Recently, a friend asked why I had left Mexico. She told me that the private practice group I founded at ABC Medical Center was, in her view, now the most successful group in the hospital. Everyone was doing very well. What could the United States offer me that I did not already have in Mexico?
It was a sincere question. It also reflected a definition of medical success I know well: a full practice, a good income, and social standing. Seen that way, leaving was hard to explain.
I left to take a leadership role at NYU. I wanted not only to operate but also to train surgeons, conduct research, and build a service that could benefit more patients than I could ever treat myself. In the 2022–2023 U.S. News & World Report rankings, NYU Langone placed third among U.S. hospitals, while NYU Grossman School of Medicine ranked second for research.[1] Dean Robert Grossman captured his view of that combination with an intentionally impossible equation: “3 + 2 = 1.” He believed it made NYU the country’s leading academic health system.[2] For me, the appeal was the chance to work where clinical care, education, and research could strengthen one another.
That record has continued. In 2026, NYU remained on the U.S. News Honor Roll, with 12 specialties in the national top ten and a tie for the most first-place specialties.[3] Its Manhattan campus topped Vizient’s comprehensive academic medical center cohort for the fifth consecutive year.[4] NYU also reports that its medical school consistently ranks among the top three research-intensive schools in active NIH funding per investigator.[5] These measures assess different things. Together, they help explain the institutional capacity I valued.
Rankings have limits. What mattered to me was having a structure that supported the work I wanted to do. It was a privilege to be part of it. I am pleased that my former colleagues have succeeded. My decision reflected a different professional ambition.
I thought of that conversation as I read Guillermo Torre Amione’s LinkedIn post on the need to develop a new generation of medical leaders in Mexico. His question deserves an answer that considers how we fund care, which work we reward, and who benefits from the medicine we can provide.
Mexico has an opportunity. To seize it, we need to stop judging the success of our doctors and hospitals without asking what the population gains.
The Cost That Falls on Families
In 2023, roughly 41% of Mexico’s current health spending came directly from patients’ pockets, according to the Commonwealth Fund’s country profile and the WHO data series published by the World Bank.[6,7] The OECD continues to place Mexico among the countries where households pay more than a third of health spending directly.[8] That is a heavy burden for a country with a public healthcare system.
We should be clear about what this means. It does not mean that every family spends 41% of its income on health or pays that share of every bill. It means that, of every hundred pesos spent on health in Mexico, roughly forty-one are paid directly when people receive care or buy medical goods. Private insurance premiums are counted separately.[7,9]
Nor does a lower out-of-pocket share prove that American healthcare is affordable. To compare the actual burden, we must account for spending levels, premiums, deductibles, and household income. One percentage cannot settle the comparison.
But Mexico’s figure raises an urgent question: why must so many people pay out of pocket for healthcare that, in a functioning system, should be covered by public financing or insurance?
Some private spending reflects choice, while some reflects delays, distance, inconvenient hours, and a lack of trust. An analysis of the 2022 National Health and Nutrition Survey (Ensanut) found that 71% of the reasons people gave for not using the services to which they were entitled concerned access, and 21% concerned perceived quality.[10] Registering someone as a beneficiary is not enough if that person cannot get the care they need.
The problem is not limited to expensive elective surgery. The OECD reports that medicines accounted for more than 60% of Mexico’s out-of-pocket spending in its 2023 comparison.[8] Often, paying means buying medicine and getting back to work.
Recorded spending also has a limit: it does not, by itself, capture the care someone needed but could not afford. A person who skips a consultation may spend nothing and remain unprotected. We must therefore measure both what families pay and the needs that go unmet.
In 2024, INEGI, Mexico’s national statistics institute, identified 44.5 million people, or 34.2% of the population, as lacking access to health services under its deprivation measure. That was an improvement from 39.1% in 2022.[11] We should acknowledge it. We should also be clear that this indicator does not directly measure care quality or wait times.
These findings must be considered together: Mexico has a high burden of out-of-pocket payments, documented barriers to access, and large gaps in protection. When public care does not arrive and a family must buy it privately, the patient bears the cost of that failure.
Excellent Hospitals, Unequal Access
Those of us who have worked at ABC Medical Center or know TecSalud’s hospitals, such as Zambrano Hellion, know that Mexico can provide excellent medical care. The same is true of many public and private services. The mistake is to treat that capacity as evidence that the country already provides adequate access.
A family paying for a consultation at a pharmacy clinic does not thereby gain access to a hospital stay at ABC, TecSalud, or Ángeles. Being able to pay for one part of treatment does not mean being able to complete it. In my experience, that distinction often disappears when we talk about “private medicine.”
