The debate over medical care in Mexico

There aren't many sure shots in life.
Medical care in Mexico is not among them. 
     The constant chatter among San Miguel expats about medical care reminds me of the fleet of old American cars cautiously sputtering, wheezing and farting along the streets of Havana.

Invariably there is something wrong with one of them and opinions abound, expressed with much gusto, about the best way to fix a malfunctioning carburator or gallbladder, and punctuated by a horror story or two about how someone's '57 Chevy expired recently, never to be revived again. Or the shock of a dear San Miguel friend who went in for a routine colonoscopy at nine in the morning and was dead by five in the afternoon, for reasons never cleared.

"If he had taken that car to my mechanic Víctor, he could have fixed it, I'm sure!" someone would offer during a post-mortem comida, only to be contradicted by another equally vehement person who'd argue that the best mechanic—or orthopedist or dentist—is not Víctor but Manuel or Dr. Gonzáles.

     One indisputable fact is that medical attention is very inexpensive in Mexico compared to the U.S.. That prompts many medically uninsured Americans to cross the border to get care, or sometimes to seek exotic treatments not available or illegal in the U.S.

Fancy this: Picture of the new MAC Hospital in San Miguel,
taken from its Facebook page. 

An eye exam with my our excellent ophthalmologist, for example, runs about fifty-five dollars. It would be at least double that in the U.S.

The flipside is that all medical and hospital care here is cash or credit card only, while in the U.S. Medicare would cover most or all of the bills, outrageously high as they might be.

     The imponderable clinker is competence: Does the doctor know what he or she is doing? Is the quality of care and facilities here comparable to those in the U.S.?

That's where opinions and experiences vary wildly among San Miguel expats and also what drives the popularity of medical evacuation insurance.

Doubts over competence are aggravated by lack of governmental or professional oversight. There is no malpractice insurance, a much-criticized and expensive safeguard in the U.S. that does push costs up—but also runs incompetent bozos out of business.

Expats often mention English fluency as a guarantee of professional competence. Having someone you can communicate with is reassuring but not necessarily a substitute for skills and experience.

In addition, there are no internet-based or other sources one can consult to determine the professional credentials of a medical practitioner or his malpractice record, or the medical specialties or mortality rates at a particular hospital for certain procedures.

In this fog of factual information, word-of-mouth and blind faith rule. Patient beware.

     Recently two medical facilities have appeared in San Miguel. One is a mid-size hospital on the outskirts of town; the other an "urgent care" clinic at a strip mall.

We don't know anything about either one except Mexican or multinational medical investors must perceive a viable market in San Miguel with its burgeoning population of expats and wealthier Mexicans. These are private, for-profit operations.

Our diminutive mayor during the opening ceremony.

  (From Correo newspaper)

During the ribbon-cutting ceremonies, San Miguel's mayor Ricardo Villarreal pointedly mentioned the city's growing population of foreign residents who'll surely take advantage of the new hospital.

New buildings and shiny machines, of course, are only as good as the people who operate them. And for testimonials about miraculous treatments or near-death experiences at these two venues we'll have to rely, again, on the grapevine.

     After living in San Miguel for more than ten years, Stew and I would rate medical care here as C-plus. We're confident enough with our medical contacts that we don't lose sleep about receiving appropriate emergency care. But anything more complex or long-term than that would take us to medical facilities on the Other Side. Pronto.

Stew suffered the worst mishap when a much-praised orthopedic surgeon—who spoke perfect English!—botched a carpal tunnel operation on his right hand that had to be redone in San Antonio. Stew's is hardly the only report of bungling by this guy. If he were practicing in the U.S. either his license or his malpractice insurance would have been cancelled long ago.

Apart from that we've run into botched treatments and just flat-out wrong diagnoses that have given us pause. Screw-ups occur anywhere and medicine is not an exact science. Still, we don't want to be part of someone's learning curve or take undue chances.

So here's our current plan. First we have established a relationship with a young doctor at the local hospital whom we would call in case of an emergency. We've used him before and he seems competent, thorough and most important, ready to call for a second opinion if he has any doubts.

We are also establishing a primary care relationship with a doctor in San Antonio whom we can visit for our annual physical and who will keep our medical records. Finally, we both have air evacuation insurance for an annual combined premium of approximately $1,000. Air evacuation to the U.S. runs about $35,000 and is not something you can haggle about in the middle of an emergency.

Meanwhile, Stew and I will be traveling to San Antonio next week to meet a potential family doctor at a major hospital who could be the new Dr. John Glynn, our primary physician in Chicago for about twenty years.

We expect to be doing some strategic shopping, restaurant-hopping and movie-watching too in between appointments.