Mexico has a population of approximately 112 million individuals, 75 per cent of which may be considered urban population, and whose life expectancy has increased from 34 years in 1930 to 76 years in 2016 and is expected to increase slightly again this year.

This fact, among others, leads to specific risks and health requirements particular to urban populations, which are prone to non-communicable sicknesses, diseases and accidents, rather than the infectious and diet-related diseases that are more common in rural communities, where there is less access to basic infrastructure and services.

This situation means a great challenge to the Mexican government in terms of rendering and regulating health services for an older population.

The Mexican government has acknowledged in several official documents the relevance of health as a fundamental human right and the obligation of the state to provide extensive healthcare to all individuals in the country – a situation that is, in reality, far from the official position of the authorities.

The Mexican Federal Constitution (the Constitution) establishes health as a fundamental right and provides the basis for the government to enact provisions regarding, inter alia, health services and medical attention.

The main law regulating these matters is the Mexican General Health Law (the Health Law) and its implementing regulations, which establish health services as a matter of public policy and interest subject to sanitary control.

The authorities in charge of health and medical-related services include the President of Mexico, the General Health Board, the Ministry of Health (MoH) and state governments, among others.

The MoH, through the Federal Committee for Protection from Sanitary Risks (COFEPRIS), has the broadest jurisdiction regarding the control and supervision of these services and activities.

The Constitution also provides the executive branch with authority to issue regulations that clarify, or specify details of, existing laws passed by Congress, including, in particular, the Regulations on Rendering Medical Services (the Services Regulations), the Regulations on Health Research Matters and the Regulations on Publicity Matters (the Publicity Regulations), as well as provisions governing the National Institute of Social Security (IMSS), the Social Security Institute for Governmental Employees (ISSSTE), and the Public Administration Organic Law, among other legal provisions.

Additionally, medical and health-related services are also subject to Official Mexican Standards (NOMs), administrative guidelines establishing technical specifications and characteristics for premises, systems, activities, methods, etc.

Provisions governing these services also include official communications and guidelines issued by the health authorities, which may or may not be published in the Federal Official Gazette.


i General

Health services can be classified into two main sectors: public and private.

Within the public sector, the most relevant health institutions are the IMSS and ISSSTE, together with the Mexican Armed Forces (SEDENA) and the Navy (SEMAR) medical services and facilities, the MoH hospitals and clinics, and local state authorities.

The private sector includes hospitals and clinics, independent services providers, private and independent medical personnel and health professionals, and to some extent, insurance companies.

The population groups entitled to medical and health services may be divided into three main groups:

  1. formally employed workers and their families;
  2. self-employed individuals, private practitioners, informal employees, unemployed individuals and other individuals not considered part of the formal employment group subject to social security; and
  3. individuals choosing to use independent health services.

The people in the first of these groups, whether in the public or private sector, are entitled to social security services. These services currently cover a considerable percentage of the Mexican population.

The second group has traditionally been dependent on health services directly provided by the MoH on a public assistance and welfare basis, as well as services provided under the Popular Insurance Programme (PIP), a programme developed to provide health services for specific diseases to those outside the first group.

The third group will normally use private medical insurance and health services through direct payment, without depending on the state's social security structures.

During the past couple of years, particular attention has been given to the development of telemedicine services, which, although not well regulated, have offered the possibility of extending better medical and health services to individuals living in isolated communities, as well as to incarcerated individuals. These telemedicine services are operated not only by the MoH, but also by the IMSS, ISSTE, SEDENA, and PEMEX, the Mexican state-owned petroleum company.

ii The role of health insurance

Insurance is compulsory to users of healthcare services who are employees, as employees, together with their employers, must contribute certain amounts to the public institutions that provide health services (the IMSS or the National Workers Housing Fund Institute (INFONAVIT)).

Health services generally provided by the IMSS and INFONAVIT include:

  1. health and maternity insurance;
  2. work-risk insurance;
  3. retirement and old-age insurance;
  4. social welfare; and
  5. other health-related insurance.

Individuals not considered 'workers' for purposes of compulsory insurance may voluntarily request an affiliation to the IMSS that may provide them with partial health and maternity insurance.

Individuals not enrolled in the above institutions may be subject to the PIP, which provides only specific health-related services (including some surgical procedures) and drugs and medicines required by patients.

