Nearly three million beneficiaries of the Mexican Social Security Institute (IMSS) received medical care outside the institution, while Mexicans spent around 9,316 million pesos on private consultations during a quarter of 2024, of which 5,599 million corresponded to households with at least one member affiliated. Difficulty getting an appointment, long waiting times, and the distance to medical units are among the problems faced by IMSS beneficiaries, according to the 2025 Continuous National Health and Nutrition Survey (Ensanut). The survey reveals that 34.6% of beneficiaries who received medical care went to establishments outside the Social Security system. Of the 8,540,278 patients treated, 2,953,669 turned to external services and 5,586,609 were treated at the institute's units.
Éctor Jaime Ramírez Barba, a physician and federal deputy from the PAN, considers it serious that millions of workers seek care outside the institution to which they contribute: "Workers are paying twice for their health: first with their contributions to the IMSS, and then when they have to go to a private office because they cannot get an appointment, cannot find medications, or need tests that the institution does not provide in a timely manner." He cites the analysis by the Center for Economic and Budgetary Research (CIEP), which indicates that Mexican households spent, on average, 6,421 pesos annually out of pocket on health services during 2024, a real increase of 7.9% compared to 2022. Among lower-income families, the increase reached up to 23%. That study specifies that 38.3% of these expenditures went to medications and 34.7% to outpatient care, while the remaining 27% corresponded to hospital services.
Ensanut highlights that among beneficiaries treated outside the Mexican Social Security Institute who explained why they did not go to their institution, 46.3% mentioned appointments scheduled too far in the future; 36.8%, long waiting times to be seen, and 33.3%, the distance to their medical unit. Ramírez Barba, secretary of the Health Committee of the Chamber of Deputies, attributes these problems to saturated facilities, insufficient staff, and deficiencies in the organization of consultations. He states that each family doctor sees, on average, 24 patients during a six-hour shift, equivalent to 15 minutes per consultation. "How can we expect a doctor to examine, diagnose, explain a treatment, and follow up on a patient with diabetes, hypertension, or another chronic illness under those conditions?" he questions.
Private doctors were the main alternative for beneficiaries treated outside the Social Security system: 41.8% went to offices located at the homes of private professionals; 19.7%, to establishments attached to pharmacies, and 17%, to offices within private hospitals. These three options accounted for 78.5% of cases. The rest turned to other services, including public health establishments. Proximity influenced the choice of location: 34.3% mentioned its closeness; 21.2%, the speed of the service; 11.8%, that no appointment was needed, and 7.7%, that appointments were granted quickly.
The survey, conducted by the Ministry of Health and the National Institute of Public Health (INSP), shows that those who paid for consultations at establishments attached to pharmacies spent, on average, 117.79 pesos, although half paid up to 65 pesos. Among patients treated at offices located in the homes of private doctors, half spent approximately 380 pesos.
The 2024 National Household Income and Expenditure Survey (ENIGH) by Inegi estimates a national quarterly expenditure of 9,315.6 million pesos on general, specialty, and pregnancy-related private consultations. Of that amount, 5,599.2 million corresponded to households with at least one IMSS beneficiary. That figure excludes medications purchased separately, clinical analyses, and other tests.
Faced with this situation, Ramírez Barba proposes establishing by law maximum care times, including a deadline of up to 72 hours for a non-urgent first family medicine consultation, as well as mechanisms for the institute to cover external services when it cannot attend to its patients in a timely manner. "If the IMSS does not guarantee timely care that it is obligated to provide, it must cover its cost. Workers have already paid for that right, and the government has the obligation to respect it," he maintains.
Private care also represents an alternative for those lacking institutional coverage. According to Ensanut, 65.1% of people without entitlement or access to health institutions who received care went to private establishments or pharmacy-attached offices. Among the entire population treated for some health problem, private services and pharmacy-attached offices accounted for 44.6% of consultations identified, compared to 52.8% for public institutions.
Ramírez Barba announces that on November 6, the director of the IMSS, Zoé Robledo; the Minister of Health, David Kershenobich; the head of the ISSSTE, Martí Batres, and the director of IMSS-Bienestar, Alejandro Svarch, will appear before the Joint Health and Social Security Committees of the Chamber of Deputies. "We want to know how many beneficiaries are waiting for a consultation, how many surgeries are pending, how many patients are not receiving their medications, and why so many families are paying for private services," he says.
Gabriela Luna Ruiz, an academic from the Department of Economics and specialist in pharmacoeconomics at the Iberoamerican University, explains that the use of private services by IMSS affiliates is not new, but waiting times, travel, and difficulties obtaining medications raise the costs of going to public institutions. She points out that offices attached to pharmacies have become a complement to public care, mainly for respiratory and gastrointestinal illnesses, although this alternative represents additional expenses for families. She explains that lower-income people have greater difficulty substituting a public consultation with private services, especially when they need prolonged treatments.
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