Transition from Seguro Popular to INSABI: What Changed?
Why Seguro Popular Ended
Seguro Popular was created in 2004 to provide healthcare coverage to Mexico’s uninsured population – those without access to IMSS or ISSSTE systems. It was a semi-decentralized model where the federal government provided funding, but states executed the delivery of services. Initially, it expanded access to millions, offering packages for basic and catastrophic care. But over time, its limitations became too severe to ignore. Funding was irregular and unevenly distributed, leading to dramatic differences in care depending on the state. Clinics in rural areas lacked staff and basic equipment. A 2018 audit by the Superior Audit Office of the Federation found major financial discrepancies – over 11 billion pesos unaccounted for. Reports of unfilled prescriptions, fake patient records, and unusable infrastructure mounted. The system became more about paper coverage than actual services. By the time the López Obrador administration took office, Seguro Popular had lost public and institutional confidence. The government argued that it perpetuated inequality rather than fixing it – and made the decision to dismantle it completely.
What INSABI Promised Instead
INSABI (Instituto de Salud para el Bienestar) launched in January 2020 as the flagship reform to replace Seguro Popular. Its vision was grounded in a rights-based model of healthcare: free, universal access for all Mexican residents, regardless of their employment status or income. No registration. No insurance cards. No premiums. The federal government would centralize control and take direct responsibility for service delivery, aiming to eliminate the inefficiencies caused by state-level intermediaries. INSABI promised access to primary and secondary care, medications, diagnostics, surgeries, and even specialized services, all without cost. It positioned itself not just as a system but as a public guarantee. The new model aimed to shift away from fragmented financing toward integrated care – especially for the most vulnerable.
How the New System Actually Works
The transition to INSABI, however, was fraught with complications. Removing Seguro Popular’s infrastructure without building a robust alternative led to major operational vacuums. INSABI was rolled out before a formal institutional structure was fully in place. The result was chaos in some areas. Several states refused to sign federal coordination agreements, keeping control of their budgets and operating parallel systems. In these states, INSABI remained a nominal presence. Even in participating states, lack of standardized protocols, shortages of medical supplies, and unclear funding mechanisms caused breakdowns in service delivery. Hospitals were unsure how to bill for services. Patients arrived expecting free care but were asked to pay out of pocket. Without a digital system to track patient histories or services rendered, transparency and accountability suffered. The centralization of services also resulted in delays in procurement and hiring, worsening pre-existing bottlenecks.
What Patients Are Saying
Public response to INSABI has been deeply mixed. In urban centers with large, well-funded hospitals, some patients have seen real improvements – no paperwork, no payments, and more streamlined visits. But in many parts of the country, particularly in remote areas, access remains unreliable. Patients report waiting months for specialist appointments or essential surgeries. Many continue to purchase their own medications due to persistent shortages. For individuals who previously had Seguro Popular cards and some form of orientation, the abrupt removal of that framework created uncertainty. They didn’t know if they were still covered, what hospitals accepted INSABI, or whether prescriptions would be honored. The promise of free healthcare was compelling – but for many, it did not match their lived experience.
What Doctors and Clinics Are Facing
Clinicians and healthcare administrators were among the hardest hit by the transition. The dismantling of Seguro Popular’s administrative systems meant that hospitals and clinics had to adapt without updated guidelines, budgets, or systems to track performance. Procurement processes for medications and equipment centralized in Mexico City caused delays in local distribution. Without state-level autonomy or clear communication from the federal government, facilities struggled to maintain continuity of care. Many medical professionals were left with questions: Which services were covered? Who paid for them? How should referrals be handled? The absence of digital tools for data management and patient tracking only worsened the confusion. Doctors also expressed concern about the sustainability of free services without a solid financial model. And while some frontline workers supported the philosophy of universal access, they lacked the tools to implement it effectively.
Was the Change Worth It?
The transition from Seguro Popular to INSABI was rooted in strong ideals: eliminate corruption, end inequality, and create a truly public health system. But the execution revealed a gap between vision and operational readiness. While Seguro Popular had its faults, it had built a network, rules, and a functioning, if imperfect, bureaucracy. Replacing it overnight without a phase-out period or contingency plans disrupted care for millions. For patients, outcomes have been uneven. Some receive more comprehensive care; others face longer waits and more uncertainty. For providers, the system introduced new burdens without new support. Critics argue that the lack of planning undermined the entire transition, while defenders say reform of this scale takes time and cannot be judged within a few years. What’s clear is that INSABI represents a dramatic shift in Mexican healthcare philosophy – but whether it will succeed in practice depends on political will, administrative reform, and long-term investment in infrastructure and transparency.