Those sections of the population not covered by any of the above programmes or medical protection may receive some basic and emergency health services from federal or local agencies.

Individuals covered by private insurance are subject to the benefits and coverage contracted and agreed with the insurance company.

iii Funding and payment for specific services

Health services rendered by these institutions are financed through the social security contributions paid by the employer and the employee.

For individuals covered by ISSSTE, SEDENA and SEMAR, the employer is the government itself, whereas in the case of private individuals and entities, part of the contribution is paid by the employer and part by the employee.

Other health services may be funded by direct budget from the federal or local governments and through 'fees' collected from the users of such services.

In the case of private parties rendering these services, funding is obtained either through direct charging of services or through payment by insurance companies on the terms and for the amounts agreed.

Public health coverage only extends to those areas of healthcare formally specified as being within the scope of the public institutions. Concepts such as 'wellness' and 'alternative health therapies' are outside the scope of the services provided by these institutions and, although not formally forbidden, in most cases they are not recognised nor do they receive public approval or coverage.


There are approximately 25,000 premises registered to provide health services, of which approximately 4,500 are hospitals (1,200 public institutions and 3,200 in the private sector).

Access to health services in private hospitals and institutions is subject to the contractual obligations established by the parties giving and receiving the services, with the competent governmental agencies only responsible for regulating the premises and the characteristics and quality of the services.

Exceptions to the above may be made in very rare cases, such as disaster situations or medical emergencies. However, such exceptions must be formally established by the appropriate governmental entities.

Accessing essential health services from public institutions is a cumbersome and time-consuming process.

With the exception of services provided by SEDENA and SEMAR, most public agencies require preliminary medical review at the hospital or clinic corresponding to the individual's registered domicile, and on the basis of the review a physician determines whether he or she can provide the applicable treatment and medicines or whether the patient requires specialist analysis, tests or procedures. If necessary, the patient will be required to schedule visits to specialist doctors or laboratory or analysis procedures, which can take months to complete.

This system is inefficient and time-consuming, resulting in delays in the provision of required treatment and medicines, and this has a direct impact on patients' health. Because of the lack of proper infrastructure and equipment, it is not possible to render the required services in all premises operated by public institutions, making it necessary for patients to travel to access services in premises at a distance from their domicile or in Mexico City. Further issues in this regard have arisen under the new administration following its general budgetary reduction, affecting health services and other areas.

Public institutions professionals are restricted in the scope of their activities by three main legal bodies: the Health Law, the Services Regulations and the Professional Practice Law. However, these are further clarified through internal regulations, procedures and structures implemented by each specific institution.

It should be noted that public and private health institutions are heavily regulated, and are only authorised to carry out the specific services and procedures included in the corresponding licences and authorisations, thus it is not possible, for example, to carry out clinical analysis at premises lacking that specific authorisation.

These authorisations and licences are only issued subject to the specific formal procedures for applications submitted to COFEPRIS or other competent authorities.

Among the relevant regulated activities are nursing services, general medical services, surgery procedures, medical procedures involving radiation sources, health services entailing investigation, psychiatric-related services, dental services, medical consultation, laboratory and medical samples, and organ and tissue preservation.

The specific technical requirements and conditions for the provision of these services are generally established in NOMs rather than in laws or regulations, and may vary greatly.

There are special legal provisions on confidentiality and privacy protection (set out in NOM-004-SSA3-2012) regarding clinical records and information obtained in the course of the provision of health services; however, in practice, many of these are unlikely to be enforced on account of a lack of necessary administrative infrastructure.


i Regulators

The federal government, through the MoH and COFEPRIS, implements, coordinates, certifies and controls all human health-related matters.

Among the MoH activities is strategic planning of the health services, health priorities determination, coordination with different governmental bodies, health attention regulation and supervision, and evaluation of services, programmes, policies and systems, etc.

COFEPRIS is the specific authority in charge of regulating and controlling any sanitary or health risks, including those related to premises, services, activities, tissue disposal and organ transplants, as well as issuing the necessary licences, authorisations or certifications required for rendering health-related services.

Sometimes, these authorisation or certification activities may be executed together with other governmental bodies, non-governmental organisations, educative institutions, civil organisations, etc.

