[Health system reforms in Mexico (1984-2024): an analysis based on the theory of change]

To analyze the challenges facing the Mexican healthcare system from a theory of change perspective and propose a feasible path to achieving effective, high-quality access.

A theory of change for the Mexican healthcare system was developed based on a narrative review that identified the desirable characteristics and mechanisms of action that lead to effective, quality access. A documentary review of the reforms to the General Health Law between 1984 and 2024 identified the potential contribution of the modifications to the system toward achieving the proposed theory of change.

The theory of change of the Mexican health system allows us to identify the path toward effective and quality access, while also highlighting areas in which progress has not been made due to the absence of interventions. Although the various reforms analyzed have generated changes in the design of the system, they have not succeeded in consolidating a design consistent with effective and quality access.

The Mexican health system requires a redesign that provides effective and quality access for the entire population, that is, an integrated system that does not segment by employment status or ability to pay. A system that includes the elements and mechanisms identified with the theory of change would make it possible to guarantee effective and quality access for the entire population.