Mexico has made significant progress in the health sector over the past few years. Through its innovative programme Seguro Popular, Mexico has virtually attained universal coverage for the population, bringing it in line with most other OECD countries. However, despite dramatic improvements in life expectancy and infant mortality, it remains below the OECD average on basic indicators of health status. While health expenditure has grown fast in the past decade, it remains much below other OECD countries. More importantly the level of public spending is particularly low and out-of-pocket payments are very high. The health system is also fragmented, leading to wasteful spending, and access to health care still varies considerably across states. Improving the country’s health services will require addressing the problems of the poorer states, targeting services where they can deliver the highest value for money, and improving the efficiency of health delivery. These changes will help Mexico deliver on the commitment contained in the 2012 Pact for Mexico to equalise quality and coverage across different health coverage schemes. This aspiration should guide further reforms to expand access to care services, with policy guided by the development of targets including the services covered and the actual utilization of services by different socio-economic groups and across regions.