqueos de trabajadores del IMSS en CDMX, Edomex y otros estados este 9 de octubre,” October 9, 2026. https://www.unotv.com/nacional/bloqueos-trabajadores-imss-en-cdmx-edomex-otros-estados-este-9-de-octubre-2026/

5. Infobae, “¿Cuándo entra en vigor la ley que crea el Servicio Universal de Salud?,” April 18, 2026. https://www.infobae.com/mexico/2026/04/18/cuando-entra-en-vigor-la-ley-que-crea-el-servicio-universal-de-salud/

6. IMSS, “Press bulletin 490/2024: IMSS-Bienestar provides free care to people without social security,” September 24, 2024. https://imss.gob.mx/sites/all/statics/i2f_news/IMSS.%20Bolet%C3%ADn.%20%20490.pdf

7. El Cronista, “Salud para todos y todas: el Gobierno confirmó servicio gratuito para ciudadanos de todas las edades,” May 17, 2026. https://www.cronista.com/mexico/actualidad-mx/salud-para-todos-y-todas-el-gobierno-confirmo-servicio-gratuito-para-ciudadanos-de-todas-las-edades/

8. UnoTV, “Mexicanos gastan más para cuidar su salud, señala México Evalúa (ENIGH 2024: 44.5 million, 34.2%),” 2025. https://www.unotv.com/negocios/mexicanos-gastan-mas-salud-estudio-mexico-evalua/

9. México Cómo Vamos, “Analysis of INEGI poverty measurement 2024 (15.6% lacking health access in 2016),” 2025. https://mexicocomovamos.mx/?p=36547

10. Crónica, “Del instrumento a la realidad: qué explica la baja reciente de la carencia de salud (39.1% in 2022 to 34.2% in 2024),” November 24, 2025. https://www.cronica.com.mx/nacional/2025/11/24/del-instrumento-a-la-realidad-que-explica-la-baja-reciente-de-la-carencia-de-salud/

11. Consultor Salud, “Credencial del Servicio Universal de Salud: adultos mayores y personas con discapacidad ya pueden registrarse,” June 1, 2026. https://consultorsalud.com.mx/?p=315003

12. Por Esto, “Amplían hasta el 14 de noviembre la credencialización del Servicio Universal de Salud en Yucatán (3.5 billion peso investment),” May 29, 2026. https://www.poresto.com/yucatan/merida/2026/5/29/amplian-hasta-el-14-de-noviembre-la-credencializacion-del-servicio-universal-de-salud-en-yucatan.amp.html

13. Chilango, “Así será la nueva credencial del Servicio Universal de Salud (98.5 million first-phase target),” January 2026. https://www.chilango.com/noticias/asi-sera-la-nueva-credencial-del-servicio-universal-de-salud-que-es-y-como-funcionara/

14. Ruptura 360, “Servicio Universal de Salud (home-visit program figures; government data, not independently verified),” 2026. https://ruptura360.mx/el-pais/servicio-universal-de-salud/

15. Tribuna, “Gobierno de Sheinbaum reporta ahorro de casi 70 mil millones de pesos en la compra de medicamentos,” October 20, 2026. https://tribuna.com.mx/mexico/2026/10/20/gobierno-de-sheinbaum-reporta-ahorro-de-casi-70-mil-millones-de-pesos-en-la-compra-de-medicamentos_704298/

16. Excélsior, “David Kershenobich destaca baja en muertes por enfermedades crónicas (2027–28 purchase five months early),” November 2026. https://www.excelsior.com.mx/nacional/muertes-enfermedades-cronicas-bajan-mexico

17. El Diario de Sonora, “La Secretaría de Salud avanza hacia el Servicio Universal de Salud 2027 con 13 nuevos hospitales,” November 6, 2026. https://eldiariodesonora.com.mx/mexico/2026/11/06/secretaria-salud-avanza-hacia-servicio-universal-salud-2027-13-nuevos-hospitales.html

18. Expansión, “Consulta salarial del IMSS: trabajadores votan por el “No” (6.8% package rejected),” October 15, 2026. https://politica.expansion.mx/mexico/2026/10/15/resultados-consulta-salarial-imss-2026-gano-el-no-sntss

19. Posta, “Trabajadores del IMSS protestan en México: qué exigen y qué respondió el gobierno (8% offer: 4% base, 4% housing aid),” October 2026. https://www.posta.com.mx/mexico/trabajadores-del-imss-protestan-en-mexico/vl2271302

20. Tiempo, “Amagan empleados del IMSS con paro nacional el 30 de octubre,” October 22, 2026. https://www.tiempo.com.mx/nacional/amagan-empleados-imss-paro-nacional-30-octubre-2026/

21. Animal Político, “Trabajadores del IMSS anuncian otra megamarcha para el 9 de noviembre,” November 2, 2026. https://grupoanimal.mx/estados/megamarcha-imss-9-noviembre

