Tuesday, January 05, 2010

Health Care in Mexico (San Miguel de Allende)

This article reprinted from the American Chronicle examines the realities and misconceptions of health care options for Americans who relocate to Mexico. It is written by Carol Schmidt and Norma Hair, two expats whom I met while doing fieldwork in San Miguel a few years ago.

In the midst of the US debates over health care reform, many are examining the health care system of Mexico, claiming that it is far superior to that of the US, and that it is luring thousands of US citizens to Mexico because they can't afford health care in the US.

In some ways those claims are true, and at the same time this publicity is a simplistic politicization of a complex reality.

This oversimplification is also being used by those who want to expand US Medicare coverage into Mexico for the benefit of the hundreds of thousands of US citizens who have already moved to Mexico.

Hundreds of thousands more of retiring baby boomers are predicted to move to less expensive Mexico because their retirement savings have been devastated by the global economic crisis. If Medicare coverage were extended into Mexico, those numbers might be even higher.

From almost eight years living in San Miguel de Allende, authoring two popular books on moving to Mexico, fielding thousands of questions on all aspects of Mexican living on my website, www.fallinginlovewithsanmiguel.com, and experiencing many aspects of the US and Mexican health care systems personally, I would like to present a more complete picture of Mexican health care.

I and my coauthors Norma Hair and Rolly Brook devote 40 pages of our latest book, The Best How-To Book on Moving to Mexico, to health care issues. We note that the three biggest worries those considering moving to Mexico have are: what to do about health care, will it really be cheaper, and will I be safe.

Our book analyzes all three concerns in depth before moving into an overview of various retirement areas in Mexico, how to make the move, and what it will be like to live in Mexico.

The health care section notes that Mexican doctors and hospitals can be just as bad or just as outstanding at those in the US, and you have to plan carefully for your medical needs just as you do in the US.

The advantages: you can get quicker care by specialists often trained in the US, often English speaking, for much lower prices. A general practitioner may charge from $2.50 to $25 USD for an office visit. A specialist's rates can be $40-60 USD and you get a full hour of caring attention, often the same day you call.

A house visit may be $10-25 USD by a general practitioner (though a tourist in a luxury hotel may be charged $90 USD for an emergency house call).

A hospital room may be $75-100 USD a night in a private Mexican hospital. Friends who have had heart attacks have been charged $3,000 for three days and nights of emergency care and stabilization, and another $3,000 for an overnight angiogram procedure in a major hospital. An echocardiogram, stress test, or Doppler cardiovascular exam may be $135 at a heart institute. A colonoscopy or an MRI may be $400 USD, ten times less than the same procedures in a US hospital.

Knee replacement surgery by internationally trained Mexican specialists may be under $6,500 USD a knee, compared to $40,000 or more at a US hospital.

If you utilize one of the General Hospitals, the basic emergency visit may be as low as $6 USD. If you require specialized services (such as the four hours of cardiac observation, x-rays and echocardiograms, and IV medications that I have required three times at a General Hospital), the rates for a low-income US retiree may be about $50 USD.

A brief interview by a social worker determines your ability to pay if you are not covered by the Seguro Publico government insurance program. Setting a broken bone may result in a total charge of about $200 in a Mexican General Hospital for a US citizen.

And if you have joined IMSS, the Mexican Social Security system for about $300 USD a year for those over age 60, your charges will be zero at an IMSS facility, including for your medications.

The disadvantages: Not every foreigner can qualify for IMSS--first you have to have a residency visa such as an FM3 or FM2, not the 180-day maximum FMT tourist permit. There is an exam on pre-existing conditions, and full coverage is phased in over three years.

Not all cities have excellent IMSS hospitals, and the clinics where you have to be seen first can be crowded with lengthy wait times (unlike the immediate care you get at a private hospital).

The drug coverage may be meaningless--the facilities often don't have many drugs available when you need them.

But if you are able to get in, and you have fulfilled the waiting periods for pre-existing conditions, and you are in an area with an excellent IMSS hospital, this can be a superior alternative to US medical insurance.

