First published in ITIJ 87, April 2008
Growing visitor numbers, business and pleasure seeking alike, have helped enervate healthcare provision in Latin America’s most vibrant economy, says Roger St. Pierre
Tourism matters to Mexico. With more than 10,000 registered hotels and 430,000 bedrooms, the country is home to the world’s seventh-largest accommodation industry, generating around US$12 billion a year. For most, the promise is of sun, sand, sea, great value shopping and dining experiences and almost an overdose of exotic culture.
But what happens when things go wrong? The dreaded ‘Montezuma’s Revenge’ is just the start of it. The climate is sub-tropical, with all that implies in health terms and, of course, accidents can and will happen. Given that almost 70 per cent of visitors – many of them with Mexican roots – come from the US, it is no surprise that a sophisticated assistance industry has developed over the years, able to offer care to meet exacting North American standards. The key players, such as Mondial Assistance, were quick to spot Mexico’s potential as it emerged from the grim days of the early to mid-Nineties, when the economy went into meltdown and the country defaulted on its national debt.
Mondial Assistance’s strategy, announced in February, to dramatically expand and develop its existing product portfolio for the business travel market, harnessing its expertise in international travel and risk management, will undoubtedly impact in Mexico, whose world trade is burgeoning, with big locally owned companies now looking beyond their national boundaries and making mergers and acquisitions abroad. Ben Smart, head of business development at Mondial Assistance, says: “As the business travel market continues to grow in Mexico, so will the risks that employers expose their employees to when sending them off on business trips all over the world. Our bespoke solutions can be tailored to help organisations meet their duty of care, enhance benefit schemes and offer their business travellers valuable peace of mind, wherever they go."
The private healthcare system also identified the enormous potential offered by what is not only a vibrant business market, but which has also become one of the world’s leading vacation destinations. Take the Amerimed Hospitals group for instance. This company’s four sophisticated facilities – located in the highly popular tourist destinations of Cancun, Puerto Vallarta and Los Cabos de San Lucas, on the Baja California peninsula – were established specifically to cater for tourists who fall ill or suffer injury.
“In 2007, we dealt with 1,300 hospitalised patients and 15,000 outpatients and around 50 per cent of those treated were citizens of other countries,” says Amerimed’s Ana Trelles. “Our market is very much visitors rather than locals, and one of our prime concerns has been to take as much trauma out of the equation as is possible. We set out to offer treatment that meets the highest international standards, and our definition of patient care extends to ensuring that, with the use of bilingual staff, our patients have no problems in communicating with the doctors and other staff who are caring for them. Our documentation is in English and is easy to understand while we also provide a diet and a regime that is familiar.
Mexico is home to the world’s seventh-largest accommodation industry
“The removal of language barriers is also key when it comes to our doctors retrieving medial files from the patient’s own doctor back home and then fully understanding what is written in them. We work closely with all the main assistance providers, like BUPA owned Amedex, Mondial Assist and Assured Assistance, all of whom have busy offices in Mexico City. We also maintain close working relationships with the international insurance companies and, unlike many hospitals in the country, who have no such links, we do not need to pressure patients for on-the-spot payment but simply do all the paperwork and arrange reimbursement from their insurers.”
Amerimed was established 10 years ago. Since then, Mexico’s provision of medical care, for locals and tourists alike, has improved dramatically and, in the country’s major cities, is of growingly high, in some cases world-class, standard.
The cost of care
At the leading hospitals, treatment costs currently stand at around 30 per cent lower than in the US. Further down the scale, the savings can be as much as 60 per cent or more, though some hospitals hike their prices considerably when they know an overseas’ insurer will be footing the bill.
Manuel Solano of consultancy Ernst & Young observes: “Only a decade ago, many Mexicans, probably a quarter of the nation’s 84 million people, were living in poverty and had little or no access to medical care and social services. Life expectancy was as low as 55 years among this underclass. Thanks to determined government efforts and input from the World Bank’s Country Assistance Strategy, things have improved dramatically since those times, and while the current wave of new prosperity is arguably too dependent on new-found oil revenues and has also yet to filter right down to the poorest in our society, the sun seems to be shining on the country’s economic prospects.”
