Perhaps one of the most vexing problems we face when moving to Mexico is "What to do about health care?"  Actually, it's a pretty common problem faced by retirees in the USA, too.  Planning for health care is a very personal thing, and certainly one size doesn't fit all.  So I don't have any universal answers, but I have tried to gather some informational resources to help you find the solution that is right for you.  I hope you find it useful.

I have divided the information into seven parts:

Choices

Insurance Companies

IMSS updated 1 March 2014

General Hospitals

Military Hospitals

Medical Evacuation

Pain Medications

Voices of Experience

I am interested in hearing from you about your health care solution that you might want to share with others.  E-mail me at Rolly@rollybrook.com.   

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Choices

Are the following statements true or false?

1.  I plan to live full-time in Mexico.

2.  I am firmly committed long-term living in Mexico.

3. I do not have a pre-existing medical condition or age that would make it impossible (or impractical) to change to a new insurance plan.

If any of these statements is false, you may want to keep your present insurance and Medicare Part B. 

Medicare will not cover you in Mexico. 

Your private insurance plan may or may not provide coverage in Mexico.  Some plans will reimburse you for medical expenses while in Mexico after you file the necessary paper work. 

You may find it easier to self-insure for minor things while in Mexico, return NoB for major things, and contract with a Med Evac service to fly you back NoB for emergencies. 

If all of the statements are true, you may still wish to look north for major medical needs.  However, many (most?) ex-pats integrate their health care with the rest of their Mexican life.  To do this you will need to choose some of these options.

1.  Self-insure.  Office visits and routine tests are so inexpensive that paying these things out of pocket is practical.  Major medical/hospitalization can also be covered by self-insurance, although most people choose to have insurance for that.  (Personally, I have chosen to self-insure.  Since I moved to México in 2000, my health care costs, including one major hospitalization, have amounted to less than I would have paid for insurance.)

2.  Buy a private insurance plan for Mexico.  Major medical/hospitalization insurance is much cheaper in Mexico – sometimes as little as 20% of the cost in the USA.

3.  Buy IMSS insurance.  If you live in an area with a major IMSS facility, you may wish to consider this very inexpensive option.

4.  Buy Seguro Popular.  If you live with a major General Hospital facility, you may wish to consider this even more inexpensive option.

5.  Drop Medicare Part B.  If you are committed to health care in Mexico, you can save several hundred dollars per year by dropping Part B.  An item in the "Voices of Experience" explains why this may be a bad idea.  I dropped Part B.  Thus far the money saved has paid for almost all my self-insurance and drugs.

It is widely believed that drugs cost less in Mexico than NoB.  For most drugs, this is  true.  But not always -- there are some medicines that cost the same or more.  Also, not all drugs available NoB are sold in Mexico;  and, sometimes, drugs are not available in the same strengths.  For example, in the USA I took one 10mg tab per day of a medicine, but in Mexico I could find that drug only in 1 and 2mg tabs.  Now to get 10mg, I spend more in Mexico than in the USA.

Another bright side of buying drugs in Mexico, most are available without a prescription.  Medical supplies (needles, et al) and equipment are also available over the counter.

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Insurance Companies

There are many companies writing insurance for Mexico.  The following six are ones that have been recommended by satisfied users on MexConnect.com.  I have no personal experience with any of the them.

Allianz Mexico, an affiliate to Allianz International. This is a very large company with several coverage options.

Blue Cross/Blue Shield blueexpat.bcbs.com lists affiliated companies that offer plans for Mexico.  You can download a short PDF booklet detailing the plans.

Groupo Inbursa offers a PPN (Preferred Provider Network) insurance program as well as a wide range of non-PPN plans, ranging from the very basic PPN plan to a traditional plan to a "go to the Mayo Clinic for elective medical care" plan (which is expensive). The prices for the plans vary with coverage.

International Medical Group imglobal.com offers world-wide medical coverage.  You may include or exclude coverage in the USA and Canada with corresponding changes in cost.

AXA Seguro (formerly ING Commercial America) has offices all over Mexico. Call them without cost in Mexico at 01-800-001-8700 or from the United States or Canada at 1-888-293-7221. These number are for their "Centros de Atenciones" where you can be forwarded to a local agent.  Local agents are also listed in local phone books.

HCC Medical Insurance Services  has a number of policies you can apply for online. They have options for Worldwide or Mexico only policies. They are licensed in the state of Indiana. An obvious advantage to purchasing coverage from a company based in the US is that the policy is written in English.

