This study presents a critical approach on health sector reform in Mexico and its impact on access and equity in state health systems. We discuss the main strategies adopted and made an assessment of its contribution to achieving equity in health, using socioeconomic indicators of health services and interventions for two moments, 1990 y 2002. We conclude that the dynamics of deepening inequalities in the period and the transformation of state health systems do not contribute to the achievement of equity in access.