Most expats know that healthcare in Mexico is generally half the cost of similar services in the United States. But is the quality of healthcare in Mexico comparable to the U.S. and Canada?
According to the World Health Organization (WHO), Mexico’s healthcare system ranked sixty-first out of 190 countries it studied. By contrast, Canada ranked thirtieth and the United States thirty-seventh. Average spending on healthcare in the country is about US$1,062 per capita, which is less than the global average of US$1,273.
To better understand healthcare in Mexico, we spoke with a native son from Michoacán who moved to Chicago at the age of 2, graduated from Indiana University with degrees in Biology and Spanish, received his medical degree from the Autonomous University of Guadalajara, practiced medicine in Chicago and then returned to Mexico to open his own medical practice along the shores of Lake Chapala in 2012.
Dr. Santiago Hernandez is a successful primary care doctor who attends to nearly 1,000 expat patients in his Chapala Med offices in Chapala and Guadalajara.
“I am the medical director and primary care physician and have a dedicated network of medical specialists in my referral network,“ Dr. Hernandez said. “Most of them are board certified in the United States. For example, the ear, nose and throat (ENT) physician was trained at Harvard and the neurosurgeon has had fellowships at the University of Washington.”
Dr. Hernandez said one of the healthcare differences between the U.S. and Mexico is that primary care doctor referrals are not necessary in Mexico, although he has adopted the U.S. practice of vetting specialists and including them in his referral network.
“In Mexico,” he said, “you can find your own healthcare specialist without a referral from your primary doctor. You can also get testing done on your own. If you woke up with a headache and felt you needed an MRI, you could get one without a doctor’s order. That can be a very expensive way to manage your healthcare. At Chapala Med we follow the same standards of care and diagnostic and treatment steps as the U.S. About 90 percent of my patients are expats, primarily from the U.S. and Canada.”
Dr. Hernandez told us many expat come to Mexico from smaller communities and often use colloquialisms that are not in any textbook, which can make it difficult for those doctors not fluent in English or grounded in American culture to understand. He views his roots in America and fluency in English as a significant added value for his patients.
“There is a large percentage of expats in Mexico who do not speak Spanish or have limited Spanish skills and find it difficult to communicate their healthcare needs,” he said. “They also feel somewhat lost in the healthcare system in Mexico and are looking for guidance, and that is what we do. We guide them through the healthcare system to get the best possible outcomes for them.”
We asked Dr. Hernandez if the level of healthcare in the rest of the country is comparable to the Guadalajara-Lake Chapala area.
“Like the United States, the quality of healthcare services vary,” he said. “If you live in more rural areas, higher quality care can be more difficult. But healthcare access in Mexico tends to be better than the U.S. Mexico’s public healthcare system – which includes IMSS and Seguro Popular – is widespread and inexpensive but the sheer volume of patients and sometimes antiquated equipment delivers poorer results.”
Instituto Mexicano de Seguro Social (IMSS) provides both Mexican citizens and expats legally residing in Mexico with medical insurance and healthcare services. Nearly two-thirds of the country is enrolled in the IMSS healthcare program. The service provides complete coverage, including prescriptions, but facilities are often overcrowded.
Seguro Popular is a public health insurance that covers a wide range of services without co-pays for its affiliates. The government of Mexico established it in an effort to expand healthcare to those without health insurance and reduce health inequities.
The best-equipped hospitals in Mexico tend to be in major cities. Dr. Hernandez pointed out San Javier and Puerta de Hierro, two private hospitals in Guadalajara, as examples of medical facilities that have the same amenities and technology that a university hospital would have in the U.S. Some of the larger IMSS hospitals – Centro Medico (civil hospital) – often have the same modern technology. But access to the technology can be painfully slow because of overcrowding at the public institution.
Becoming a physician in Mexico is as rigorous as the U.S., Canada or other developed countries, requiring four years of medical school, a year of internship at a hospital and a year of public service serving as a small town doctor. After passing national medical exams, physicians are granted their medical license.
The qualifications to become a nurse are not comparable to the U.S. A nursing degree in Mexico is considered more of a technical or vocational degree and requires completion of just a two-year program. The overall quality of nursing care in the country generally is very good, according to Dr. Hernandez.
Medical procedures also can sometimes differ from the U.S. Dr. Hernandez believes that often more novel and experimental procedures are used in Mexico.
“We tend to experiment more often with the European school of thought in mind,” he said. “As an example, when a patient is having a heart attack they go into the catheter lab and historically we have put guide wires and stents through one of the vessels in the lower leg to reach the heart. Here, I noticed doctors using the radial artery in the hand, not the lower leg. It is a European procedure that has not yet been widely adopted in the U.S. because of training costs and equipment.”
For emergencies, some expats carry health insurance that pays for an air evacuation to a U.S. hospital. Dr. Hernandez does not believe that is necessary.
“We can handle just about everything locally,” he said. “In fact, in can be problematic in evacuating someone to the U.S. The patient must be very stable and it is very expensive.”
Some retirees on a limited budget return to the U.S for expensive procedures that are covered under Medicare, if they do not carry adequate health insurance in Mexico. Medicare does not cover the cost of healthcare in Mexico, although expat organizations have been trying to persuade the U.S. government to do so for years.
“I had a patient who had severe cardiac problems,” Dr. Hernandez said. “Rather than take care of his problem here, he decided to jump on a plane and fly to a Veterans Administration hospital in Oklahoma because he was living on a limited income. He could not afford health insurance in Mexico, so the overall expense of the procedure was too much for him. It could have been done locally, but the VA was a lower cost solution for him.”
One of the significant differences between U.S. and Mexico healthcare services is cost. Generally, healthcare services are at least 50 percent lower than north of the border.
“I am one of the most expensive doctors in the area,” Dr. Hernandez said, “but my initial visit is still just US$65. The first visit is one hour and it includes a complete medical history workup. Subsequent visits are just US$45. I also maintain electronic medical records for the patient, which is unusual in Mexico. Most doctors require their patients to keep their own medical records.”
If you are looking for the very least expensive medical care, look no further than your local pharmacy. Most provide a doctor in residence at the pharmacy for about US$3. Doctors at pharmacies, though, make a commission on the medications they prescribe for you.
Dr. Hernandez said Mexico is trying to place more medications under government control, much like the Federal Drug Administration does in the U.S. But for now, only sedatives, hypnotics, opioids and pain medications require a prescription from your doctor. If you are looking for erectile dysfunction, hypertension, diabetes and other similar medications, you just have to ask for it.
After four years of building his practice, Dr. Hernandez has good advice for expats in Mexico who are seeking the very best health care.
“Look for someone who will spend time getting to know you and who you can trust to guide you through the healthcare system,” he said. “When you find that person, you can benefit from Mexico’s healthcare system and live a very long and prosperous life.”