Jaltemba Sol

Andres Oppenheimer: Inside Mexico's health care

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By Andres Oppenheimer -

Published 12:00 am PDT Tuesday, July 15, 2008

MEXICO CITY — For several years, this column has championed the idea that Mexico — and Latin America in general — could become a huge medical tourism destination for millions of Americans seeking more affordable health care, or simply wanting more personalized medical attention.

Little did I know that I would be hospitalized for three weeks in Mexico City last month and experience a foreign country's medical system from the inside.

Before we get into my experience, let's take a quick look at why I have maintained that the globalization of medical services will become an increasingly useful option for Americans who can't afford ever-increasing U.S. health-care costs, and a major business opportunity for countries in the region.

U.S. medical tourism to Latin America — India, Singapore and other Asian countries as well — is growing at an annual rate of nearly 20 percent, according to most estimates.

About 180,000 Americans are crossing borders every year for medical procedures such as knee and hip replacements, health screenings or oral surgeries, said Josef Woodman, author of Patients Beyond Borders.

In addition, 400,000 Americans go abroad for "wellness travel" or "alternative therapies," which would bring the total to about 580,000.

Milika Bookman, author of Medical Tourism in Developing Countries, estimates that tiny Costa Rica alone attracts as many as 150,000 medical tourists a year, most of them Americans.

The reasons behind the slow-motion exodus of American patients from the United States is simple: About 45 million Americans lack health insurance, and another 30 million are underinsured. In addition, many others who have insurance go abroad for cosmetic surgeries that are not covered by their U.S. insurance.

A heart bypass — including surgery and a hospital stay in a private, single-bed room — costs an average of $100,000 in the United States, $27,000 in Mexico and $24,000 in Costa Rica, according to Patients Beyond Borders' estimates.

A hip replacement goes for an average of $45,000 in the United States, $11,000 in Mexico and $9,700 in Costa Rica. A face-lift costs an average of $13,200 in the United States, $3,100 in Costa Rica and $8,550 in Mexico.

The stampede of Americans seeking affordable health care in other countries is bound to grow. Over the next three decades, there will be an estimated 100 million American baby boomers reaching retirement age. Many of them will not be able to afford their medical services at home.

As happens in Europe, where German, British and Swedish retirees move to Spain for several months a year in search of more personalized medical care, cheaper living costs and sunnier skies, growing numbers of Americans will move into retirement communities in northern Mexico, Costa Rica and other Latin American countries.

But are these countries ready to provide first-world medical services? Judging from my recent experience in Mexico City, the answer is an unequivocal yes, with a few obvious caveats.

On June 9, while having dinner at a restaurant with two Mexican officials, I suddenly fell ill, tried unsuccessfully to throw up, and blew up my esophagus in the process. It's a rare medical condition, known as Boerhaave Syndrome, with a high risk of death.

To my great fortune, the two officials with me not only called an ambulance, they telephoned a senior official of the Angeles Hospital chain, as well as president of Mexico's National Autonomous University, Dr. Jose Narro, a physician by training.

By the time the ambulance arrived at the nearest hospital — the Angeles Mocel hospital — they had convened a first-class team of physicians who were awaiting me. It didn't take long for Dr. Jorge Salas, the lung doctor who presided over the team, to rule out a heart attack and enlist thoracic surgeon Dr. Patricio Santillan for an operation to remove the more than four pints of gastric fluid in my chest.

After a six-hour operation, I spent two weeks in intensive care and another week in a single-bed room until I was released — with all tests showing excellent results — on June 28. Doctors tell me that I should be back to normal in a matter of weeks.

Throughout this ordeal, the Mexican doctors and nurses couldn't have been more caring, or spent more time with me. From Day 1, all doctors gave me their cellphone numbers, asking me not to hesitate to call them if I had any questions. When they visited my room, they did more than just look at my chart. The team, which included cardiologist Mario Velez and internist Paul Frenk, would spend more than an hour explaining the ups and downs of the healing process.

The nurses couldn't have been nicer. They called me by my first name — I prefer that to the more impersonal "honey" or "darling" often heard in U.S. hospitals — encouraged me to walk along the corridors with them for exercise, and often helped me distract myself by talking about their lives or discussing the issues of the day.

My single-bed room was about four times the size of an average U.S.

hospital room, with a plasma TV and an Internet connection.

"I'm not surprised by what you tell me," Patients Beyond Borders' author Woodman said. "In the estimated 100 hospitals I visited in the last year in Taiwan, Korea, India, Costa Rica, Mexico and other countries, American patients have all said the quality of the treatment was better than what they had experienced in the United States." When I returned to Miami with the Mexican doctors' final reports, and underwent tests at the University of Miami Hospital, the U.S.

doctors' verdict was unanimous: The Mexican doctors had done a superb job.

In fact, their prompt detection of the problem and swift operation saved my life. And the final hospital bill was $42,000 — a fraction of the more than $170,000 it would have cost in the United States, according to UM officials and insurance cost analysis experts.

Of course, there is a major caveat to this story: I got a royal treatment, which other foreigners may not get. My syndicated Miami Herald column runs in more than a dozen Mexican newspapers, my Oppenheimer Presenta television show runs on Mexican television, and several of my books have been bestsellers in Mexico.

And the fact that Angeles chain President Olegario Vazquez Adir and UNAM's President Narro took a personal interest in my case, as did Mexico City Mayor Marcelo Ebrard, with whom I had a prescheduled interview the day after my operation, obviously helped me get special attention.

Medical tourism experts warn that there are both good hospitals and lousy hospitals in Mexico. You can land in a bad one, and you are history (plus you can forget about suing anybody for malpractice).

Before you pick any foreign hospital, you should check the Joint Commission International's list of hospitals that abide by U.S.

standards. There are now more than 160 U.S.-accredited hospitals abroad, including some in Mexico and Brazil. Five years ago, there were only about three dozen outside the United States.

But the medical tourism trend seems unstoppable, and U.S. hospitals are beginning to join it for fear of being left out altogether. A Johns Hopkins hospital was recently opened in Panama, and U.S.-certified physicians perform several operations there at a fraction of U.S. costs.

The University of Miami's International Medicine Institute is looking into investing in a hospital in Cartagena, Colombia, and seeking associations with hospitals in the Dominican Republic and the Bahamas.

While foreigners will continue to come to the United States for highly technical medical procedures that are not available in their home countries, U.S. hospitals will seek to get a slice of the business of simpler medical procedures abroad.

"Medical tourism is making us seriously consider partnering with hospitals abroad," says Eduardo de Marchena, the University of Miami's associate dean for international medicine.

Asked whether ever-growing numbers of Americans will flock abroad for medical treatment, Marc Lippman, chairman of the University of Miami's Internal Medicine Department, told me that he doubts it.

"There is a major reason why that may not be the case, and it is that we are currently in an absolutely unsustainable health care mess in this country," he said, adding that it's "inevitable that there will have to be solutions, and depending on what those solutions are, we may become more competitive again." My opinion: If Mexican doctors and nurses give their regular patients just a fraction of the royal treatment that they gave me, they are offering a much more personalized service than one can find in most U.S. hospitals. Good healthcare with personal warmth could become a major draw for potential medical tourists, and a huge boon for Latin America's economies.