With its beautiful views, delicious food, and warm climate, Mexico is an attractive destination for expats and holidaymakers from around the world. Those settling in Mexico from abroad can enjoy an exceptional quality of life with a relatively low cost of living.

The country is especially popular as a retirement destination for Americans and Canadians, alongside medical tourists drawn to the excellent quality of private care available at a more affordable rate than in many other regions.

As with many warmer countries, there is a risk of mosquito bites and travel advice suggests that visitors to Mexico take precautions to avoid this if possible, although the Zika virus, malaria, and dengue fever are usually concentrated in certain areas at specific times of the year.

Healthcare system in Mexico is a three-tier model

The healthcare system in Mexico is a three-tier model, comprising a very basic level of care available to nationals without an income; care provided by the Mexican social security system (IMSS) funded partly by employees and partly by their employer and also open to expats and their dependants; and then there is the private sector.

Within the IMSS, coverage includes general practitioner and specialist consultations, hospital care, medicines, dental care and standard tests or examinations. It also provides some income replacement for up to a year if illness or accident prevents an individual from working. It can be joined voluntarily, for example, by the self-employed or temporary residents. However, there are significant waiting times for certain treatments.

Private healthcare in Mexico is considered excellent, and despite having access to the IMSS, most expats choose private facilities. This of course comes at a cost, and private health insurance is needed. Visitors to the country may find that some private hospitals in Mexico do not accept international health insurance, so patients will have to pay for their treatment and make a claim from their health insurance provider afterwards.

Smaller treatment centres and pharmacies are widely available in Mexican towns and cities, though less so in more rural areas. Most over-the-counter medications are available, with a wider variety and lower price than in many other countries.

Cost estimates given to ITIJ by Isabelle Moins, Chief Executive Officer of April International Care France, indicate that in Mexico’s private health sector, a GP consultation is likely to be around M$1,200 (GB£43), a specialist consultation slightly more, a caesarean section delivery may cost about M$120,000 (£4,300), and an appendectomy may cost up to M$200,000 (£7,200).

While health professionals in Mexico are generally well qualified and their expertise high, the medical equipment and quality of health facilities are not always the most consistent around the country, particularly in the public sector, where the standards of comfort and equipment are uneven. The best-equipped facilities are concentrated in the major cities and often belong to the private sector.

The public sector, whose care is fully covered by the mandatory health insurance system, is also very popular with the local population, and as such its wait times can be very long.

While many high value-added establishments are available in the major cities, they are rarer and often less well equipped in other parts of the country. In the event of an accident, as well as for scheduled treatments, travel to one of the main Mexican cities is therefore highly recommended. In order to overcome the limitations of the Mexican health system, the vast majority of expats take out supplementary health insurance.

President Joe Cronin of International Citizens Group, Inc. expanded on the payment process. “Many tourists and expats are surprised to find that Mexican hospitals often require patients to prove they can pay, or even pay in advance, before they receive treatment,” he said.

“Travellers should also be aware that there are two types of pharmacies – Segunda Clase (second class), which provides over-the-counter medication only, and Primera Clase (first class), which also provides restricted prescription medication

“Travellers heading to Mexico should bring a Guarantee of Payment certificate from their insurance provider so they are less likely to find themselves out of pocket. Prices can also be inflated for foreigners, so it is important to choose your medical facility carefully. A good travel insurance or global medical insurance plan will help you find the right facility.

“Travellers should also be aware that there are two types of pharmacies – Segunda Clase (second class), which provides over-the-counter medication only, and Primera Clase (first class), which also provides restricted prescription medication and is harder to find. If your doctor writes a prescription, you will need to ask him to direct you to a Primera Clase pharmacy.”

The big private hospital groups tend to be based in Mexico's larger cities such as Mexico City, Tijuana, Monterrey, and Guadalajara. English-speaking doctors are more readily available here and regions that are well-known for expats, such as Lake Chapala or Puerto Vallarta.