Based on the comments I have found, AXA (ING) and Groupo Inbursa seem to be the most popular.

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IMSS

Instituto Mexicano del Seguro Social, IMSS, is the Mexican social security system.  Among other things, it includes an extensive, country-wide HMO-type health care system offering free out-patient clinics, hospitals, and drugs.  Membership is automatic and free for employees of covered businesses (which is most companies).  It is available for very low annual fees to everybody else including foreigners holding a visa card (not a Visitante).  The cost depends on age. 

The out-patient clinics are notorious for over crowding and long waits to see a doctor -- not unlike many HMOs in the USA.  For this reason, people who can afford to see a private doctor do so rather than going to an IMSS clinic.  Often it is the same doctor who could be seen in either place.  Many doctors split their days between IMSS and their own offices.  This provides the doctor with a steady income and, importantly, a good retirement benefit. (Doctors in Mexico rarely make nearly as much money as doctors NoB.)

The free drug program is often rather hollow due to the lack of funds to stock the pharmacies.  The IMSS free drug coverage only applies to drugs from their pharmacies; there is no reimbursement for drugs purchased outside the system.  The drug program also covers immunizations (flu, etc), and those always seem to be available.  Flu shots are generally available free to anyone over 55 whether a member of IMSS or not.  In my town each fall/winter, health care workers go from door to door giving free flu shots.

The IMSS hospitals vary from pretty plain in smaller communities to outstanding in the larger cities.  Most expats who join IMSS do so for the hospitalization benefit, not the out-patient clinic or the drug program.  As with the clinics, the hospitals are staffed with both fulltime doctors and private physicians who share their time with IMSS.

Look here for information about joining IMSS.

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General Hospitals and Seguro Popular Insurance

Most cities have a General Hospital to serve those who do not have IMSS coverage and cannot afford a private hospital.  Some are rather plain vanilla, others are excellent and may be better than the IMSS down the street.  Access to the General Hospitals is through Seguro Popular.

Seguro Popular is a basic health insurance plan that pays for services at the General Hospitals. It is a very low cost health insurance program sponsored by the federal government for anyone who does not have a health insurance program such as IMSS.  Non-citizens are accepted. Unlike IMSS and other insurance plans, Seguro Popular does not exclude pre-existing conditions, and no physical is required.  The policies are issued for a three-year period and can be renewed.  The policy only covers services at the General Hospitals.

Application can be made at your local Seguro Popular office.  You will need the original and a copy of these:

a utility bill showing your address

your CURP card

your visa card and passport

There is no charge for the application

The cost for this insurance is very low -- anywhere from free to a couple thousand pesos.  Check with your local office for the exact cost.

Military Hospitals

Military hospitals are far less common than General hospitals.  They are open to the public on a space available basis.  They are considered to be superior to most IMSS and General hospitals.  They cost more than General hospitals but considerable less than private hospitals.

Non-citizens may use the Military hospitals.  No prior qualifications or other paperwork is required.

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Medical Evacuation

There are many companies offering emergency medical evacuation.  Before choosing a company, read the details of coverage very carefully.  There are considerable differences among policies, and it is easy to buy less than you think you are getting.  Here are two interesting ones.

Global Underwriters http://www.globalunderwriters.com/ has a variety of policies for various parts of the world.  Be sure to read their exclusions.

This question was posed to www.SkyMed.Com:  "I am a US citizen living full time in Mexico, can I purchase an annual SkyMed family or individual policy that would provide an evacuation for me to my former US home/hospital?"

SkyMed's response was:

"We have a separate product for ex-pats that actually provides dual coverage. We would air evacuate you from your home (hospital) in Mexico to the States for medical care. Or, if you were traveling within our covered areas and you were hospitalized, we would return you to Mexico upon discharge. This is vastly different from our basic product, that stipulates you must be traveling and 100 air miles or more from your home."

The policy covers more than just México.  You are covered while in the USA, (including Alaska & Hawaii), Canada, the Caribbean, Belize and Costa Rica;

For permanent residents, the cost for an individual is $595/year, and for a family, $995/year, plus a one-time application fee.

For snowbirds – six months or less in Mexico it's 249 a year for an individual and $499 for a family.

Short trip coverage is available.  Contact Cathie Smith for details.

Prices updated 1 March 2014.

