Background: Between 2019 and 2024, changes were made to Mexico's Public Health System to improve health care for the population with social security, which modified the organization and the leadership. Objective: Comprehensively analyze the changes made in the public to serve the population without social security and formulate proposals to achieve universal health. Material and methods: Qualitative research was carried out with a focus group technique to comprehensively analyze the changes made and formulate proposals. Results: Most of the changes made between 2019 and 2024 created the legal framework for the Health System for Welfare and the IMSS-BIENESTAR agency, in order to improve the care of the population without social security, but at the same time modified the leadership in the Public Health System. Opportunities for improvement were identified and proposals were made to strengthen the organization of services, management, financing and training of health personnel. Conclusions: Changes to the health system have weaknesses that can be corrected to improve its sustainability and advance in the construction of a universal health system.