However, IMSS is already overloaded trying to care for Mexico's population, and the crush of new US members is an added burden.

Every time you visit many Mexican doctors, it is as if you are there the first time--no records may have been kept. (On the other hand, most US doctors do not have the time under insurance pressures to spend perusing your records anyway.)

You are responsible for keeping your own medical records--you will be given your own x-rays and test results to keep and to bring with you to future doctor and hospital visits.

You can walk into medical laboratories in most areas and order your own cholesterol tests and other blood work to keep track of your own health, no doctors' prescription necessary.

Most US drugs that require prescriptions are over the counter in Mexico, at a lower price. Serious pain medications and psychiatric drugs still require a doctor's prescription.

In weighing the pros and cons of having something like knee replacement surgery done in Mexico where I would have to pay all the charges out of pocket, or in the US where Medicare would cover most of it, I took into consideration the transportation costs of going back and forth to a US hospital from my central Mexico home in San Miguel de Allende.

I knew that it would take many visits before finally getting a hospital date in the US, not the speedy process of Mexico, and that the transportation and housing and restaurant costs would mount up, not to mention the copays.

Mexican hospitals encourage a member of the family to stay with a patient throughout a hospital stay, a cot or sofa provided for that purpose. That reduces the expenses of the person who accompanies you to a Mexican hospital.

Of course it also reduces the charges of the hospital, which expects the relative to perform routine assistance like feeding, bathing and pillow fluffing.

I determined it would be cheaper overall to have my knee replacements in Mexico rather than return to the US where Medicare would pay a large part of the $40,000. I was very pleased with both knee replacements, which went smoothly, and two years later I am as active and pain-free as I was before arthritis struck.

If I'd had family in the US who could have provided me a place to stay during the numerous exams and appointments and the therapy time afterward, that decision might have been different.

Just as in the US, smaller rural hospitals may not have the facilities to provide the excellent care of a big city hospital. Problems such as a shortage of a rare blood type could lead to death in a small rural hospital, in the US as in Mexico.

Could a pilot project to bring Medicare coverage to US citizens living in Mexico work? Several organizations are campaigning for this expansion to happen.

At this same time, there are great concerns by conservatives in particular in the US over Medicare overall, with calls for it to be privatized and made smaller.

At the same time there is an effort to offer Medicare coverage to those ages 55-64 as part of health care reform.

Adding another program to expand Medicare coverage into Mexico is a political tinderbox, considering what polls show many US citizens think about anything that could be conceived as helping Mexico.

Many US expatriates living in Mexico find that the attitude toward them back in the US is, "Love it or leave it, and you left, so don't expect any help from us."

The fact that many Mexican doctors and hospitals are not used to keeping accurate and detailed records that would be sufficient for Medicare documentation is a serious problem for any pilot Medicare project in Mexico.

A few of the major hospital chains such as the 22 Angeles hospitals might be able to meet Medicare requirements, though resistance might be encountered on the part of some Mexican doctors and hospital staff, already overburdened by their own country's health care needs.

And then there are concerns by many in the US that all government programs in Mexico may include some form of corruption, so that no money will be awarded for any pilot program in Mexico.

As an example, the $1.4 billion Merida project to provide US support to Mexican efforts to fight the drug cartels has been thwarted and delayed at every step. Only a very small percentage of the funds have actually been spent in the two years since the project was approved.

These are a few of the realities and complexities of health care in Mexico for US expatriates, and for the possibility of a Medicare pilot project to help US citizens already living in Mexico.

 For more information read The Best How-To Book on Moving to Mexico and the forums at www.fallinginlovewithsanmiguel.com. You may contact the author at smacarol@hotmail.com.


Alice said...

I just tried to find your web-site and book on the internet. No luck. Found your article on health care in Mexico very interesting.

Deb said...

Thank you Alice. My professional website is http://mason.gmu.edu/~dshutika. My book, Beyond the Borderlands, will be available from the University of California Press in August. Please check back for more information on the book. Deb