A director of Mexico’s PAC said back in 2000: “Few would have believed half a decade ago, when we were experiencing our worst ever economic crisis, that by now we would be just a few steps away from providing basic healthcare services for each and every Mexican. Back then, the nearest clinic for many of our people in rural areas was two days away by mule.”
Move on another half-decade and today healthcare has become a right, not a privilege. With this has come a massive expansion of the private health sector – and there are private, non-profit players in the game too. Through two highly-specialised hospitals and a general hospital, all three in the city of Monterrey, 160 miles south of the US border, the Christus Muguerza group has more than 70 years’ experience of providing for the local community and serving the assistance needs of visitors. The first hospital group in Mexico to receive Joint Commission International (JCI) accreditation, Christus Muguerza has since 2001 been affiliated to Christus Health, a non-profit, faith-based health system, headquartered in Dallas, Texas, that comprises some 40 hospitals, in-patient and long-term care facilities, as well as a large number of clinics, physician offices and healthcare services, located in more than 70 North American cities. Over the past four years, Christus Muguerza has invested more than US$100 million in updated facilities, technology and service line development, enabling the group to maintain its role as a leader in technological innovation and sophisticated medical infrastructure.
a sophisticated assistance industry has developed over the years
While the finest of the Instituto Mexicano de Seguro Social (IMSS) state-run hospitals are today among the country’s best equipped, they are geared to locals rather than visiting tourists. Although many of the physicians they employ speak English, having trained in the US, Canada or Europe, most of the ancillary staff do not, so foreign patients need the assistance of someone who can translate. As with most socialised medical systems, the wait for care is often longer than in the private system, but in general the standards of treatment and aftercare are high.
Most émigrés resident in the country choose the private healthcare route however. A policy taken out with Grupo Nacional Provincial, for example, provides care at all major hospitals in Mexico and up to a US$60,000 claims limit when travelling abroad. Given the relatively low costs involved, medical tourism has been growing fast, with hip replacements, dental treatment and Lasik eye treatment coming in at 25 to 50-per-cent savings over first-world costs.
Considering the high standards now available in Mexico, repatriation is not a major issue, except where the patient is adamant that they prefer to be treated in their home country. Amerimed’s Ana Trelles comments: “There are virtually no major procedures that we cannot carry out here to the most exacting standards.”
Should repatriation be the choice, Mexico has a well-developed air ambulance sector. Though its fleet of five modern ICU-configured Learjet aircraft and 12 pilots – six of them part-time, six full-time – is headquartered in El Paso, Texas, Global Life Flight maintains bases in the Mexican cities of Monterrey, Guadalajara, Cancun and Toluca (Mexico City). They also provide critical care ground transportation and helicopter evacuation flights. Company president Dr Roberto Dumois says: “We operate bedside-to-bedside critical and non-critical medical evacuation flights on a moment’s notice. Each of our aircraft is equipped as an airborne intensive care unit and has full-time medical staff on-board. We are quite literally a rare bird in the air ambulance business. While others stick strictly to a cash-only payment arrangement, we work with patients and their insurers to make things easier, where necessary offering a range of payment options.”
Established back in 1998, AirLink Ambulance is an American-owned organisation operating in Mexico from bases in Guadalajara, Los Cabos (Baja California), Puerto Vallarta and Toluca (Mexico City). It has to date carried out more than 1,300 air ambulance evacuations. “Using dedicated ground and air ambulances, we operate a complete bed-to-bed service for patients in need of basic, advanced or critical care life support who are not well enough to travel on a commercial flight. Our aircraft are equipped as mini intensive-care units,” says AirLink’s Nicky Smith. “Mexico has a substantial network of small, local airports, so we can usually get our aircraft close to the patient’s location.” The company operates Learjets and a King Air 90. “Our Learjets can fly at more than 500 miles per hour, yet they are manoeuvrable and only need a relatively short runway. Able to fly above other commercial traffic and well clear of base weather and turbulence, they are ideal for international flights.”
treatment costs currently stand at around 30 per cent lower than in the US
US$1,500 per hour seems to be the going rate for an air ambulance flight. Medical costs on the ground are, however, highly variable: “Yes, they are considerably less than in the US, or for that matter Europe, but some Canadian insurers find it cheaper to repatriate their policyholders and potential bills can sometimes run up as high as US$30,000, at which point it can be more cost-effective to take the patient home and get them into Canada’s very good state system,” says Ana Trelles.