These services regulations include mechanisms and structures to certify education centres imparting medical, nursing, therapy, rehabilitation and other health-related education.

Certification of health professionals is controlled by the education institutions providing this knowledge, as well as the Public Education Ministry through its General Professional Practices Directorate.

Generally, health professionals must have a degree issued by a recognised education centre, and a federal professional practice licence issued by the Directorate. Additional certifications may be issued by specialised organisations coordinated by the National Academy of Medicine and the Mexican Surgery Academy.

Most of the approximately 80 medical schools in Mexico are associated with the National Association of Medical Faculties and Schools of Medicine, and around half of them are recognised by the Mexican Council for the Accreditation of Medical Education; although not authorities themselves, these institutions are recognised as being qualified to certify the quality of medical education.

Similarly, the certification of nursing and related practices is the responsibility of the Mexican Council of Nursing Certification.

In the case of institutions, operating licences and authorisations are governed by COFEPRIS based on the specific provisions of the Health Law and applicable NOMs.

Premises certification and authorisation is subject to compliance with technical and formal requirements established by NOMs and the criteria and requirements stipulated by COFEPRIS.

ii Institutional healthcare providers

Under Article 34 of the Health Law, rendering of health-related services requires a licence or authorisation according to the type of services rendered or premises operated. In other cases, such as private practice and consultation premises, it is only necessary to file a premises operation notice.

Generally, formal licences and authorisations are required for premises where some sort of technical activity is rendered, for example, analysis laboratories, rehabilitation centres, premises where surgical procedures are rendered and premises where x-ray or similar technologies are operated.

Possibly some of the most complex authorisations and heavily regulated services are those concerning cosmetic surgery and other kinds of procedures not necessarily related to diseases or medical conditions, but which present a clear health risk for individuals receiving these services. Currently, a Sanitary Alert regarding premises where cosmetic procedures are carried out has been issued by COFEPRIS, and over 250 premises where these kind of services are rendered were subject to administrative procedures bound for their foreclosure.

Although the authorisation and licensing procedures for the operation of specific premises appear clear and straightforward, in practice, a considerable number of issues are left to the personal perception of governmental officials, which can lead to practical complications in securing these authorisations, as well as raising the possibility of corrupt acts.

The general rule is that these licences and authorisations may be secured by filing the corresponding application, paying the applicable federal or local government fees and demonstrating compliance with the technical and formal requirements, and they may be subject to inspections and on-site visits.

Licences and authorisations may be revoked or suspended by the health authorities if the corresponding requirements fail to be met during the course of the operation of the premises, or if it is determined that the operation of the premises may present a sanitary risk to the population.

In all cases, these revocation or suspension procedures are subject to the formal requirements for verification procedures set out by the Health Law and its implementing regulations and the Federal Law on Administrative Procedures; essentially this implies the formal service of notice of a review, including the scope of the review, authorised officials, preliminary determinations, preliminary arguments and evidence provided by the party under review, and upon conclusion of the review a final resolution issued by the authority.

Any party affected by an unfavourable decision issued by the competent health authorities may, as a general rule, file an administrative appeal with the same authority that carried out the determination, or file a nullity petition with the administrative court of justice. In very specific cases involving direct constitutional provisions, it is possible to file a constitutional remedy or amparo petition.

These alternatives present specific challenges and requirements and their filing will greatly depend on the nature of the resolution, imposition of fines and penalties, and particular issues of the resolution.

Pursuant to the Health Law Articles 373, 375, 419, 420, et al., failure to secure the applicable licence or authorisation, or to file the corresponding notices, may result in penalties ranging from temporary to definitive closure of premises, and fines ranging from approximately US$8,000 to US$25,000.

In some cases, operating and providing services without the proper or required licences and authorisations may also constitute a criminal offence subject to criminal procedures under the Federal Criminal Code.

iii Healthcare professionals

In principle, the authorisation and licensing of health and medical professionals are conditional on presentation of corresponding degrees or titles issued by duly authorised educational institutions or third parties recognised by the MoH and COFEPRIS as entitled to certify professional capability in health-related matters.

Under Article 79 of the Health Law, individuals exercising professional activities related to medicine, dentistry, biology, bacteriology, infirmary care, social work, chemistry, psychology, nutrition, pathology and other related professions require a degree recognised by and duly registered with the education authorities when health or medical-related activities are carried out by those individuals.

