The Servicio Universal de Salud (SUS) is the flagship initiative of President Claudia Sheinbaum’s government to centralize Mexico’s medical care into a single universal healthcare system. With a decree announced on April 7, 2026, this initiative has moved from promise to action and is already beginning to take shape.
This decision formalized the creation of a framework that will integrate the services of the Mexican Social Security Institute (IMSS), the Institute for Social Security and Services for State Workers (ISSSTE), and IMSS-Bienestar, the three institutions that form the backbone of public healthcare in Mexico. Together, these efforts plan to unlock healthcare access for 120 million Mexican citizens.
The central idea of the SUS is that citizens will be able to access medical benefits, institutions, and professionals across the entire system, regardless of their affiliation and employment status. In practice, this means that patients—whether enrolled in IMSS, ISSSTE, or IMSS-Bienestar—will have the right to receive care in any public facility, with continuity of treatment and access to specialized services.
The goal is to overcome the historical fragmentation of Mexico’s health system and move toward a centralized universal coverage, where institutional affiliation no longer acts as a barrier and care is organized around medical needs.
“The real challenge lies in how to structure it legally and ensure that financing follows the person.”
Mexico’s public health system is sustained through a combination of financing sources. The IMSS relies on tripartite payroll contributions from workers, employers, and the federal government; the ISSSTE operates under a similar framework, with contributions from public servants, government agencies, and federal support. IMSS-Bienestar, aimed at the population without social security, depends primarily on federal resources channeled through the Health and Wellbeing Fund (Fonsabi).
Together, these institutions reflect a mixed model that combines labor and employer contributions with fiscal transfers, seeking to guarantee universal coverage across different segments of the population.
Brazil as Inspiration
“The idea of a universal health system is conceptually correct because it allows for better use of resources—patients could access equipment and services available in any institution, regardless of affiliation. The real challenge lies in how to structure it legally and ensure that financing follows the person, rather than the person being tied to their contribution,” said Héctor Valle Mesto, executive president of Fundación Mexicana para la Salud (FUNSALUD), a leading Mexican think tank and nonprofit dedicated to health policy, research, and innovation.
In an interview with NPQ, Mesto emphasized the need for strengthening within the health system, recognizing that primary care should remain public but that there are areas where the private sector can play a supportive role. The goal, he noted, is to make the most of this collaboration for the benefit of the population.
The construction of this new national health system draws inspiration from Brazil’s Sistema Único de Saúde, largely regarded as one of the largest free public healthcare networks in the world.
Created in 1988 following Brazil’s new Constitution, Brazil’s system guarantees universal and free access to medical services, ranging from primary care to specialized treatments, and has become an international benchmark for its ability to integrate hospitals, clinics, and preventive programs under a single framework.
“[It] is a major global example, developed on the basis of principles such as universality, comprehensiveness, and equity, which guide the Brazilian government and are fundamental to the success of healthcare for the population,” Fernanda De Negri, secretary of Science, Technology, and Innovation in Health at the Ministry of Health of the Republic of Brazil, said in an interview with NPQ.
She added that, for organizing a large-scale health system, guidelines such as decentralization, regionalization, and social control are essential and can be replicated in countries in similar size to Brazil.
When it comes to exporting Brazil’s experiences to more fragmented health systems, De Negri explained that challenges include integrating different subsystems, expanding equitable access to services and technologies, strengthening institutional and governance capacity, reducing regional and social inequalities in access to health, and developing a productive and technological base that contributes to health sovereignty.
International cooperation seeks to address these challenges through the exchange of experiences and the joint development of capacities.
History of the Project
President Sheinbaum’s project revives an objective first pursued under her predecessor, Andrés Manuel López Obrador, who sought to universalize healthcare.
In 2019, López Obrador replaced the Seguro Popular with the Institute of Health for Wellbeing (Insabi). The Seguro Popular, created in 2004 during Vicente Fox’s administration, had been one of the most ambitious efforts to expand healthcare coverage in Mexico. At its peak, it covered more than 50 million Mexicans and reduced out-of-pocket health spending—a significant achievement in a country marked by deep inequalities.
Gustavo Leal Fernández, a professor and researcher at the Universidad Autónoma Metropolitana (UAM‑Xochimilco), and an expert in public health policy and social security, explained in an interview with NPQ that the arrival of the Morena Party and President López Obrador in 2018, did not immediately create a new system. Instead, what emerged was an unfinished project, one that has continued under President Sheinbaum and is marked by a recentralization of the health sector.
“During the neoliberal period (1982–2018), two decisions were made that proved extremely costly for the health sector. The first was the decentralization process, which worked very poorly because it was carried out under conditions of economic austerity,” he said.