Cathie Smith LoCicero is the VP Latin America for SkyMed cathie.smith@skymed.com toll free number in the USA 1-866-460-3486.

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Pain Medications

Chronic pain suffers should be aware that getting Class 2/Schedule II pain medication (either natural or synthetic narcotics like Oxycontin and Methadone) is difficult in Mexico. But it is not impossible, and with a little preparation, you should be able to get the medication you need.

Generally, only doctors specializing in pain management and having narcotics certification can prescribe such drugs in Mexico, and they are not that common, even in cities. For example, there are only three in Guadalajara as of this writing. So it would be wise to locate one before arriving, or at least to establish that there are some in the area you’ll be visiting. This may not be as easy as it sounds as local doctors do not always know of the existence of such narcotics certified doctors. When you do find one, be prepared to show proof that your need for the drugs is legitimate - these drugs are dangerous and have a history of abuse. Mexican doctors, like their US and Canadian counterparts, are duly cautious. Recent prescriptions and medical records should suffice.

Finding pharmacies that carry the drugs is also a challenge – again, cities are the best bet. Your US prescriptions will typically not be accepted in Mexico, so you will need to get prescriptions from a Mexican doctor.

Class 2 drugs tend to be more expensive in Mexico than in the US. The premium over the US will likely vary by Mexican state and drug; however, experience in the Guadalajara area is indicative – Methadone is about 8 times more expensive there than in the US. If the drugs need to be shipped to you from a major city, the premium will be higher – there is the case of someone in Puerto Vallarta paying $300 to have a 30-day supply of Percocet sent from Guadalajara.

A short list of Schedule II drugs: Cocaine, Codeine (standalone), Morphine, Oxycontin, Oxycodone, OxyIR, Percodan, and Percocet

If Codeine is mixed with either aspirin or acetaminophen (as in Canadian 222’s), it is a Schedule III drug.

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Voices of Experience

From the internet I have gathered a few little stories about encounters with the Mexican health care system.  They have not been especially selected to present a positive view, that's just the way it is.   Health care in Mexico is widely perceived to be more patient friendly than NoB for a great deal less money.  That has been my own experience as well.

I'll begin with my own story:

I was having serious breathing problems.  It had been getting worse over the past five days, finally forcing me to call my doctor.  After hearing the symptoms described over the phone, the doctor order me to go to Hospital Angles across the river in Torreón and gave me the name of a cardiologist affiliated with the hospital.  He said it is the finest private hospital in the area.  The hospital looks like a four star hotel, complete with a porte-cochere with a uniformed attendant who whisked me away in a wheelchair through a grand lobby and atrium to the urgent care area where I was met by an English-speaking doctor, a male nurse and a couple stout orderlies who helped me on to the gurney and hooked me up to oxygen. 

The English-speaking cardiologist arrived shortly on a late Saturday afternoon. Then started the rounds of tests, x-rays, EKG, various injections, and, of course, that damn IV. in my bad hand. He confirmed what my local doctor had surmised; I had suffered a pulmonary embolism, and it was life-threatening.

He ordered me admitted to the hospital. After presenting my US credit card to the admitting office, I was wheeled up to a very nice room which, in Mexican custom, had a pullout bed for family. I wanted my friend Enrique to go home, the nurse said no, he needed to stay because my condition was unstable, and I should not be left alone. Gad how he snores!

The food was good and always more than I could eat.  I was allowed to order each meal from a menu printed in both Spanish and English.

The nursing staff did not speak English, and my Spanish is a bit meager, but we managed just fine.

In my four days in the hospital there were more shots and pills than I can remember, two more EKGs, and a very interesting sonic scan of the heart.  My doctor set the screen so I could watch the scan.  Very interesting.  The left side of my heart looked like other pictures I had seen, but the right side was obviously not OK.

I am self-insured, so I was a bit worried about all the high-tech stuff in this palatial hospital and a high-powered cardiologist.

The hospital bill was about US$2,800, and the doctor wanted only US$350 for his services including lengthy, unhurried visits twice each day.

My plan to self-insure still seems to be working. I have spent less on medical care in the past 8 years than insurance would have cost.  In fact, it has all been covered by the money saved from dropping Medicare Part B.

If you have to get sick, Mexico is a good place to do it.

What seems to keep me coming back down to Lakeside (other than I love it here) is the extremely favorable cost of medical services here.

