The Paradox of Mexico’s Healthcare System

Mexico’s healthcare system is caught in a paradox. It is both sprawling and scarce, fragmented yet overburdened. Public health institutions—like the IMSS, ISSSTE, and a maze of smaller agencies—form a complex web that, in theory, should provide coverage for most of the population. In practice, millions remain underserved, particularly in rural and low-income regions. Private healthcare fills part of the gap, but at a cost so steep that nearly half of all health spending in Mexico comes straight from household pockets.

The figures tell a sobering story. With a population of 131 million, Mexico’s healthcare coverage lags behind, reaching just 77% compared to over 89% in other OECD countries. It spends a mere 5.7% of its GDP on health—far below the OECD average of 9.2%. Physicians are few and concentrated in cities. Rural clinics echo with absence. And while digital innovation flickers at the edges, most of the system remains analog, overtaxed, and under-resourced.

The government’s most recent answer, the “Programa de Trabajo del Sector Salud 2024-2030,” gestures toward prevention, digitalization, and improved care. Yet in a system haunted by bureaucracy, labor precarity, and systemic inequities, one must ask: can public reform alone shoulder the weight of transformation?

Reviving Cooperativism in a Digital Age

If the public sector stumbles and private healthcare excludes, is there a third path?

Mexico doesn’t need to import an answer from elsewhere. It can rediscover one within its own history: the cooperative. Since the 19th century, cooperatives in Mexico have allowed workers and consumers to reclaim economic agency, bypassing intermediaries and resisting extractive business models. With over 8.9 million members in savings and credit cooperatives alone, the model clearly resonates. But cooperativism remains an uphill climb. Legal red tape, lack of financing, and a cultural preference for private ownership have kept its potential locked in a closet.

Still, the digital revolution presents a remarkable opportunity. Platform cooperatives—owned and governed by their users and workers—offer a chance to reclaim the tools of digital capitalism for the common good. They stand in stark contrast to Silicon Valley platforms built on gig labor, data extraction, and winner-takes-all economics. In healthcare, this distinction becomes a matter not just of fairness but of life and death.

A Blueprint for a Mexican Healthcare Platform Cooperative

Imagine a digital healthcare platform where the power lies not in the hands of investors, but in those of patients and doctors. Where governance is democratic, where data is secure, and where profits, instead of being siphoned off to shareholders, are reinvested in care and community.

This is the vision behind a healthcare platform cooperative for Mexico.

The benefits are not abstract. For physicians, such a platform could mean fair wages, job security, and professional autonomy. It would provide access to shared technology—telemedicine platforms, digital health records, diagnostic tools—usually out of reach for small practices. It could also counter burnout by redistributing workload and offering ownership, not just employment.

For patients, especially those priced out of private care or trapped in the inertia of the public system, the platform could offer sliding-scale services, membership-based participation in governance, and access to preventive care often ignored in traditional models. Rural communities, long sidelined, could connect to urban specialists without leaving home. Instead of top-down medicine, a cooperative model invites a horizontal ethic: care as a mutual endeavor, not a transaction.

Of course, no strategy is complete without structure. As part of my fellowship at the Institute for the Cooperative Digital Economy (ICDE) at The New School, I will be developing a strategic plan to bring this model to life. It will define the mission, ownership models (worker-owned, patient-owned, or multi-stakeholder), legal frameworks, governance mechanisms, and sustainable revenue streams. It will align with healthcare regulations in Mexico while centering the needs of those too often ignored by the status quo.

This effort will not move forward in isolation. A coalition is already forming: doctors working in both public and private sectors, pushing for new employment models; institutions like INAES supporting cooperative development; NGOs and technologists working on digital platforms; and the international ICDE network, offering case studies and collaborative research.

From Brazil’s Unimed to Costa Rica’s Coopesiba, other countries have walked this road. Their experience offers valuable lessons—not blueprints to copy, but models to adapt, critique, and reimagine in the Mexican context.

Health, Democracy, and the Future

In the end, a healthcare platform cooperative is not just a technical innovation or an economic alternative. It is a political act. It asserts that care should not be a commodity, that workers deserve stability and voice, and that technology, far from being the enemy of equity, can be its ally—if we build it differently.

Mexico’s healthcare crisis is not simply a matter of policy inefficiency or funding gaps. It is a mirror reflecting deeper contradictions: between public need and private gain, between urban privilege and rural neglect, between technological promise and social exclusion.

So the question is not whether cooperatives can “fix” healthcare. The question is whether we’re ready to admit that the current system isn’t just failing—it’s failing predictably. And whether, in that admission, we can begin to imagine something more democratic, more sustainable, and more humane.

I welcome collaboration with researchers, doctors, developers, and dreamers. If you see yourself in this vision, let’s talk.

About the author