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Mexico an increasing option for medical care

Arizonans find quality procedures at a fraction of the cost

PHOENIX —As Gov. Jan Brewer’s administration grappled with a public outcry earlier this year over cuts denying organ transplants to dozens served by the state’s Medicaid system, Dr. Robert H. Page of Tempe called her office to propose a solution:

Send the patients to Mexico.

At a meeting later with a member of Brewer’s staff, Page, who has a family practice in Tempe, explained his reasoning. In Mexico, he said, private, internationally-accredited hospitals can perform transplants for a fraction of what U.S. hospitals would charge the state.

The governor’s office didn’t go that route—the state eventually restored the transplant funding—but since 2008 Page has been referring uninsured and under-insured patients in need of surgery to Mexico.

It became a second business, MedToGo International.

Page isn’t the only one who thinks that Mexico is a big part of the future of U.S. health care. The idea is part of a trend in Arizona and across the nation of U.S. health care businesses reaching across the border.

This summer, MedToGo International, which Page started with his two sons, plans to begin sending patients to Mexico for organ transplants for the first time.

“If you come in with something broken, I’ll send you to the best orthopedic surgery here in Tempe or Mesa, but if you don’t have insurance, what do you do? This is our solution,” said Page, who was raised on the border in Douglas and went to medical school in Mexico.

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Page said he got the idea for MedToGo International when an uninsured patient needed an emergency prostate operation.

After calling around and getting discounts from a local surgeon, hospital and anesthesiologist, the surgery cost came down to $13,000, he said, but it still wasn’t low enough for the patient.

On a whim, Page called a urologist in Hermosillo, Mexico, and sent the patient there, where he had the surgery and spent two days in the hospital. The total cost: $1,250.

“As a family practitioner, I’ve been called a gatekeeper for 20 years now,” he said. “We bring [patients] in and send them to the right specialty, … but if you don’t have insurance, I’m going to send you to Mexico.”

A growing business

In Mexico, medical services can cost as little as one-tenth of what the same services would cost in the United States. That applies to prescriptions and optical, dental and other medical care.

Page said it’s a myth there aren’t well-trained doctors throughout the country.

Other businesses in Arizona and the Southwest are expanding into Mexico or sending patients and clients across the border.

In Texas, the large Catholic hospital chain Christus Health expanded into Mexico in 2001, two years after it opened, and began coordinating travel for health care several years ago.

“We were really interested in becoming a cross-border system,” spokeswoman Abby Lowe said from the company’s Dallas-area headquarters. “We know the world is getting flatter and borders are less important than they used to be, at least where care is concerned.”

Christus has hospitals in six U.S. states and operates clinics, ambulance services and hospitals in five Mexican states.

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Some of the Mexican facilities are able to do procedures U.S. hospitals can’t, Lowe said, because of different testing, patents and technologies that have hit Mexico first.

The company also coordinates medical travel for patients to be treated in Mexico.

The online system involves reviewing information about the procedure a patient wants and checking prices, selecting a specialist and filling out medical information. A medical coordinator reviews the information and a specialist responds within 24 hours to report whether the patient has been selected, date availability and an estimated quote.

“We’re definitely looking to move forward and expand internationally,” Lowe said. “People have been moving back and forth across the border for years and years — this is a natural fit.”

No Arizona hospitals have expanded across the border to date.

California's insurance plans

In Southern California, more than 3,000 people are enrolled in Blue Shield of California’s Access Baja cross-border insurance plans for employer groups.

The insurance plans send people across the Mexican border to 12 pharmacies, six hospitals and various specialists and personal physicians in Tijuana and Mexicali for some of their health services at discounted rates.

The Access Baja HMO Provider Network plans, which premiered in 2000, are about one-third of the cost of other traditional health plans in California, said Mary Taing, a spokeswoman for the company. Employees at companies that purchase the plans must live within 50 miles of the border to qualify.

There aren’t any similar insurance plans being offered in Arizona, though there has been speculation that it will happen soon.

Government officials in the Mexican state of Sonora, directly south of Arizona, are heavily promoting medical tourism to Mexico by Americans.

Will Humble, director of the Arizona Department of Health Services, has worked with Sonoran health officials to provide expertise as Mexico promotes some its private hospitals to uninsured, under-insured and retired Americans. He said visiting a hospital in Hermosillo left him impressed.

“You wouldn’t have known if you were at Mayo (Clinic) or Hermosillo in Mexico,” he said. “It’s just really well done with high quality doctors and obviously good care.”

Public hospitals and private ones—particularly those that are internationally accredited—often vary in quality, as do facilities city to city.

Humble said Mexican officials are smart to target Americans by promoting accredited hospitals that meet the same standards as ones in Phoenix rather than medical facilities such as those in border towns offering dental or eye care.

“If I was broke and I was facing a surgery that I was needing to have done (in Mexico), I would not hesitate at all, especially with the hospital in Hermosillo,” he said.

Acela Escobar, a 62-year-old Yuma County resident who was born in Mexico, began crossing the border for health care after her husband, who worked for a trucking company, lost their insurance after an accident and subsequent legal battle.

“I was very sick and without insurance,” Escobar said in Spanish. “I went to Mexico to find a doctor so I could get medicine.”

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High quality care

Across the border, she said she has gotten high-quality care for ulcers, osteoporosis, glaucoma, insomnia and arthritis.

“Here, a doctor would charge my insurance $400 for one consultation. In Mexico, they charge me $20,” she said. “In Mexico, I see a lot of Americans when I go to an appointment.”

Meanwhile, thousands of Arizonans every year cross the border to patronize dentists.