Mexico is one of the major destinations worldwide for medical tourism. The largest hospital group, Grupo Angeles, has almost 30 hospitals in Mexico. Other large providers are the CMQ hospital group, ABC medical group based in Mexico City, and independent facilities. All these hospitals cater to the wider population as well, but generally treat individuals with private insurance or those paying out of pocket.

Near the US border, hospitals can sometimes see more American patients than Mexican, as large numbers travel south looking for accessible care. Individuals may have either no coverage for a particular service, or would need to pay an excess. Americans and Canadians travel there for surgery or medication they either would not get or would be much more expensive in their own country.

For example, a Canadian cancer patient can connect to a facility or group of oncologists in Mexico with the latest equipment all under one roof in a private hospital with good infrastructure. Hospital Angeles de las Lomas in Mexico City is one such centre, a huge private hospital with global leading specialists with access to the latest in technology. They have made significant financial investments in their technology and equipment.

Regarding the Covid-19 pandemic, patterns of infection in Mexico have reflected those in other large countries, although overall mortality has been at levels disproportionate to the country's population. The most recent rise in cases following 2021's end-of-year celebrations were largely linked to the Omicron variant. Furthermore, it may be that the true rate is higher than official figures as Mexico is thought to have a low testing rate in comparison to other countries, particularly at the beginning of the pandemic.

Covid has stretched Mexico's public health system to the limit. Public medical services are at capacity, with long waiting lists, however many private hospitals have remained Covid free, strictly testing for Covid before admittance. As Mexico comprises 32 partially self-governing states, each has responded in distinct ways to the pandemic, with varying policies and other public health responses from each authority.

Another effect of Mexico's decentralisation in the 1980s and 1990s is on health system governance. Each of the states operates autonomously, with branches of the Ministry of Health in 32 local health secretariats, each with different organisational structures and processes.

A 2018 review of quality governance in the Mexican health system published in The Lancet Global Health found that half of available examining rooms and hospital beds in the country are private. "Long waiting times and inadequate supply of healthcare services contribute to high demand for private healthcare and high out-of-pocket expenditures," it stated.

For those selecting a hospital in Mexico for treatment, one key factor is how well it meets recognised standards of quality. To be eligible for accreditation, a healthcare organisation must have been established for at least a year and meet several strict criteria.

Joel A. Roos MD, Vice President of International Accreditation, Quality Improvement, and Patient Safety at Joint Commission International (JCI) said: “As a leading international accrediting organisation, JCI proudly includes Mexico as a country that contains JCI-accredited healthcare organisations.

"To date, we continue to receive significant interest from Mexico-based healthcare organisations seeking JCI accreditation, which we welcome,” he told ITIJ.

David Broderick, Head of Global Medical Provider Management for Allianz Partners told ITIJ about the quality of the links between insurance companies and major private hospitals in Mexico.

He said: “To get the best value and outcome for our customers, it’s important to have a strong, open and transparent relationship with our medical providers, so we invest time in building those relationships. Ultimately, we have shared objectives – the wellbeing and health outcomes of patients, so we’re generally on the same page, which helps.”

However, the process may not always go smoothly: “Very occasionally, we see slight variances in the medical and administrative treatment of patients, where it’s not fully in line with normal local market practice, e.g. treatment charges and billing,” said Broderick.

“Our policy is to always achieve the best price and treatment for our customers, and this needs to be in line with what is reasonable and customary in that country or region. There can sometimes be other challenges, such as getting medical records or supporting information quickly, but that’s not limited to this particular region. Which is why it’s so important to have a good relationship, to be able to discuss and address things quickly.”

Broderick suggests that relationships can be improved by having a local market presence and expertise. “This really helps to solve any issues that might arise when liaising with medical providers, and it also demonstrates a commitment to the market, ultimately helping to deliver a better all-round experience for our customers.”

For expats, holidaymakers and medical tourists alike, those who travel to Mexico can expect a high standard of healthcare, with leading centres of excellence to be found, offering the full range of services at an affordable rate. As with any country, however, insurers need to be wary of abusive billing practices and hospitals that have been burned by previous experiences with payers who don’t actually adhere to their guarantees of payment (GOP). But that’s a topic for another issue of ITIJ. Coming soon to an industry publication near you...