Mexico does not have a universal-access National Health System. The health system is highly fragmented among different institutions that provide services depending on affiliation. For those formally employed, social security and health services are provided by two institutions, the Mexican Social Security Institute (IMSS) for those in the private sector, and the Institute for Social Security and Services for State Employees (ISSSTE) for those employed in the national or state-level public sector. In addition, the Ministry of Health provides health services for those who are employed in the informal sector or those who did not accrue enough time in formal employment to be eligible to services at IMSS or ISSSTE.

Within all these sub-systems, services are organised and accessed within a gate-keeping system where people have access to primary care clinics with general or family doctors (equivalent to GPs) as the first point of contact. They conduct first assessments, diagnoses, and treatment and, when necessary, refer patients to specialist physicians, laboratory or diagnostic tests, and major procedures such as hospitalisation or treatments that are provided within a hospital setting.

All private services can be accessed at the point of service, irrespective of service needed such as diagnosis/care of specialist physicians, diagnostic tests, or hospitalisation. These services have to be paid directly to the provider through out-of-pocket payments or insurance policies where insurance companies cover the costs or reimburse the patient, depending on the plan they contracted.

All public (MoH) and social security institutions are based on a reference system (gatekeeping), where primary care units –usually named family medicine clinics—are the main point of access and where care is provided by primary care physicians. When needed, they refer patients to any laboratory or diagnostic tests.

In the private sector, access is mostly through specialist doctors, responding to a specific need –either from previous diagnosis or expected need. Since a change in legislation in the year 2001, a segment of the private sector that has significantly increased is the use of pharmacists who provide “health orientation” by General Practitioners (medico general) and have profited from the parallel sale of medications (Gutierrez et al., 2014).

References:

Gutiérrez, J. P., García-Saisó, S., Dolci, G. F., & Ávila, M. H. (2014). Effective access to health care in Mexico. BMC Health Services Research, 14(1). https://doi.org/10.1186/1472-6963-14-186