MEXICO CITY: HEALTH FEDERALIZATION, RELATIVE AUTONOMY AND SOCIAL CITIZENSHIP IN AN URBAN CONTEXT (2019–2024)

Abstract

This article analyzes the reconfiguration of Mexico’s health system between 2019 and 2024, focusing on health federalization and its subnational effects. Using a qualitative approach, it examines the case of Mexico City due to its relative autonomy and strong institutional capacity. The reform involved a normative and financial recentralization that reshaped multilevel governance. However, it did not completely eliminate subnational margins of autonomy. In an initial stage, Mexico City maintained operational control over its health services. Subsequently, it moved toward progressive centralization with the implementation of IMSS-Bienestar. The process was uneven in both planning and financing.It generated differentiated arrangements depending on the institutional capacity of each state. Subnational autonomy was reconfigured through negotiated processes.
The case highlights limitations in achieving effective universal access in unequal urban contexts.

Keywords: healthcare federalization, multilevel governance, subnational autonomy, Mexico City, Social citizenship.