La Jornada: What does the decree say about the SUS?

The publication of the decree on the Universal Health System (SUS) at the beginning of May helped to unravel what is being sought with this system. At the outset, it should be noted that the decree is based on the Constitution and the international agreements signed by Mexico. Thus, health as a human right and health protection, which means access to health services, must be guaranteed. Both issues have been declared over four decades, but in different ways as I pointed out in my previous article ( The Day 4/17/26). That is, the idea is not new, but it has been understood in various ways, which can fit both neoliberal and progressive thinking.

A significant issue is that it is only a presidential decree and not a change in the General Health Law (LGT). This is important because it indicates two issues. On the one hand, it concerns the health system, but it would not necessarily have widespread application. For example, it would not regulate the private sector. In this sense, it is striking who signed this decree. First, there is President Claudia Sheinbaum Pardo, followed by the Secretaries of the Interior, the SHCP, Welfare, Energy, Health and the head of the Digital Transformation and Telecommunications Agency.

It is striking that the public institutions directly involved in the provision of health services, the IMSS, the OPD IMSS-Bienestar and the Issste do not appear among the signatories. That is, the usual actors in the public health sector do not appear. This is particularly striking, since the decree directly involves them, both in terms of their infrastructure, their staff, their budgets and “the continuity of care.”

The first point of the agreement is that coordination and operational integration between the federal public institutions that provide health services and that are part of it is mandatory, as long as the health services of the federal entities can adhere to the agreement. This formulation would mean that state health systems that did not adhere to federalization may or may not integrate into SUS. That is, the voluntary nature of federalization is maintained.

The second article defines the SUS as a comprehensive and integrated network for the provision of health services, composed of the IMSS, the Issste and the OPD IMSS-Bienestar, the health services of Pemex, Federal Reference Hospitals, the National Institutes of Health, the medical units in charge of the Coordinating Commission of National Institutes of Health and High Specialty Hospitals, etc. This network will provide free medical services and medications in accordance with the rules established by the decree. It is made explicit that this must occur without affecting their financial capacity and without diminishing the quality of the services that the institutions provide to their respective populations in charge.

This point is undoubtedly one of the most controversial, since initially the aforementioned institutions have a serious overload of demand at their different levels of care. Therefore, the insistence of the President and senior health officials on accelerating the renovation and equipping of existing units and building new ones. However, for this to be possible, profound regulatory changes would have to be made, both to speed up the works and to find new forms of contracting such as, for example, so-called “turnkey” hospitals.

Another complex article to apply is the one referring to the coordination of the compensation scheme between the institutions. It will be in the hands of Siscosam (the former undersecretary of planning and governance) to coordinate the compensation scheme for its efficient operation. This scheme already exists, but has not worked satisfactorily. To do this, it will rely on telematic systems. Clinical records will also be made that can be consulted in all institutions, regardless of where the patient belongs; An important issue but difficult to homogenize because a significant number of hospitals and institutions already have their records automated and are not very willing to change them.

The SUS will have a national registry, which will be integrated once people register to request the issuance of their health credential. Said registration will be free, using the Unique Population Registration Key (CURP) as a unique identifier. The national registry will be administered by the Ministry of Health. The census would be the basis of “service exchange” and “service continuity” as I analyzed in my previous article. A fundamental issue is that those who have the least access to automated systems are the poorest population, who would most need the exchange of services.

Mexico urgently needs a SUS, but to do so we must fundamentally resolve the problems that have prevented it until today.