As I have argued elsewhere on this blog, declaring healthcare a right is not the same as financing it, and financing it is not the same as ensuring that a patient receives care.[12] Excellent hospitals alone do not solve that problem.
We must also distinguish among institutional models. ABC describes itself as a nonprofit institution. TecSalud brings hospitals, training, and research together within its academic model.[13,14] Ángeles belongs to Grupo Vazol, which describes it as Mexico’s largest private hospital network.[15] Whatever measure of size we use, the distinction matters: a commercial hospital network and an academic institution need not have the same priorities.
The business surrounding a hospital can include real estate, medical offices, retail space, and parking. The environmental filing for the Hospital Ángeles Polanco project describes hospital facilities alongside medical offices, a shopping center, and parking.[16] The commercial model extends beyond clinical care. The filing does not tell us how much profit each activity earns.
A hospital café is not the problem, nor is revenue itself. Profit does not prove poor medicine, just as nonprofit status does not guarantee good management. As I argue in my book project, Mission Requires Margin, a mission cannot survive without financial strength. The same principle informs my writing here: the questions are how money is earned, who decides how it is used, and whether it strengthens the mission.[17]
In healthcare, I would add three questions: How much does the institution contribute to professional training? What clinical results can it demonstrate? Who does it exclude?
The Success We Learn to Recognize
My friend’s question stayed with me because I have encountered versions of it elsewhere. In some parts of Mexican private medicine, income and visible prosperity serve as evidence of prestige. That is a personal observation, not a description of every physician in the country.
I have seen social media videos in which a doctor arrives in a Mercedes or BMW before promoting the treatments they offer. The car becomes part of the professional introduction. We can debate whether that advertising works. As a patient, I would rather know when those treatments are appropriate, what risks they pose, and what results they deliver.
Having money does not discredit a physician. Using it as evidence of competence, however, confuses the issue.
The harder question is what opportunities we offer to someone who wants to spend part of the week teaching, reviewing complications, or answering a clinical question. If that work reduces their income and does not count toward promotion, we are asking them to subsidize it with their time. It then seems odd to lament a shortage of researchers or the departure of talent.
I am not suggesting that Mexico lacks academic medicine. That would ignore its national institutes, universities, public hospitals, and the physicians who have devoted their lives to training others. IMSS itself maintains a research structure and a clinical journal published since 1962.[18] The question is how to expand and sustain those careers and how to make that work part of more institutions.
This is where Guillermo’s proposal has practical value. In 2026, TecSalud described a model that integrates care, teaching, and research within clinical institutes.[14] We should expect that investment to yield useful knowledge, rigorous training, and benefits that extend beyond its own hospitals. We should also enable other centers to adapt the model to their patients and resources.
IMSS Needs Continuity and Public Accountability
Any national transformation must include IMSS, the Mexican Social Security Institute. Its scale alone makes that unavoidable: at the end of 2024, 62.6 million people were registered with its family medicine units, equivalent to 47.3% of Mexico’s population.[19] Its doctors, nurses, researchers, and hospitals are indispensable to reform. That is precisely why its performance deserves scrutiny beyond support for or opposition to the government of the day.
Its political ties have a concrete basis: Mexico’s Social Security Law provides that the president appoints the director general. It also establishes a Technical Council with representatives of the government, workers, and employers.[20] That structure does not prove that every decision is partisan. It does require us to ask what protects clinical decisions, professional careers, and the continuity of programs from political or sectoral pressure.
I want an IMSS where a good project can survive a change in administration; where positions of responsibility require proven ability; where reporting a delay or complication helps correct it; and where patients can find out who is accountable when a referral goes nowhere.
We should also distinguish the contributory IMSS system from IMSS-Bienestar, the separate body that serves people without social security coverage. Sharing part of a name does not erase differences in the populations served, funding, and organization.[6]
The Universal Health Service proposal announced in 2026 aims to coordinate access across institutions through a phased rollout.[21] That is a sensible direction. Its success should be judged by the care people actually receive, rather than by the number of cards issued.
More Resources, with Clear Obligations
Mexico needs to invest more in health care. The OECD’s 2025 report places total health spending at 5.9% of GDP, compared with an average of 9.3% among its members.[22] Calls for efficiency must not become an excuse to leave services understaffed, without equipment, or without medicines.
A larger budget should also include commitments that can be verified. I would start with what patients can recognize: medicines in stock, timely appointments, completed referrals, full courses of treatment, and fewer unexpected payments. Publishing those results by institution and region would show where care is improving and where action is needed.
I would apply the same approach to quality. Counting consultations and operations describes activity. To assess their value, we need to know about complications, recovery, readmissions, and outcomes that matter to patients, with adjustments for case complexity. Centers that treat the most difficult cases should not be penalized for doing so.
