In particular, the 2005 review’s recommendations to introduce a purchaser-provider split has not been implemented, apart from in a few scattered settings (such as Hidalgo state’s experimentation with new payment methods, and in the SS institutes’ contracting with private providers for certain high-demand interventions, such as obstetrics or haemodialysis). The model of workforce contracts remains largely the same. System governance, too, remains largely unreformed. Apart from very occasional convenios to allow SP and the SS institutes to exchange services, few mechanisms have been created to support closer working across the subsystems.