In 2007 I came down 'just' to get a crown replaced. This was after my Colorado dentist said, "Of course we can replace that crown you just lost. I can get to it in 6 weeks and it will cost $1,100". I hopped on a plane ($375) and had that crown replaced here for $160US. Got it done the day after I arrived and got a vacation to boot. Saved $500 in the process.

I am here now having chosen to have some elective eye surgery in Guadalajara by a very good eye surgeon at a very nice hospital. Airfare was $400. Surgery was $19,000 pesos including the hospital. Couple of trips to Guadalajara $100 pesos. Total around $2,400US. I was quoted $5,600 by a Denver surgeon.

My wife got a root canal at 1/3 the cost here and a bite-plane night guard made-to-order for $185US instead of the $585 her dentist was going to charge her. She broke even on her trip but got 10 days in paradise for her efforts.

One night near midnight, I fell in the bathroom and broke a rib.  I was in great pain and certainly did not feel like driving to an emergency room.  I didn't know any doctors, so I called my neighbor who went for a doctor who came right over.  He examined me and confirmed that I had indeed broken a rib.  He gave me a pain shot and a prescription for pain pills and suggested that I come to his office the next day for an X-ray.  The cost for this late night house call and pain medicine was $150 pesos (about 15 US dollars).  I had broken ribs before, so I was not concerned about going for an X-ray.  When I didn't show up at his office, the doctor came back to my house to check on me -- no charge.  When did such a thing ever happen in the USA?

I have had two other late night house calls for $150 pesos.  Office visits have been $100 to $150 pesos.

On another occasion, I had not had a heart check for several years, so I went to see a board-certified cardiologist.  He did a very complete exam, including an EKG, for $500 pesos (about 50 US dollars).  I was able to go directly to this specialist without having to be referred by my family physician.  You can't do that NoB.

I had great dental care in Playa del Carmen.  Walked in off the street to a brand new office, a branch of an established office in Cancun.  3 hours later I had a root canal, complicated base preparation, and impression for a crown.  Very professional manner, quite gentle technique, English good enough to explain everything and answer questions.  10 days later I had a porcelain crown made by a lab in the States. $420 USD total.

Question: I've heard about the excellent private health care available in Mexico. My question is whether it is necessary to pay cash up front before receiving services from private doctors or hospitals? In the case of an urgent or emergency situation, this may not be possible, as one would not be stopping at an ATM to withdraw cash on the way to a hospital or doctor in this situation. Are credit cards accepted in private hospitals or for private doctor visits, if urgent care is needed?

Answer: Usually, in an emergency, there are friends or family around to make the necessary financial arrangements. It is not unusual for a doctor to actually transport the patient to the hospital in his own vehicle and make whatever deposit is required*. Unlike many places NoB, the emphasis in Mexico is on 'care' for the person; details can be worked out later. However, after the 'stabilization' and 'first aid' are completed, there may be a need to arrange for payment if a hospital stay, surgery or other additional care is required. Yes, many hospitals will take your credit card or even your personal check. Remember, checks just don't bounce in Mexico, unless you like Mexican jails as your next place of abode while you 'make good.'  It is, therefore, a good idea to carry a check in your wallet for an account in which you keep emergency funds; or, perhaps, one of those checks which actually creates a loan against your credit line.

*Rolly's note: This is a good example why is it wise to establish a relationship with a doctor in your community.

We have a friend who last year was in an auto accident and severely injured, he ended up at a private hospital in Guadalajara and ran thru money like it was water. We came to find out in talking with his various physicians over our visits for several months that each of those physicians have a connection with the civil hospital and do their IMSS time. The reason is that they will eventually be eligible for a full salary pension from the Mexican government after 20 years of service. Both of his primary physicians said the outcome would have been similar if he had been treated at the civil hospital. And they told us for really serious emergencies that is the best first stop even if you change to a private hospital later for the more recuperative stages. Our interest in the IMSS is for traveling around Mexico, if you can't communicate because of illness or accident whomever is treating you will know you have IMSS.

We know two people who are having their cancer treatment thru IMSS and have been for several years, they found their physicians privately and those physicians agreed to treat them thru the civil system, it has worked well for them. One does pay her physician "under the table" and the other does not. But both private practice physicians had privileges at the civil hospital and were willing to negotiate with the hospital on behalf of these patients to have the medicines available. These people have been in Mexico a long time.