Phoenix-based dental tourism company Dáyo Dental runs a weekly chartered van service to take patients to dentists in Tijuana, Nogales, Los Algodones, Puerto Peñasco (Rocky Point) and Cancún.

Since it opened in 2006, the business has had more than 1,500 clients, said Ron Vinluan, one of the company’s founders and its managing director. Between 2009 and 2010, the company saw a 41 percent increase in revenue and a 36 percent increase in clients.

“The high cost of dentistry is not unique in a few states—it’s an issue all over the United States,” Vinluan said.

To make clients feel safe and looked after, the company provides all transportation between hotels, airports and the dental clinics, which some Americans request because of violence or perceived violence from the drug cartels.

“We go through a screening process with the dentists before we really look into a partnership,” Vinluan said. “And we send large volumes of patients so we get discounted prices (from the dentists) and pass those on to clientele.”

Patients from California increasing

There has been little research on exactly how many Americans or U.S. residents cross into Mexico for health care, and the U.S. government keeps no statistics. But a 2009 study out of the University of California, Los Angeles’ Center for Health Policy found that nearly 1 million Californians seek medical care in Mexico annually.

While half of these were Mexican immigrants, both long- and short-stay, the number of Americans traveling across the border for care is likely increasing, said Steven Wallace, co-author of the study and associate director of the center.

“In the number of people who go down, the biggest driver was a lack of health insurance,” Wallace said. “After health care reform, there’s still an estimated 20 million people without insurance, and that’s a group that will continue to find Mexico attractive because of the lower cost of care.”

Non-Latino whites in the United States are most likely to cross the border for prescription drugs, Wallace said, but his study didn’t specifically ask what service each person was seeking in Mexico. He has found that immigrants are more likely to cross for dental care.

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“With the recession and lost jobs, 2 million Californians lost health insurance and the population is up, so that is driving more people to Mexico,” Wallace said.

The Mexican government’s secretary of tourism said earlier this year that based on previous visitor patterns, the country is expecting 650,000 medical visitors by 2020 and predicted they will spend $50 million.

Growth in medical tourism for Arizona

Amar Gupta, the University of Arizona’s Thomas R. Brown Endowed Professor of Management and Technology who has led research in medical tourism between the United States and Mexico, said the industry is poised for rapid growth in Arizona over the next several years. His research has been identified by others as some of the most in-depth and thorough that exists on medical tourism between the United States and Mexico.

Gupta predicted that Arizona insurance companies will begin to include liability coverage for some treatments in Mexico.

“We’ll see this happening in the next two to three years,” he said, adding that this could eventually be extended to require that certain procedures be completed in other countries, which is the case in some European countries.

“California is ahead of us with this with some plans already covering treatment in Mexico. It’s just a matter of time because American insurance companies are very enterprising.” More people will feel comfortable using their American insurance in Mexico, he said.

Such insurance companies will likely lead to more companies or doctor partnerships, he said.

Since Arizona has a strong telemedicine system, Gupta said he anticipates that the medical tourism and telemedicine industries will grow hand in hand. He called for international laws that would allow doctors to treat patients across state and country lines.

Over the next two decades, an increasing number of people will cross the border both ways, sometimes Americans seeking specific treatments in Mexico and sometimes Mexicans seeking specific treatments in the U.S., Gupta said, though immigration laws and procedural restrictions that slow down border crossing could slow the growth of medical tourism.

“I expect all kinds of new partnerships to develop and evolve over time,” he said, cautioning that it’s easy for U.S. doctors to go to Mexico and begin treating patients there but difficult for Mexican doctors to do the same in this country.

Because of that, Gupta said he mainly expects to see American companies continue to expand into Mexico.

“It’s a new business opportunity for American corporations more than anything else,” he said.


TucsonSentinel.com's original reporting and curation of border and immigration news is generously supported in part by a grant from the Ethics and Excellence in Journalism Foundation.

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Tessa Muggeridge/Cronkite News Service

Businesses offering medical and dental services line streets near the border in Los Algondones, Mexico, near Yuma.

Some rates for procedures in Mexico

In El Paso, Texas, the Medicare reimbursement rate for a general consultation with a physician in the United States was $119 in 2009, compared to $8 in a public hospital or $19 in a private hospital just across the border in Ciudad Juarez, Mexico, according to data from the Bureau of Business Research at the University of Texas at Austin.

A hysterectomy, for example, would cost about $3,698 in El Paso and about $654 at a public hospital in Juarez or $1,539 at a private one, according to the bureau.

The Medical Tourism Association, a Florida-based international group made up of health care providers, hospitals, insurance companies, individual doctors and medical travel coordinators, did a survey in 2010 that compared the costs of various medical treatments between 13 countries, including the U.S. and Mexico. The international high for a heart bypass was $144,000 in the U.S. At $27,000, the rate in Mexico was near middle. The lowest figure was $5,200 in India.

Professional guidelines

  • Medical care outside of the U.S. must be voluntary.
  • Financial incentives to travel shouldn’t inappropriately limit the diagnostic and therapeutic alternatives offered to patients or restrict treatment or referral options.
  • Patients should only be referred to institutions accredited by recognized international bodies.
  • Local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return.
  • Coverage must include the cost of necessary follow-up care in the United States.
  • Patients should be informed of their rights and legal options prior to agreeing to treatment.
  • Patients should have access to physician licensing and outcome data, as well as facility accreditation and outcomes data.
  • The transfer of patient medical records should be consistent the Health Insurance Portability and Accountability Act (HIPAA).
  • Patients should receive information about the potential risks of combining surgical procedures with long flights and vacations.

Source: American Medical Association