22. Mi Morelia, “IMSS buscará mejorar oferta salarial tras rechazo de trabajadores,” October 15, 2026. https://mimorelia.com/mexico/imss-buscara-mejorar-oferta-salarial-rechazo-trabajadores-n5594779

23. Plano Informativo, “¿Será gasto en salud menor a lo sugerido a nivel internacional? (CIEP analysis of the 2027 package),” September 2026. https://planoinformativo.com/1171046/sera-gasto-en-salud-menor-a-lo-sugerido-a-nivel-internacional

24. Noticieros GREM, “Credencialización del sistema de salud se puede quedar en un buen deseo: Luis Javier Cortés (CIEP 2026 per-beneficiary spending),” January 23, 2026. https://www.noticierosgrem.com.mx/credencializacion-del-sistema-de-salud-se-puede-quedar-en-un-buen-deseo-luis-javier-cortes/

25. Infobae, “Paquete Económico 2027: estos son los puntos clave sobre deuda pública, inversión y crecimiento,” September 9, 2026. https://www.infobae.com/mexico/2026/09/09/paquete-economico-2027-estos-son-los-puntos-clave-sobre-deuda-publica-inversion-y-crecimiento/

26. El Financiero (opinion), “Presupuesto de salud 2027: falta la caja de compensación,” September 22, 2026. https://www.elfinanciero.com.mx/opinion/colaborador-invitado/2026/09/22/presupuesto-de-salud-2027-falta-la-caja-de-compensacion/

27. Tiempo, “Decreta Clau Servicio Universal; atenderá cualquier hospital público (Chihuahua not applying at the start),” April 18, 2026. https://www.tiempo.com.mx/local/decreto-servicio-universal-de-salud-claudia-sheinbaum-2026/

28. UnoTV, “La mañanera de Claudia Sheinbaum, 7 de abril de 2026 (plan to include states outside IMSS-Bienestar),” April 7, 2026. https://www.unotv.com/nacional/la-mananera-de-claudia-sheinbaum-7-de-abril-de-2026/

29. Expansión, “Por decreto, Sheinbaum va por Sistema Universal de Salud a partir del 1 de enero de 2027,” April 7, 2026. https://politica.expansion.mx/presidencia/2026/04/07/claudia-sheinbaum-va-por-sistema-universal-de-salud

30. Gaceta Parlamentaria, Chamber of Deputies, “Initiative to reform the General Health Law (PAN, Dep. Ramírez Barba),” October 6, 2026. https://gaceta.diputados.gob.mx/PDF/66/2026/oct/20261006-II-2-1.pdf

31. Revista Abogacía, “El Servicio Universal de Salud: ¿avance en derechos o exceso reglamentario?,” 2026. https://www.revistaabogacia.com/el-servicio-universal-de-salud-avance-en-derechos-o-exceso-reglamentario/amp/

32. World Health Organization, “Universal health coverage (UHC) fact sheet,” December 2025. https://who.int/mediacentre/factsheets/fs395/en/

33. US Census Bureau (via InsuranceNewsNet), “Income, Poverty and Health Insurance Coverage in the United States: 2024,” September 2025. https://insurancenewsnet.com/oarticle/income-poverty-and-health-insurance-coverage-in-the-united-states-2024

34. World Bank, “Progress toward 1.5 billion health care goal advances as countries adopt National Health Compacts,” December 6, 2025. https://www.worldbank.org/en/news/press-release/2025/12/06/national-health-compacts-reforms-expand-affordable-care-create-jobs-boost-economic-growth

35. Fraser Institute, “Waiting Your Turn: Wait Times for Health Care in Canada, 2025,” December 2025. https://www.fraserinstitute.org/STUDIES/WAITING-YOUR-TURN-WAIT-TIMES-FOR-HEALTH-CARE-IN-CANADA-2025

36. OECD / IDB / World Bank, “Health at a Glance: Latin America and the Caribbean 2026 (unmet need, 3.2% to 73%),” September 2026. https://www.oecd.org/en/publications/health-at-a-glance-latin-america-and-the-caribbean-2026_445b3259-en.html

37. OECD / IDB / World Bank, “Health at a Glance: LAC 2026, financing chapter (out-of-pocket 32% vs 20%),” September 2026. https://www.oecd.org/en/publications/health-at-a-glance-latin-america-and-the-caribbean-2026_445b3259-en/full-report/financing-of-healthcare-from-households-out-of-pocket-payments-voluntary-payment-schemes-and-external-resources_7a3e7d25.html

38. El Cronista, “Market ticker on page: about 18.64 pesos per US dollar (used for dollar conversions),” November 8, 2026. https://www.cronista.com/mexico/actualidad-mx/salud-para-todos-y-todas-el-gobierno-confirmo-servicio-gratuito-para-ciudadanos-de-todas-las-edades/

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Featured Image: President Claudia Sheinbaum inspects an ISSSTE Clinic-Hospital in Morelia, Michoacán/©Government of Mexico

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