Training and research need dedicated budgets, protected time, technical support, and promotion criteria. Adding “academic” to a hospital’s name is not enough. We must pay for the work that commitment requires and assess what it produces.
Public-private collaboration can be part of the answer if it meets specific needs, with transparent pricing, enforceable quality standards, and protection against additional charges to patients. Its purpose should be to provide the care that is missing. Contracts and results must be open to scrutiny.
Guillermo is right to call for institutions capable of training new leaders. I would add that we need a definition of success that recognizes those who teach well, produce useful evidence, improve public services, and expand access, alongside those who build a good private practice.
Mexico has left patients bearing too much of the financial burden without ensuring adequate access or quality. It has the talent to change that. It needs to fund that talent, organize its work, and demand results.
A country’s medical success must also be measured by the care available to those who cannot afford to pay.
References and Further Reading
1. NYU Langone Health. NYU Langone Health Ranks No. 1 in New York & No. 3 in the Nation. July 26, 2022. Rankings for 2022–2023; the medical school ranking is for research. View source
2. NYU Langone Health. 3+2=1. Impossible Math? It All Adds Up at NYU Langone Health. Fall 2022. View source
3. NYU Langone Health. NYU Langone Health Once Again Holds the Most No. 1–Ranked Specialties in the Nation in U.S. News & World Report Rankings. August 4, 2026. The first-place distinction is shared with other institutions. View source
4. NYU Langone Health. NYU Langone Health Is Named No. 1 Health System for 5th Consecutive Year by Vizient. September 24, 2026. View source
5. NYU Langone Health. About Us. Research section; institutional report of active NIH funding per investigator. Accessed October 23, 2026. View source
6. Commonwealth Fund. International Health Care System Profiles: Mexico. 2026; Cost Sharing and Out-of-Pocket Spending section, using 2023 data. View source
7. World Bank / WHO. Out-of-pocket expenditure (% of current health expenditure) — Mexico. Indicator SH.XPD.OOPC.CH.ZS; series through 2023, with an update dated December 2025. View source
8. OECD. Health at a Glance 2025. Financial hardship and out-of-pocket expenditure. Comparative data for 2023 or the nearest available year. View source
9. World Bank. Mexico: Health Financing Profile. Definition of out-of-pocket spending and exclusion of insurance premiums. View source
10. Utilización de servicios de salud en México: cascada de atención primaria en 2022 [Health service utilization in Mexico: the primary care cascade in 2022]. Salud Pública de México. 2023. PMID: 38060950. View source
11. INEGI. Pobreza multidimensional 2024 [Multidimensional Poverty 2024]. Press release 118/25, August 13, 2025, section VII, p. 6. View source
12. Castañeda P. Mexico’s Health Is a U.S. Strategic Interest: A healthier Mexico strengthens North America. Texican Health Consulting. 2026. View source
13. Centro Médico ABC. La labor social dentro del Centro Médico ABC [Social outreach at ABC Medical Center]. July 16, 2021. Institutional statement of nonprofit status. View source
14. Tecnológico de Monterrey. Instituciones del Grupo Educativo informan avances [Educational Group institutions report progress]. 2026 Board Meeting; section on TecSalud’s plans to transform healthcare in Mexico. View source
15. Grupo Vazol. Olegario Vázquez Aldir presenta la visión de Grupo Vazol: una nueva identidad para un legado que mira al futuro [Olegario Vázquez Aldir presents Grupo Vazol’s vision]. Corporate statement about the size of its hospital network. View source
16. SEDEMA, Mexico City. Environmental filing for the Hospital Ángeles Polanco project, published on the transparency portal. Description of hospital facilities, medical offices, shopping center, and parking. View source
17. Castañeda P. FIFA Is a Nonprofit. It Is Not Naïve: What the World Cup can teach healthcare about the money required to keep a mission alive. Texican Health Consulting. June 29, 2026. View source
18. IMSS. Revista Médica del Instituto Mexicano del Seguro Social. About the journal; volume 64, 2026. View source
19. IMSS. Programa Institucional del Instituto Mexicano del Seguro Social 2025–2030. Diario Oficial de la Federación, August 29, 2025. Registered population at the end of 2024. View source
20. Ley del Seguro Social [Social Security Law]. Text indicating its latest amendment as January 15, 2026. Articles 258, 263, and 267: General Assembly, Technical Council, and appointment of the director general. View source
21. El País. Así será el Servicio Universal de Salud que unirá al IMSS, ISSSTE e IMSS-Bienestar [The Universal Health Service that will link IMSS, ISSSTE, and IMSS-Bienestar]. April 7, 2026. View source
22. OECD. Health at a Glance 2025: Mexico. View source