I had a serious bleeding ulcer and went to IMSS. It took 3 pints of blood and a week in the hospital to save my life and get me back to "normal". Total cost ZERO. I have no idea what the cost would have been in one of the private hospitals but I think if I had had to go there we would have been eating beans and tortillas for a long time.

I promised I would report on our IMSS “experience” after my husband survived his hernia repair. It HAS been an experience and we have learned a lot. Here goes:

He got the hernia in early December. Since it wasn’t painful, we decided to view it as an opportunity to “learn” the IMSS system.

We started in Chapala with the early-bird crowd at 7:00 am. It took two trips like this to finally get an appointment to see a doctor. I speak enough Spanish to communicate…..my husband speaks NO Spanish. We have a very good friend and candidate for sainthood who speaks fluent Spanish. Having a translator is ABSOLUTELY ESSENTIAL in Chapala because we never did find anyone who admitted to speaking even minimal English. Once he got in to see the doctor, the diagnosis was obvious, and we were told to come back yet a 4th time for a paper that would transfer him to Guadalajara. Four visits=one appointment. By this time it was the first of January.

With this magic paper in hand, we managed to find IMSS #89 by (you guessed it) 7:00 in the morning. We got to see a doctor around 10:00. He was very professional, spoke a little English, and had an intern with him who spoke fluent English. He wrote ‘prescriptions’ for blood work and an EKG and told us to come back when that was all done. Bloodwork = come back next week. EKG= come back the week after that.

We were really glad his condition wasn’t life threatening.

At this point in the process, I screwed up and cost us another 2 weeks. I assumed (never assume) that once we got the lab work done, the appointment with the doctor was assured. Not so. EVERYTHING goes through the reception area. When you get there, you check in and get your card stamped. Before you leave, you check in again and get your next appointment. By the time I realized what I hadn’t done, we had to make one more trip just to make an appointment.

The next trip (is this the 8th or the 9th??) we took our saintly translator and were determined to get surgery scheduled. At some point in the morning, ST discovered that we were being passed over for appointments and raised hell at the reception desk. We got in immediately. Surgery scheduled for a month later.

Sure am glad this isn’t life threatening.

It is now February 25th and we (hubby, me, and saintly translator) are at the hospital at you-know-what-time. This is another one of those times when having a translator is ABSOLUTELY ESSENTIAL By 7:30 he (the patient, not the translator) was dressed in a cute little green gown standing around with a group of similarly dressed people of both sexes. A roll of masking tape was passed to tape the back of the gowns more securely. At 8:00 the whole group was taken into pre-op and the family and hangers-on were told to wait outside for ‘a few hours’.

That ‘few hours’ turned out to be twelve. NEVER go to any IMSS facility without a book or two. At exactly 8:00 that night, they finally said they had a room for him. Surgery had been done at 9:00 am. and he had been in post-op since that time. I was exhausted, so I tucked him into bed with the two pillows I’d brought, made sure he had water, his glasses, his cell phone, and his clothes. Then I went home. The next morning, at 10:00 he was released and had to occupy a bench for an hour until I could get back in to get him.

When we got back home, he told me he had been given a prescription for pain medication and antibiotic. NOW he tells me. Oh well, I can get it filled at IMSS in Chapala…..NOT! Prescriptions HAVE to be filled where they are given to be covered by IMSS. Rather than make another trip to Guad, I took the paper to a local pharmacy and got it filled. I also discovered that he was in possession of a paper instructing him to go to reception and make an appointment for a follow-up. We’ll have to go back to Guad to do that next week.

Time from first appointment to surgery: 12 weeks
Total cost medical: Zero
Total other cost: About two tanks of gas running back and forth.

Analysis: I found myself comparing the IMSS hospital with our county hospitals in the states……think Parkland or Cook County. One big difference is that in the states, security is as big a concern in county hospitals as medical care. Metal detectors on all the doors, armed guards in the parking lots etc. I always considered Parkland to be a filthy hospital. Compared to that, #89 was squeaky clean.

The medical care at IMSS was impressive. There were doctors all over the place and med students everywhere. Many of the students spoke English and there were quite a few from other countries. Apparently they can do their internship in Mexico and then transfer to a school in the states (somewhere in New York) for their residency. Then they are licensed to practice in the states. Everyone at the hospital was very kind and helpful. The dreaded "night nurse" did not exist.