Similarly, the exercise of technical and auxiliary activities that require specific knowledge related to medical care, dentistry, clinical laboratory, infirmary care, physical therapy and rehabilitation, prostheses, orthopaedics, biostatistics, pharmacy, etc., is also conditional on possession of a relevant degree issued by a recognised institution.

Individuals carrying out these activities without the proper certification or degrees may be subject to fines and imprisonment under Article 250 of the Federal Criminal Code.

Under Mexican law, it is not necessary for these individuals to have professional or malpractice insurance. However, in view of recent developments regarding damages arising from negligence and malpractice, this kind of insurance is being more commonly implemented and contracted.

Some healthcare-related services may be carried out by non-professional individuals, on the general condition that they do not appear or present themselves as professionals. In addition, there are specific exceptions, such as traditional medicine practitioners and similar practices.


i Overview

Under Mexican law, there is no specific procedure or system for the compensation of possible injuries or damage arising from improper or incorrect medical services and procedures.

Individuals affected or harmed by a medical procedure or service may file a lawsuit (ordinary civil procedure) to request the compensation of damages.

Until recently, only direct damages could be requested; however, recent jurisprudential criteria have raised the possibility of affected parties filing for punitive and consequential damages, as well as moral damages arising from medical negligence and malpractice.

In 1996, the National Commission for Medical Arbitration was created, the main purpose of which is to solve, in an amicable manner and in a process undertaken prior to judicial procedures, disputes between medical services suppliers and patients However, from a practical perspective this option is generally ignored or proves ineffective in achieving settlements.

From a criminal perspective, medical negligence may result in a number of possible criminal offences, ranging from physical harm all the way up to murder.

ii Notable cases

Because of social media and technology, a significant number of cases regarding medical negligence and malpractice in public health institutions have recently been brought to public attention, and have been analysed by institutions responsible for protecting human rights through the applicable mechanisms (the National Human Rights Commission and local human rights civil organisations).

These cases include the denial of childbirth health services to individuals not formally registered with the IMSS or other institutions, the denial of health services to the indigenous population or poor or homeless individuals, incorrect limb amputations, incorrect organ removals and violations of privacy of patients through exposure on social networks.

Although health professionals involved in these situations have argued that in most cases there is no malpractice or negligence, the fact is that there is a greater awareness of these situations and a greater interest by the public and diverse governmental institutions in controlling or, even better, eradicating them, and in securing assurances that they will be resolved satisfactorily and will not be repeated.

Although these situations have been politicised, from the evidence available from most cases of this type, it has been determined that actual malpractice or negligence by health professionals is not uncommon in public institutions.

In this context, there has been a trend for the award of punitive and moral damages to the victims in these situations, and for direct punishment of both the individuals responsible for the malpractice or negligence and the institution.

On the other hand, doctors and other health professionals have staged a series of demonstrations about political involvement in health-service matters and lodged complaints regarding the poor or limited technical and logistical resources in several governmental health institutions, including lack of personnel and equipment, lack of formal processes, lack of opportunities, and extremely low wages and salaries.


Ownership of a healthcare business is not restricted to a specific kind of legal entity or individuals holding specific degrees or similar qualifications, nor on the basis of nationality, financial viability, etc.

The ownership of the business itself is not restricted or regulated; however, as noted above, the technical characteristics and conditions of the premises where services are rendered, as well as the technical qualifications of the individuals rendering the services, are subject to certain conditions and requirements.

It should also be noted that the option exists for health professionals holding titles and degrees in other countries to provide services in Mexico – and this is most often seen in relation to, for example, the provision of cosmetic procedures, with medical tourism a booming industry in some parts of the country.


Procurement of health services is generally carried out by governmental entities responsible for the provision of the services, directly or indirectly. The procurement and, when it occurs, the bidding procedure are carried out directly by the entity or institution requiring the services.

These processes may be on a federal, local or, in some cases, municipal basis, with the most relevant provisions being those included in the Federal Law on Acquisitions, Leasing and Services of the Public Sector.

Under this Law, participants in a public procurement or bidding procedures are required to file a technical and an economic proposal that will be assessed and, as the case may be, result in an award.

