Objective: To evaluate advancements and challenges in the separation of functions within Mexico's System of Social Protection in Health.
Material and methods: A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis.
Results: The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions.
Conclusion: Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.