Sunday, September 10, 2017

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.

16 comments:

  1. Air evacuation! That gives me the chuckles. As if Mexico is Timbuktu.

    Excellent healthcare is available in Mexico. You just have to know where it is. There are lousy doctors and facilities, and there are excellent ones. Like border towns, I suspect that San Miguel, with its Gringos and cash, is a magnet for less-competent but ambitious medical personnel. I have no proof. It's just a gut feeling that seems sensible.

    My medical experiences over the almost 18 years I've lived in Mexico have been 99 percent positive. I would not dream of going to the U.S. for healthcare. No need.

    I recently had a foot problem that sent me to a clinic that I normally would not have used. My regular doctor was out of town. The clinic doctor kind of misdiagnosed the problem but his treatment was correct. Go figger. It was not a life-challenging issue, so no harm done.

    The doctors, specialists and otherwise, whom I've used in Mexico have been not only competent, their offices are more comfortable, the service is quicker, the appointments take far less time, and you don't feel like a cog in the medical line.

    Color me a satisfied customer.

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    1. I will mark you as a happy camper. You're right in your suspicions about San Miguel becoming a magnet for charlatans and greedy medical operators. In fact I've heard the building of this new hospital (and a new airport) are part of a campaign to turn San Miguel into a "medical destination". I've also noted that our local funeral home, the Jardines de Paz, is doubling its facilities. Hmm.

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  2. I hold the same view as Al. I have extensive experience with medical care in this country having raised 3 children to adulthood, the oldest is 38. There are also medical professionals in the family including surgeons and the owner of a small hospital. So I don't base my opinions on gut feelings.

    One of our children recently underwent extensive neurological testing, EEG, brain mapping and MRI. The results were interpreted completely different by two highly regarded neurologists in Guadalajara.

    Now we must decide which treatment to follow. It is basically a flip of the coin.

    Years ago I worked in the forests of Tabasco and Chiapas where I became stricken with dengue fever. The doctor in Villahermosa nearly drowned me by giving me so much IV liquids. I finally yanked the needle out of my arm and left the clinic.

    I'll spare the readers the many other stories, mostly good but some bad, on our experiences with health care in this country.

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    1. Stew and I have also experienced diagnoses by Mexican doctors that were contradicted by doctors back in the U.S. or completely missed down here. That's scary because you don't know what's going on. Hope you work it out in Guadalajara.

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  3. I'm with you. I've established a long term relationship with an internist, a cardiologist and eye doctor. Now, after my accident, I now know well a plastic surgeon. I interviewed each of the above doctors when I was not in need about their credentials, etc.
    Then I checked them out. I would do the same in the USA. I've used all of the above for either needed care or when I have had an emergency. BUT, when I had to have a gall bladder removed, I met with the internist who suggested that I go to the USA as my Medicare would pay for it and they did. The cost to the ins.companies and Medicare in the USA was $30,000 - in SMA it would have been $6000 according to the internist.I now have Skymed, just in case, and hope to never, ever need it! Have fun in San Antonio. Hope you get up into the Hill Country too.

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    1. Barbara, I too know some good docs in San Miguel but for anything major I think we'd head back to the US. Another aspect is that although medical treatment in Mexico is less expensive, it can still add up and in the US Medicare would pay for it.
      It was 100 here today. You forgot to tell me about the heat in Texas.

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  4. I think you put too much faith in the medical care of the US. Recently, a medical journal reported that medical malpractice is among the 10 causes of deaths in America, and don’t count the “mistakes” that leave people with serious complications for erroneous diagnostics. Another big problem is the ridiculous overprice of medical treatment in America. The most routine exam would cost you several hundred dollars. Recently, my wife went for a hearth test and the charge was 12K. People think that because Medicare or medical insurance pay for most of the cost they are Ok, but they are not because these costs come back to society in higher premiums, taxes and deductibles. Another big problem is the inefficiency of the health care system in the US. To get an appointment with a specialist would take you several weeks, the offices of family doctors are crowded and the physicians would give you 15 minutes of their time if you are lucky. The bureaucracy of insurance companies is horrible. As you know, the US ranks well below Canada, France and other developed countries in health care and it’s mainly because big conglomerates are having hansom profits at the expense of most Americans. Of course, they have congressmen in their pockets with their “political contributions.” Now, they are very good at promoting the idea that the “US health system is the best in the world.” It is if you are billionaire but for most Americans it’s just a money dump. In reality, the Mexican medical has problems too but if you are careful you can get great health care with less hassle.

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    1. Superb take on the situation, Señor Ponce. Were I to find myself with a serious health problem in the U.S., I would get myself med-evac'd to Mexico. I wonder if such a policy is sold. Should be.

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    2. Carlos, your absolutely right that the BIG problem with medicine in the US are runaway costs, even compared to European countries. I've also been impressed with the basic medical care our Mexican garden and his family get (if you can put up with the waits.) In my own case, I don't believe medical care in the US is the best in the world, but I trust it more than the Mexican model.

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    3. Felipe: you're being a little presumptuous. What makes you think they would let you back into Mexico?? Al

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  5. Are you ever goin to let that poor dog in? He keeps peering through window, ever hopeful. Phil

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    1. Phil: thank you for your concern for Lucy. Rest assured she gets in and out, and fed, whenever she wants. I'll let her know you asked.

      Al

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  6. I agree that you are overly-optimistic about the standard of care in the US, and perhaps about the extent of Medicare Part A coverage. The Grupo Medica Sur in Mexico City is accredited by JCI to US standards of care AND is part of the Mayo Clinic Care Network. I'd go there from SMA before a medi-vac flight to Chicago. But to each his own...

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    1. To each his own, as you say. I wouldn't opt for a four-hour ambulance ride to a hospital I don't know in Mexico City, no matter how good it is, particularly on a cash out of pocket basis with no insurance coverage.

      Al

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  7. So what about us unfortunates who haven't yet hit 65 and don't yet qualify for Medicare? By law we are required to hold a high minimum care policy that is well over $500/mo w/ $8000 deductible! Al, would it be impertinent to ask how old you are? And having lived in MX for so long have you always carried a US health insurance policy? Thanks. Anyone, please chime in!

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    1. Mr. X: What about the unfortunates who haven't hit 65 and don't yet qualify for Medicare? That is indeed the question of the hour. Stew and I moved to Mexico when we were in our late fifties and if hadn't been for a health insurance plan, which fortunately covered "domestic partners", from my former employer, we would have been out of luck. The plan was high-premiums with so-so coverage (particularly in a foreign country) but it was the only option. We dipped our toes in the "free market" insurance market, but it was even more expensive and the "pre-existing" exclusions ruled out coverage of anything we would be likely to have. It was a joke. Not impertinent to ask: Stew is turning 71 in November and I'll be 70 in December. I fully sympathize with your concerns but have no answers, and neither do the politicians, I'm afraid.

      Thanks for writing.

      Al

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