Under this Law, the kinds of public procurement may be diverse, including national and international goods and services procurement procedures.

In some very isolated cases, the procurement procedures may be restricted to three or more specific suppliers; however, the procuring entity must justify the imposition of a limit on the number of participants.

Finally, in some specific cases, including cases of national security or emergencies, governmental agencies may carry out the services procurement by direct assignment.

It is worth noting that in cases of national services procurement processes, legal entities resident in countries with which Mexico has entered into a free trade agreement may participate and be considered domestic suppliers, if the corresponding agreement has specific clauses to this effect.

In this context, the entry into force (in June 2017) of the new national anti-corruption system and provisions may result in the introduction of new anti-corruption clauses and conditions into the requirements for public procurement and tenders. Developments of this kind would be of particular relevance for entities providing services to public health institutions in Mexico given the scale of the service provision required and the practical implications of monitoring this provision.

Although no new legal provisions regarding the public procurement of goods have been enacted, very important policies and practical measures have been implemented by the Mexican authorities in this area. Many of these policies and practical measures are, to say the least, contrary to the existing provisions regarding public procurement. A considerable number of acquisitions of medical devices, services, pharmaceutical products and other goods related to health services have been approved under the 'exception' categories of the applicable laws; these exceptions include the use of restricted invitations to tender, and the direct assignment of goods and services.


The rules regulating the advertising of health-related services are far less restrictive than those regulating the advertising of pharmaceutical products and medical devices; however, this marketing and promotion must meet specific requirements and controls established in the Publicity Regulations.

The concept of 'publicity' for health-related matters included in the above Regulations is defined as any activity that includes all creation, planning, playing and broadcasting processes of advertisements in communications media with the purpose of promoting the sale or consumption of products or services.

Under the Health Law, there is a difference between publicity intended for health professionals and publicity intended for the public at large.

Publicity intended for health professionals covers information regarding characteristics of services, procedures and scientific information used for publicity or promotional purposes but restricted to specialised media given to health professionals.

Publicity intended for the public at large is more restricted under the Health Law, and, in general, requires specific licences and authorisations prior to the actual broadcasting or publication of such publicity.

Although the existing provisions are specifically applicable to publicity for goods and products rather than services, the general principles regarding the availability of scientific information and hard data supporting the publicity's claims are also applicable to publicity for services.


Health is a major concern for the Mexican government, and not only because of the number of individuals in the country and costs associated with it.

Owing to a lack of necessary human and economic resources, the government implemented various programmes to provide the greatest possible number of services to the greatest amount of the population under the most cost-efficient structures; many of these programmes have recently been repealed or restructured following the new administration's focus on costs and budgetary restrictions, many of which have had a direct effect on health programmes for specific conditions and diseases.

Health services face a considerable number of challenges and how they tackle these will greatly depend on the availability of necessary funding and efficient expenditure by the authorities. Considering the general policies being implemented, with drastic budgetary cuts to governmental expenditure in all areas, including those related to health services, it will be a very challenging year for this sector; these new policies have similarly difficult implications for the practical acquisition of human health-related goods and services.

The main purpose of many of these programmes was to render services to the poorest and most isolated communities in the country. However, it now seems possible that the procedures and technologies that were to be introduced as a result of these programmes will not be implemented at least for several more years.

The use of many of these technologies – which formed part of the National Digital Strategy undertaken by the executive branch of government since 2014 to facilitate the introduction of more efficient and responsive procedures, including by means of remote access – will most likely be left until a future time.

Many of the COFEPRIS online projects (which have the potential to replace up to one-third of the various traditional formal written procedures with electronic filing) may be delayed or possibly cancelled.

As a consequence of the aforementioned new anti-corruption laws and the federal government's strategies and policies regarding reduction of expenses, the business structures implemented by most companies engaged in governmental sales and the provision of services will have to undertake substantive reviews and implement new mechanisms. Because a considerable number of services that would have been outsourced or procured from private entities are likely to be dispensed with, this will be of particular relevance to the health services industry, especially for entities providing services directly or indirectly to governmental entities or other entities subject to these kinds of controls.

Diabetes, one of the most common and direct consequences of obesity, has seen constant and very fast growth in Mexico and represents one of the largest health costs for the Mexican authorities. Close to 10 per cent of the Mexican population has some degree of diabetes, among the highest percentages in the Organisation for Economic Co-operation and Development (OECD) countries.

