Patients Without Borders

by Mary Cuddehe | September 11, 2009

Ciudad Juárez, Mexico, is a bleak, dusty factory town across the border from El Paso, Texas. Long a nexus for drug runners vying for control of smuggling routes, it has earned a reputation for gunfights, abductions, and murdered women. In recent weeks, the violence fueled by drug cartels has spiked, and not for the first time. There have been beheadings, public shootouts, and murders of dealers, police, and bystanders. The U.S. Consulate has issued a travel advisory for the area. And, in the midst of all this, Juárez has a message for you: Looking for a good deal on heart surgery?

The city of 1.6 million is one of a few Mexican border towns quietly promoting state-of-the-art hospitals that cater to international patients--Juárez has five such facilities--and betting that refugees from the tattered U.S. health care system will come. On paper, at least, the numbers look promising: According to a 2008 study by Deloitte LLP, 750,000 Americans traveled abroad for medical care in 2007. That number is expected to reach six million by 2010.

This past spring, around the time Mexican President Felipe Calderón sent thousands of troops to Juárez in an attempt to quell a surge in violence, I met with Alvaro Navarro. The director of economic development for Juárez, he is the man pushing the city’s medical-tourism dreams. Tall, handsome, and seemingly undeterred by the long odds, Navarro works out of an office in one of the city’s few modern glass buildings. As he described it to me, the plan was simple: Woo tourists--at last count, Mexico was among the world’s top ten destinations--to come for medical procedures and help them arrange sightseeing trips while they are there. He spoke in the sly tone of a man who’d just gotten in on the ground floor of something really huge. “Medical tourism--it’s going to be bigger than the maquila,” he said, referring to the foreign-owned factories that dot Juárez. “The United States is the biggest client,” he went on. “Or, should I say, the biggest patient.”

Navarro escorted me to a conference room to show me what he meant. His assistant, a young, pretty brunette, switched off the lights and guided us through a slideshow. A jumble of PowerPoint charts and graphs compared prices in Mexico with those in the United States and Asia. Mexico fell somewhere in between. A heart-bypass operation that runs $130,000 in the United States would be about $9,000 in India and $25,000
in Mexico. But, add a $1,200 plane ticket, a 30-hour round-trip flight, and the cultural foreignness factor to the mix, and driving to Mexico might just beat flying to Asia. The presentation ended with a preview of Juárez’s new but still rudimentary and Spanish-only website, which Navarro said would eventually serve the entire border area.

With millions of dollars in government support and private capital, other Mexican cities--places like Tijuana--are also gearing up to attract patients. The private-public nature of this venture sidesteps what some experts say is a pitfall that developing nations, where millions often don’t have access to proper health care, can face. “The last thing that the government wants is to be seen investing in medical tourism, which is health care for [the] rich, while domestically, they are not providing sufficient health care,” says Milica Bookman, co-author of Medical Tourism in Developing Countries and an economics professor at Saint Joseph’s University in Philadelphia. Though Mexico constitutionally guarantees the right to health care, underfunded public health institutions tend to offer substandard care, and many Mexicans can’t afford the private alternatives.

 

 

To lure American patients, Mexican hospitals are widening their menu of services to include procedures like hip replacements, heart surgeries, and gastric banding. (Americans have traditionally traveled there for bargain dental crowns, tummy tucks, and nose jobs.) They are also working to increase procedural transparency, a key to winning accreditation from the Joint Commission International, the global arm of the organization that accredits U.S. hospitals.

Americans are learning about all of this online, then organizing trips themselves or contracting with medical-tourism brokers. Last December, Sue Nagy was laid off from her job as an office manager. The 47-year-old from Waukegan, Illinois, didn’t have insurance to cover a $60,000 cardiac ablation, but a three-year-old start-up, WorldMedAssist, put together a trip to Tijuana for $12,000. “Half of my family were like, ‘Good idea,’ and the other half were like, ‘Are you crazy?’ One friend said, ‘You can’t drink water there; why would you have surgery there?,’” says Nagy, recalling the hospital’s “beautiful” terrace where she convalesced and the two-night stay at a luxury hotel that followed. “It all worked out much better than I could’ve expected,” she says. “I got good care.”

Nagy was treated at Hospital Angeles, which belongs to Grupo Angeles, the largest private chain in Mexico. When the hospital opened three years ago, 70 percent of its patients were American. Carlos Zavala, the hospital’s business development director, told me that, despite a recent drop in numbers, his company had opened an office in San Diego with the express purpose of signing up Latino patients. “We have to go after that market. ... We are two hours from eight million Mexicans. To us, that’s the future,” he said. As for the unchecked violence, Zavala wasn’t too concerned, calling it isolated: “Mexico has always had drug violence. It’s not unknown. Most people that actually have come to Mexico understand--and they do feel safe.”

Insurance companies also see an opportunity. Aetna, WellPoint, and other providers have launched pilot programs offering global options. “Two thousand dollars a day goes a whole lot farther in Monterrey than in Michigan,” says David Boucher, the president of Companion Global Healthcare, a subsidiary of Blue Cross Blue Shield South Carolina that calls itself a “medical travel facilitator” for individuals and businesses. Boucher says his company has signed up 185 employers since 2007. “I’m not gonna blow smoke, but it’s been very consistent,” he says. “Three to five years from now, many Americans . . . will have a global health care option.

Whether the Zavalas and Navarros of Mexico get to see their dreams lived out will depend in part on how many of their hospitals can win international accreditation, and also on how effectively they can sell their brand. Of course, the bigger determinant will be whether the violence ever abates and how the country is perceived as a result. Hip replacements at cut-rate prices will only appeal so much if Juárez and other cities can’t shake their gangland image.

 

Mary Cuddehe is a writer in Mexico City.

 

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