There is no nursing care as we know it at IMSS. If a patient is incapacitated, he or she needs to have someone with them to attend to nursing duties. Don was ambulatory, so I left him alone for the night. He said his only problem was having to track down a urinal.
Sounds major to me.

So are private insurance and a private hospital better than IMSS? Absolutely!! Is IMSS better than nothing? Absolutely!! Is it better than Medicare? Right now I think they are about equal except that the quality of medical personnel at IMSS is far better than the Medicare doctors I’ve met.

As far as cost goes, I estimate that Don’s surgery would cost about $12,000.00 in the US. According to our niece-the-hospital-administrator, Medicare would allow about 70% of that. That’s $8,400.00. Then they pay 80% of the allowable. So Medicare would pay $6,720.00 and we would be responsible for the remaining $5,280.00. That’s why you have to buy supplemental insurance.

Although we have not had any major procedures performed here in Mexico, our experiences have been quite encouraging (wife's broken ankle; food poisoning requiring an overnight stay in a small, Morelia hospital).  Our local family doctor charges us $100 MXP a visit; specialists ran as high as $700 MXP.  The part about Mexican doctors taking time to listen and explain things has, in general, been true in our experience.  In the US, a visit to our doctor would entail long times in the waiting room, long waits in the exam room, nurses who never could seem to remember or to be able to look up one's medications, and an actual physical exam that was usually perfunctory and hurried.  Here, the reverse has been true.

A friend of mine in Guadalajara needed an MRI -- she'd put it off in Canada because the system for getting it was so unwieldy.  In Toronto, they'd estimated 9 months before she could get the appointment.

She noticed an MRI clinic on a street near where she was staying here in the city.  She walked in and asked how long the wait might be before she could get an appointment. The receptionist glanced at his watch and asked, "Can you wait 20 minutes? I'm sorry it will be so long."

We have ING major medical policy for Mexico with emergency coverage when out of Mexico -- no matter where in the world – up to US$50,000 (dollars). The US$50,000 is intended to cover you in an emergency and give you an opportunity to get back to Mexico for primary treatment.

We just paid our annual major medical premium today. I am 64 and paid $13,2740 Pesos and my wife, who is 59, paid MX$10,867Pesos for a total annual premium of MX$24,141 (pesos) (or about US$2,200 per annum/$183 a month) with a MX$25,000 deductible. That is for the "Cliente Especial" coverage which includes a private suite for hospital stays in top hospitals of my choice.

I figure similar coverage in the U.S. would cost me at least six times that much in premiums - probably more -- and the hospitals in Guadalajara are a hell of a lot nicer than any hospitals I have seen in the U.S.

While NoB, my wife developed a serious problem with her eyesight. She went to a couple of specialists there. While escorting her, one looked at me and said I also have a problem. A thorough exam established that a red dot in the middle of my eye was about 50% likely to be cancerous.

Naturally, I thought that it was a good idea to see about it right away, have it cut out, biopsied, etc. He agreed, however, his receptionist blandly told me that they had no openings for two months. The doctor confirmed it.  Evidently, its no problem if they don't have time to deal with it.

Back home in Mexico my wife experienced some symptoms that made her concerned about a heart attack.  We went to a highly recommended heart specialist that afternoon, who checked her out, assured her it wasn't serious, but gave her his home phone number.

I think that this typifies the basic difference -- along with cost, quality of care, etc.  You can get prompt service in Mexico, and it is good care.  While Medicare may pay for our care NoB, we will have problems getting the care in a timely manner, and the cost of getting there and arranging our lives around their convenience make it much more unlikely that we will receive the care we need.  Mexico does it much better.

I have one comment about giving up Medicare Part B.  I have friends who moved to Ajijic "forever."  They did not continue their Part B.  They had an excellent Mexican major policy with NY Life.  Then, he had a stroke.   He was very happy with his insurance as far as paying for all his medical expenses. But the stroke affected his speech and language centers, and what he could not get here was S&L therapy in English.  In order to get that important need met, he would have to return to the US.  It required a stiff penalty to buy back into Part B, and a waiting time before he could go back for what he needed.  So, I do not recommend giving up any part of Medicare; you just never know.

I'm not about to debate U.S. doctors vs. Mexican doctors but all of our experiences have been good so far.   Private practice doctors take us right away.  Our son’s dermatologist was charging 250 pesos a couple of years ago but I understand it's now 300.  My wife's doctor charges 300 pesos for an office visit including exam.  100 pesos without exam.  Seemed like she is well known and respected in this city, so we feel like we made the right choice.

