Health policies and reforms in Mexico (2000-2024): segmentation and challenges for universal rights

The Mexican health system is historically segmented, being based on social insurance for formal workers and public health actions for the general population. This study characterizes health reforms in Mexico from 2000 to 2024 considering the trajectory of health policies, coverage, and use of the health system. This research involved a literature review, documentary analysis, secondary data and interviews with key informants. We observed moments of reform under the influence of various groups and government political orientations. From 2003 to 2018, the implementation of a Popular Health Insurance with limited supply of services for informal workers and the poor increased coverage but reiterated segmentation and inequalities. From 2018 to 2024, center-left governments extinguished popular insurance and adopted reform strategies that centralized actions in the Federal Government and integrated efforts between institutions and public services. The results also showed the growing use of private clinics adjacent to pharmacies. In the period, the adopted reforms failed to overcome the legacy of segmentation by clientele, organizational fragmentation, and inequalities in health. Despite the announcement in April 2026 of reforms toward universal health some challenges can still be noticed, namely: insufficient public funding, limitations in infrastructure and the health workforce in the states, resistance from states and social security institutions, federative and political-party conflicts, expansion of private services under scarce regulation, and territorial inequalities and inequalities between social groups.