Objective: To analyze organizational, political and economic changes resulting from the decentralization of the health system for those in Mexico without health insurance.
Methods: Three states, selected by considering the percentage of the population living in poverty, the political party in power and their stage of decentralization (the first was in 1984 and the second in 1997) were included. Interviews were conducted during 2007 with key informants from the state health care services, users of health care services, and community leaders. Data were analyzed from an anthropological and economic perspective.
Results: Decentralization occurred in a heterogeneous way in each state, with responsibilities being transferred from federal to state level but without breaking the dependence on the central-federal level. The reforms driven from the federal level to create a scheme based on a principle of financial subsidies and democratization of the health system face challenges for their political and organizational consolidation.
Conclusions: The anthropological approach adopted in this analysis shows the relevance of considering organizational, economic and political factors as key components of the decentralization process.
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