We have never used the IMSS, but most of our relatives use it for out-patient services, and they complain about long waits to see a doctor and follow-up appointments being set way into the future.  I have a friend who lives in Mexico full time.  He has IMSS insurance.  They diagnosed his prostrate cancer, and operated on him in their Guadalajara hospital.  He has been going back on a regular basis to be checked.  To date, the cancer has not returned and all is well.  He is very happy with the treatment he received.

I recently visited a doctor at the Hospital Los Angeles del Carmen, a medium sized private hospital (one of the best in Guadalajara). The place reminds you of a hotel when you come in -- clean, quiet and certainly considered to be one of the nicest and most advanced hospitals here.  It is not exactly cheap to stay there, but it is much cheaper than anything in the United States!

A 2-day childbirth program including 2 nights and all hospital fees and meds, except for the gynecologist, is 13,000 pesos (about US$1,300).   In the USA today you cannot even get a shared bed in a room with 2 other people for less than US$1500 a day in the US.  A visit to the emergency ward here at this hospital, with complete blood and urine tests, costs around 540 to 600 pesos, compared with entering an emergency ward in the United States where you could easily pay US$1000 or more.  A woman I knew got glass in her foot in Massachusetts, drove to a private hospital, and still waited for more than 6 hours to be seen and treated.  Total cost: US$2600!  In Mexico is would probably been less than US$100.

The Economist magazine last month had an extensive article on the United States' looming health crisis, and the fact that 50 million Americans have no insurance, companies are cutting back on health benefits, and the cost of insurance and/or treatment has completely gone out the window.  Not so in Mexico.

I recently decided to go for a minor emergency to the Hospital General in San Miguel rather than the private Hospital de la Fe.  I was charged $61 pesos (US$6) for the ER visit that included an EKG.  For the same care I would have paid probably US$1,000+ in the States, and probably US$150 at the private SMA hospital. The government hospital even rounded up an intern who spoke English!  This hospital is moving into a new 60-bed building later this year. It is supposed to be a Level 3 hospital with MRI and CAT scan equipment, capable of doing everything short of such complicated procedures such as a liver transplant.

For those who decide to go back to the States temporarily for something major, consider the costs of maintaining two households while you're in the States  plus the travel and higher food expenses.

I was reluctant to change doctors when I first moved from Mexico to the USA.  I traveled to Mexico for medical checkups (dentist, ob-gyn, etc). My friends insisted I was being silly since I am insured I should start going to the doctors here in the USA.

Dealing with a number of American doctors -- two general MDs (visits for checkups and treatment of colds and flu) and two ob-gyns for me, plus a pediatrician and orthodontist for my daughter -- I have been constantly disappointed and even angered, so I am quitting American medical attention for good and returning to my old practice of traveling to Mexico to get treated.

Here in the USA, our insurance company seems to be on a quest to charge us for the weirdest things way after the fact, springing unexpected charges on typical medical visits that should be covered.   The co-pay is what I would normal pay for a whole consult with a reputable doctor in Mexico, and I won't even go into the price of medicines here compared to Mexican prices.

Health care in the USA makes me feel like a moving part in an assembly line.  I'm made to wait hours before I get to see a doctor who'll spend no more than a minute with me.  I end up feeling like I didn't even have a chance to explain what was wrong.  I didn't get a thorough check-up or pertinent advice.   Not to mention not prescribing something on an emergency situation through a phone call, no home visits, no follow-ups, no bedside manners, no seeing a specialist before being referred by a general doctor first, nothing.  Mexico is completely different.  The doctors care about you.

I know a number of doctors who studied medicine in Mexico and practice in the USA with much merit and recognition, or that study in the USA and go back to practice in Mexico.  Mexican doctors seem better-prepared in dealing with infections and other ailments much more common in Mexico.

I spend most of my life in a small village in the mountains SE of Puebla.  My best friend, mi compadre, is a doctor.  I talk a lot to him about medicine. He is an ob/gyn specialist around 40 years old.

He told me Mexican doctors can move to the United States as follows:

1. Study English intensively and pass a test, he did not say, but I assume it includes written medical English as well as spoken.

2. Once they pass the English test, he claims they must go to the US embassy in DF and take the same medical boards as the US doctors.

