Health insurance coverage in Mexico: progress, inequalities and remaining challenges towards UHC2030
File(s)
Published version
Author(s)
Servan-Mori, Edson
Cerecero-Garcia, Diego
Meneses-Navarro, Sergio
Hone, Thomas
Mohar-Betancourt, Alejandro
Type
Journal Article
Abstract
Background
Universal health coverage (UHC) requires strong institutional capacity, equity-oriented policies, sustained political and financial commitment and public trust. However, public confidence in many health systems, including Mexico’s, has been chronically undermined. This study aims to document Mexico’s health coverage trajectory by offering a comprehensive, disaggregated and longitudinal assessment of insurance coverage from 2000 to 2023 – highlighting both achievements and setbacks in the context of UHC2030 goals.
Methods
This study used nationally representative data from Mexico’s National Household Income and Expenditure Survey (ENIGH) from 2000 to 2022, with projections for 2023. Households were classified into mutually exclusive health insurance categories on the basis of institutional affiliation. National and subnational trends in coverage were analysed, with attention to major reforms and disruptions. A distance-to-frontier metric quantified the gap between 2023 coverage and each state’s historical maximum, enabling assessment of progress toward UHC goals.
Results
Between 2000 and 2015, Mexico reduced the uninsured population from 55% to 6.2%, largely driven by Seguro Popular (SP) expansion benefiting Indigenous peoples, rural and low-income households in high-deprivation states. Following SP’s dismantling in 2019, the launch of Health Institute for Welfare (INSABI), and the COVID-19 pandemic, uninsured rates rose sharply to 29.1% by 2023. The greatest losses in coverage occurred in southern states and among marginalized groups, deepening territorial and social inequalities. The decline in mixed public coverage further reflects system fragmentation and eroding public trust. The distance-to-frontier analysis revealed that several states need to more than double their coverage to regain previous levels.
Conclusions
Mexico’s experience highlights that health coverage gains are reversible without strong institutional foundations, political consensus and social legitimacy. Rebuilding and sustaining UHC requires deliberate efforts to address structural inequalities, strengthen institutions and restore public trust. For other low- and middle-income countries, this case emphasizes the urgent need for institutions restructured to foster adaptive capacity alongside equity-focused strategies to achieve and sustain UHC.
Universal health coverage (UHC) requires strong institutional capacity, equity-oriented policies, sustained political and financial commitment and public trust. However, public confidence in many health systems, including Mexico’s, has been chronically undermined. This study aims to document Mexico’s health coverage trajectory by offering a comprehensive, disaggregated and longitudinal assessment of insurance coverage from 2000 to 2023 – highlighting both achievements and setbacks in the context of UHC2030 goals.
Methods
This study used nationally representative data from Mexico’s National Household Income and Expenditure Survey (ENIGH) from 2000 to 2022, with projections for 2023. Households were classified into mutually exclusive health insurance categories on the basis of institutional affiliation. National and subnational trends in coverage were analysed, with attention to major reforms and disruptions. A distance-to-frontier metric quantified the gap between 2023 coverage and each state’s historical maximum, enabling assessment of progress toward UHC goals.
Results
Between 2000 and 2015, Mexico reduced the uninsured population from 55% to 6.2%, largely driven by Seguro Popular (SP) expansion benefiting Indigenous peoples, rural and low-income households in high-deprivation states. Following SP’s dismantling in 2019, the launch of Health Institute for Welfare (INSABI), and the COVID-19 pandemic, uninsured rates rose sharply to 29.1% by 2023. The greatest losses in coverage occurred in southern states and among marginalized groups, deepening territorial and social inequalities. The decline in mixed public coverage further reflects system fragmentation and eroding public trust. The distance-to-frontier analysis revealed that several states need to more than double their coverage to regain previous levels.
Conclusions
Mexico’s experience highlights that health coverage gains are reversible without strong institutional foundations, political consensus and social legitimacy. Rebuilding and sustaining UHC requires deliberate efforts to address structural inequalities, strengthen institutions and restore public trust. For other low- and middle-income countries, this case emphasizes the urgent need for institutions restructured to foster adaptive capacity alongside equity-focused strategies to achieve and sustain UHC.
Date Issued
2025-10-30
Date Acceptance
2025-09-16
Citation
Health Research Policy and Systems, 2025, 23
ISSN
1478-4505
Publisher
BMC
Journal / Book Title
Health Research Policy and Systems
Volume
23
Copyright Statement
© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/41168778
PII: 10.1186/s12961-025-01405-w
Subjects
Health Care Sciences & Services
Health insurance coverage
Health Policy & Services
Health system fragmentation
Inequalities in health coverage
Life Sciences & Biomedicine
Mexico
Science & Technology
Social protection
Universal health coverage
Publication Status
Published
Coverage Spatial
England
Article Number
145
Date Publish Online
2025-10-30