Mexico’s health system: far from Denmark

A hospital in Queretaro, Mexico. Image credit: Associated Press / Alamy.

By David Agren.

Former President Andrés Manuel López Obrador often trolled the country in his morning press conferences. One of his favourite trolls was insisting Mexico would have a health system on par with Denmark by the time he left office. He mentioned the Nordic country more than 40 times in his mañaneras. And he insisted at his final informe (state of the nation address) on 1 September that the public health system in Mexico “is not like Denmark, it’s better than Denmark.” He later insisted it was all a joke.

The joke was on Mexicans however. Health coverage slipped during his administration. Shortages of medicines were rife. The death toll soared during the pandemic as AMLO imposed austerity – while spending lavishly on prestige projects – and coronavirus czar Hugo López Gatell gaslit the public with an evening press conference. A series of calamities struck IMSS hospitals as patients were trapped and even crushed in lifts.

President Claudia Sheinbaum has promised to improve health outcomes in Mexico – without promising Danish outcomes or recognizing AMLO’s shortcomings. But the president’s first budget slashed health spending by 11 per cent, suggesting healthcare continues holding the same low priority as her predecessor.

Sheinbaum faces a budget crunch in 2025 as she confronts the hangover of AMLO’s pre-election spending binge. AMLO boosted social spending ahead of the 2024 election, boosting payments in his cash-stipend schemes for seniors. The payments proved popular as Sheinbaum claimed more than 60 per cent of the vote. 

AMLO’s spending binge left a budget deficit of nearly 6 per cent, however, which the 2025 budget aims to reduce. The 2025 budget doesn’t touch the cash stipend schemes, which Sheinbaum wants to expand. But it targets both health and education with cuts – showing the priority MORENA governments put on stipends over social programs.

“A left-wing government would have invested heavily in health. It would have been a basic priority,” Xavier Tello, a health policy analyst, said in a June interview. AMLO often boasted that Mexico was saving money, ostensibly by eliminating graft. But Tello compared the logic to a person not going to the grocery store: they would save money, but they wouldn’t eat. “They're saving or cutting money to use for something other than medicines,” he told The Lancet in 2021.

The underspending continues a trend in Mexico of both PRI and MORENA governments underspending on health. AMLO insisted that going after graft would radically improve the medical system. Analysts agreed. But they also pointed to the principal reason Mexico would never reach the level of Denmark: it spends little on health – just 2.9 per cent of GDP in 2023, lowest in the OECD.

“Mexico has chronic underfinancing,” said Octavio Gómez Dantes, a researcher in health systems at the National Institute of Public Health. “We’re well below the Latin American average.”

AMLO targeted graft in the bulk purchase of medicines. The purchase was carried out by the IMSS, but the attempt at replacing it through other parts of the government resulted in widespread shortages. Cancer patients in their families protested the shortage of life-saving medicines – drawing a rebuke from López-Gatell, who accused them of being pawns of right-wingers with “an almost coup-like vision.”

The former president also scrapped Seguro Popular, a health insurance scheme for people not receiving care through the social security systems. AMLO insisted it wasn’t “secure” nor “popular.” But it covered everything from checkups to organ transplants to HIV antiretroviral drugs. 

Its disappearance left 39.1 per cent of Mexicans without health coverage, according to a 2022 survey from CONEVAL. That represented a 16.2 increase from 2018. Equally troubling, 3·1% of Mexican households reported catastrophic health expenses in 2020, nearly double the number from two years earlier. 

Sheinbaum overlooked those shortcomings when introducing her health policies prior to the 2024 election. Her grab bag of policies included more nurses and homecare, better training and more prevention. It was all sensible stuff. But the proposal lacked a diagnosis of the situation confronting Mexico.

“They present themselves as the continuation of the 4T,” AMLO’s political project, Gómez Dantes said. “And in health, there’s a consensus that López Obrador’s health proposals were a disaster.”

Sheinbaum insists she’s spending more, saying Friday that more money is going into IMSS Bienestar, the successor to Seguro Popular. But the country still spends little on health – something that won’t change as the budget for priority cash-stipend schemes continue escalating.