I asked him how often he lost a patient.  He shuddered and said never!!  He says if anyone dies in his care, there will be a government investigation, and if he made a mistake, even a small one, he will lose his license -- and all his patients would go somewhere else.  Has anyone seen the statistics how many people die in the States from doctor error?  And, almost never does a doctor lose his license for killing a patient.

When he first got Internet, he had an ob/gyn patient who had an infection.  He did what he thought was the correct treatment, but was worried that he might have missed something.  He asked me to help him, I found a paper from Johns Hopkins which discussed that exact problem.  He read through the solution, and was quite relieved to know he was doing everything.

A few years ago, on one of our ventures SOB, I picked up a case of dysentery (scary thing!) and asked our hotel clerk for advice re a doctor. He told me that in Mexico, a pharmacist acts as an "assistant doctor", especially in emergency situations. This was in a small coastal village, and a day's trip by bus away from a real doctor. We went to the local pharmacy and he explained to the pharmacist the problem, and the pharmacist said, "Do you want a single shot, or 3 days of pills?" I choose the pills, and in two days there were no signs of the dysentery - pills were something like $7, w/o a prescription, of course - shot was $10, no other charges.

When I got home, I told my doc of the experience and showed him the pill bottle. He told me that if I had dysentery while under his care, this was the exact med he would have prescribed - but in the US, it would have cost at least 4xs as much!

Having spend some years in Med School and currently working in the American pharmaceutical industry, my opinion is that the top Mexican doctors are equal to the top US doctors simply because they have studied in the same schools, practiced in the same hospitals (Mayo Clinic, Johns Hopkins, etc), they receive the same continuous education and they have access to the same technology.  The difference is that when Mexican doctors return to Mexico they charge less than they would in the US, although they certainly are more expensive than regular doctors with domestic-only training.

Many Mexican top specialists are internationally recognized. For example, I know several who are often called from the US, Europe or Australia to perform surgery or to give courses at top schools and healthcare institutions. (One of them is a neurosurgeon from Veracruz. He invented a revolutionary surgical technique some years ago that is now used worldwide.)  Another advantage is that doctors in Mexico, no matter how expensive they might be, dedicate a good share of their time working part-time at governmental institutions like IMSS, and not only in small neighborhood clinics but in the high end national specialty centers like Instituto Nacional de Nutrición, Instituto Nacional de Cancerología, Instituto de Cardiología Ignacio Chavez, etc.  The good thing about these centers is that you can receive the best healthcare available by world standards for little money, the downside is that these hospitals have a huge demand (a lot of patients from all over the country come to Mexico City to be treated for serious diseases like cancer, complications at advanced stages of AIDS and other immunosuppressive diseases or to receive organ transplants), so it's often necessary to wait for long periods of time to get an appointment or scheduled surgery. However, you can also see these specialists at private hospitals and it would be less expensive than in the US.

Regarding not high-end but regular average doctors I would say the average US physician is better trained than the average Mexican physician but as others have mentioned:

1) Personal attention is generally better in Mexico.

2) For not so sophisticated medical procedures/diagnosis the difference in training is hardly noticeable in praxis.

3) The US has its fair share of appalling doctors, so an American training is not necessarily a guarantee of quality or even competency.

4) For serious disease and complicated treatments, internationally educated Mexican doctors are as reliable and competent as their American counterparts for less $$$$.

The only thing definitely better in the US are experimental treatments and clinical trials.  For instance, the experimental cancer treatments you can receive at Mayo or MD Anderson is something you can't get in Mexico.

I was on the research faculty at University of California San Francisco Med School for a while and have had the opportunity to observe medical training here in Mexico.  Speaking in very general terms, the US med school students are better educated and the training is more rigorous.  In the US, doctors have much more opportunity for continuing education.  Having said that, the average doctor in the US seldom uses the advanced training and equipment for most of his/her patients who get better with the "tincture of time."  I think that for a high percentage of cases, the private Mexican doctors are adequate and certainly are more giving of their time.  For the conditions with which they have practical experience, they are quite good. For the most crucial medical care, I would probably want to return to my very expensive providers in the US.  On the other hand, if the result was simply to prolong life without consideration of quality of life, I might reconsider.  Many Mexican doctors are more than adequately trained and have advanced skills and equipment, but generally speaking they are not quite as good as their US counterparts.  There is considerable overlap and many medical doctors in the US are inferior to their Mexican counterpart. 

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