It’s not just the cost, it’s the care.
By James Murray for WOLF STREET:
An acquaintance of mine was walking around with a bandaged hand so I asked him what had happened. He was working and something slipped and he ended up with a nasty gash on the back of his hand. He went down to the local clinic and they put in 8 stitches. The total bill was $52.
Three years ago, I fell on a tile floor and broke my pelvis in 3 places. I was picked up by an ambulance, driven 40 miles to a private hospital where I spent 6 days and had a 5 hour surgery to repair the damage. They put in 3 pins, a plate, and 6 screws. The total bill was $22,000. I have no idea just how many stitches they put in, but the incision is 14″ long.
That was the total bill, no insurance.
However, I live in Mexico in a small town south of Guadalajara. I hate to even guess what the surgery would have cost me in the US.
When I came here a decade ago, people would disappear and the story would be that they went back to the US, because of health problems, to avail themselves of Medicaid/Medicare. However, now Americans are showing up here to get healthcare, especially dental, plastic surgery, and outpatient procedures. They can pay cash and still come out well ahead of paying deductibles in the US.
If you ask the medical profession in the US why there is such a difference in price, you generally get a “Well, Mexico is a 3rd-rate country with 3rd-rate medicine” answer. That is just not true. Medical care is as good in Mexico as in the US and in a lot of ways, better.
A large percentage of healthcare in Mexico is government run, either through IMSS or Seguro Popular. IMSS is for people under retirement age. Seguro Popular is for people over retirement age and the poor. In both instances, the government owns the facilities and employs the people working there.
IMSS is funded by employers. If you work in Mexico, your employer is required to pay for your IMSS. The payments are small and depend on age. For a young person, the premium can be under $100 per year, rising to about $300 per year at age 60. Anyone who lives permanently in Mexico can join IMSS for the same yearly rate that employers pay. There are some restrictions on the first two years of the policy. After that everything is covered and there is no deductible or copay.
Seguro Popular is free if you are over 60 years old. All you have to do is sign up and prove you live in Mexico. Seguro Popular has its own clinics and hospitals just like IMSS but if they lack something, they will send you to an IMSS hospital.
According to published figures, employers pay about 44% of the IMSS cost. The rest is covered by the government. Since Seguro Popular is “free.” I presume that the Mexican government funds 100% of that program.
There are also private hospitals and charity hospitals in Mexico. No matter who you are or your status, you can get healthcare in Mexico.
Most of the medical professionals who work for IMSS or Seguro Popular have a private practice as well. A friend of mine had to have a kidney removed. He was at IMSS the day of the surgery and the surgeon came in and said “Last chance, I can do it this morning or this afternoon.” When my friend asked the difference, the doctor said “This morning is free. This afternoon is next door at the private hospital and I charge $8000.” He went the IMSS route.
Most of the private hospitals are totally or largely owned by the doctors who work there and they are fiercely competitive on price, quality, and service. You can go to any private hospital in Mexico and ask for a price for a procedure and get a price, plus they will gladly give you a tour to point out their equipment and people. In Mexico, you are required by law to post prices of any procedure that is done in the hospital.
There is private insurance in Mexico but it is relatively expensive ($3,000-6,000 per person per year) and works totally different. When you are discharged from a private hospital, you are expected to pay when you leave. If you have insurance, the hospital calls the insurance rep and he shows up with a checkbook. Everyone looks over the bill, the insurance rep cuts a check for his portion, you pay the rest, and the bill is settled. Unlike the US where insurance companies make all kinds of discount deals, in Mexico, everyone pays the same.
One of the major differences I’ve observed is the amount of paperwork here is much lower. I had bypass surgery in the US and got a 42 page bill in the mail. It was just for the blood work over 6 days. When I had hip surgery in a private Mexican hospital, the bill was 2 pages. One listed the 6 doctors that saw me and the other page listed the hospital charges. Neither one was a full page.
The hospital did charge me a 3% service charge because I paid with a credit card and an extra $9.00 for the TV but other than that, the bill was exactly as the rate chart stated.
You see several differences between Mexico and the US with healthcare, especially with the payment system.
In the US, most people who have insurance think of costs in terms of insurance premiums, copays, deductibles, etc. If you have a $2,000 deductible, you know your costs going in. Insured patients rarely know or care about the actual costs.
In Mexico, since most healthcare is cash based, people shop for price and reputation, both of which are easy to find. Also, education is cheap in Mexico, and there is an excess of medical professionals. Doctors with good reputations stay busy. Doctors with poor reputations end up driving taxis.
Most people in Mexico have either Seguro Popular or IMSS as their “catastrophe” backup and pay the little stuff out of pocket.
Drugs work differently here. You can buy almost all drugs without a prescription except antibiotics and narcotics. I pay less today for the same drugs I’ve been taking for years now than I paid a decade ago in the US with insurance. There is a maximum price on each box and everyone discounts 10-30%. The pills are all blister packed so they can’t be tampered with and they are the same manufacturers that sell in the US.
There’s a whole attitude difference between Mexico and the US when it comes to medicine. I’ve had major and minor surgery on both sides of the border, and I like the Mexico side better, not just the cost, the care.
When I had a minor hernia operation at a local clinic, the surgeon had an emergency, and I was late getting into surgery. It was pretty late when the last IV ran out, and the surgeon stopped by and said I could spend the night free if I wanted. I told him I hated hospitals. He wanted to know how I was getting home. I intended to call a friend, I said. He asked where I lived and said he would take me home.
He took me home (only a few blocks), made sure that I got inside ok, made sure that I had everything I needed close at hand, gave me his card with his home phone, office phone, and cell phone, and told me to call him anytime if I had questions or problems. By James Murray for WOLF STREET
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