There are still problems, such as the lack of medical professionals in rural areas and the difficulty in obtaining certain medications.
Criticisms sealed the old system’s fate: territorial disparities stemming from decentralized resource management, a limited focus on hospital and curative care at the expense of prevention, chronic underfunding that never reached internationally recommended levels, allegations of corruption, and systemic fragmentation due to its coexistence with IMSS and ISSSTE, which led to inefficiency.
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During López Obrador’s administration, Insabi also faced serious challenges and was eventually replaced by IMSS-Bienestar.
“Health House by House”
The Mexican government now seeks to replicate Brazil’s experience by consolidating all medical records of all Mexicans into a centralized system. This means committing to a model that prioritizes equity and universality, while also confronting the challenges of financing, inter-institutional coordination, and long-term sustainability.
Arturo Contreras Camero, a Mexican journalist specializing in health issues, told NPQ that the Sheinbaum administration’s proposal “is not actually a reform, since no reform is currently underway. In legal terms, what exists is a presidential decree aimed at creating a universal health system. In that sense, there is no legislative process involved.”
But Camero added that this presidential decision represents a historic shift that is “a 180-degree turn from what had been done and from the health policy trend that had been imposed in the country since, I’d say, the 1980s or 1990s, even the early 2000s. It was all about privatization, about letting the State step back from public health and leaving that space to private companies, turning it into a major profit-driven sector.”
He explained that today there are still problems, such as the lack of medical professionals in rural areas and the difficulty in obtaining certain medications. “During the previous administration, there was an attempt to involve the Pan American Health Organization, which has a consolidated purchasing scheme and can provide advice on which companies to buy from and where, but it didn’t work very well. They weren’t able to solve this issue,” he said.
But Mexico’s cooperation with Brazil has opened the door to an exchange of technical and managerial expertise that could accelerate the transition toward a more efficient and accessible system.
In August of 2025, Mexico and Brazil signed two memorandums of understanding in the field of health. The first seeks mutual recognition of regulatory capacities, faster harmonization of health records, facilitation of clinical research, and certification of pharmaceutical plants even in third countries.
The second focuses on cooperation in the production of vaccines and active pharmaceutical ingredients, with the aim of boosting local production of strategic medicines and strengthening regional health sovereignty. A bilateral Mexico–Brazil health committee was also established, meeting monthly to monitor progress and ensure that commitments translate into concrete results.
“Mexico and Brazil share a similar vision in recognizing health as a constitutional right, which is a positive foundation. Yet both countries face major challenges in financing and deep territorial inequalities. Brazil has advanced further in primary care through its community health agents and Family Health strategy—a model that achieves genuine territorial presence within local communities,” said Mesto.
He explained that Mexico is now developing an initiative called “Salud Casa por Casa” (health house by house), still in its early stages. The program aims to bring medical services directly to people’s homes, especially 65-plus adults and those with disabilities. Once teams begin visiting households, the initiative often reveals unexpected health conditions that require immediate attention.
On this matter, Fernández told NPQ that Mexico no longer has a strong prevention policy as required by primary health care, one focused on the absence of disease rather than on traditional measures that merely address existing damage. He stressed that the system lacks a genuine strategy for community work outside the health sector aimed at preventing the onset of illness.
The system will ensure that patients can remain within the same institution throughout the entire treatment cycle of complex diseases.
Stages of the Plan
Implementing a single healthcare model also raises questions about how to adapt a framework designed for a country of over 200 million inhabitants. In reality, Mexico is marked by regional inequalities and a healthcare infrastructure still in the process of integration.
The Ministry of Health’s plan envisions several stages. The first includes ensuring that high-risk pregnancies, heart attacks, strokes, and breast cancer can be treated in any health unit, while guaranteeing continuity of care for conditions such as cancer and kidney failure within the same hospital, and universalizing vaccines across all public hospitals.
The second stage, scheduled for the second half of 2027, foresees the exchange of specialized services between institutions—such as laboratories, imaging studies, and radiotherapy—with the goal of speeding up diagnoses and making better use of available resources. According to Deputy Minister Eduardo Clark, the system will ensure that patients can remain within the same institution throughout the entire treatment cycle of complex diseases.
The third stage, planned for 2028, will expand universalization through prescriptions valid in any institution, referrals to specialized consultations, and standardized primary care for chronic diseases such as diabetes.
The plan also includes the Universal Health Service credential, designed to register all Mexicans. The registration process, launched in March 2026, will continue throughout the year and provide access to a mobile application to check eligibility and available health units. A second update, scheduled for 2027, will add features for appointment scheduling, digital medical records, and teleconsultations.
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