According to MoH data, in 2013, 55,992 people died from type 2 diabetes and during the same period 148,681 died from cardiovascular diseases. These developments produced serious concerns regarding obesity, lack of access and inequality, among others, and prompted moves to tackle the population's health problems through better regulation of the health services industry. This is possibly the greatest challenge in health matters that the authorities will face in the coming years.

Obesity and diabetes are considered an epidemic in Mexico, affecting 33 per cent of the child population and at least 72.5 per cent of the adult population according to the National Institute for Public Health. As this is such an epidemic, the authorities and private sector have implemented programmes to prevent obesity and being overweight, including the National Strategy for the Prevention and Control of Overweight, Obesity and Diabetes (ENPCSOD). ENPCSOD aims to change processes and principles within the public health services, and improve health and hygiene through the promotion of healthy lifestyles and education campaigns and by monitoring medical conditions associated with this problem. Other ENPCSOD measures include federal education reform regarding nutrition in education institutions, an increase in the population's physical activity and sports, the creation of specialist centres for the care of diabetic patients, and the implementation of a 'nutritional quality' stamp for food products of a high nutritional quality.

Notwithstanding the significance of obesity and diabetes in the general context of national health, several of the programmes for its prevention and treatment have been cancelled or put on standby by the federal government subject to assessment of previous programmes and their results to determine whether these were properly implemented by prior administrations.

Various diabetes-related centres dealing with internal medicine, psychology, nephrology, cardiology, ophthalmology, nutrition, etc. that were opened throughout the country to provide free advice and treatment to individuals with diabetes have been closed or their services cancelled by the new administration.

The private sector has also participated in these efforts through the creation of the Nutrition Health Alliance, which has proposed specific actions for inclusion in a General Law against Overweight and Obesity to introduce special programmes and key policies in this area.

As regards rare diseases, Mexico now has 24 hospitals authorised for treatment of 14 of the most common of the 7,000 illnesses considered worldwide to be rare diseases.

According to the Pan American Health Organization, the most urgent threats presented by infectious diseases and illnesses include dengue and Zika, which are still present in Mexico because of its geography, with vast regions suitable for mosquito reproduction, and the lack of health services and absence of preventive action.

During 2016, 19,510 cases of dengue were confirmed in Mexico, with 19 subsequent deaths. Zika has also been a particular concern in view of the risks of microcephaly in babies that the virus presents for pregnant women. The number of pregnant women formally registered as having this virus during 2016 was 3,669.

The reported number of chikungunya cases was 722 during 2016, according to the Pan American Health Organization.

According to the OECD, Mexico suffers from significant inequality and lack of access to health systems, which together with inadequate preventive action has led to the lowest life expectancy of all OECD countries.


While health is one of the most important human rights enshrined in Mexican law, it represents an area of very significant cost and presents challenging issues of public policy for the government to consider.

From a strict legal perspective, a very detailed and robust regulatory regime has been implemented in connection with the rendering of services that may affect health and well-being in any manner; however, from a practical perspective, very significant constraints exist for the authorities in relation to the human and monetary resources required to correctly implement and enforce these regulatory provisions.

Corruption is a major issue when dealing with authorisations, licences and similar issues in connection with health services because of the position of the authorities, and in many cases, the lack of public information regarding the position or rules of application of the applicable provisions by the authorities.

Obesity and diabetes are among the most pressing national health concerns and are thus a primary focus of the health authorities, from both a direct and an indirect perspective. Furthermore, although they are particularly focused on the services and processes that attend these conditions, the authorities' emphasis tends to be more punitive than preventive.

The formal authorisation of certain substances, such as THC and plant derivatives, to be used as recognised medicines or legal drugs will probably present an important challenge for the authorities regarding the therapeutic application of these products and the provision of related services.

Very significant changes to policies on the provision of health services and related activities will have direct effects on the population that uses public health services, as the sums originally budgeted for expenditure on particular programmes tackling the most socially pressing conditions and diseases have either been cancelled, put on standby or considerably reduced. This situation that will have a direct economic effect on the health of the considerable number of Mexicans who depend on public health services.


1 José Alberto Campos-Vargas is a partner at Sánchez Devanny.