Mexico and the Caribbean are among the top travel destinations globally. Trinidad and Tobago is among Lonely Planet’s best destinations to travel to in 2025, while Guadalajara features on National Geographic’s ‘The 25 best places in the world to travel to in 2025’ list. Before Covid-19 hit, the Caribbean islands were visited by more than 25 million tourists annually. In 2022, more than 38 million tourists travelled to Mexico, a particularly impressive number given that this was a year during which significant recovery from the pandemic was underway.

Caribbean patients who can afford it usually head to nearby destinations such as Miami in Florida or Medellín or Bogotá in Colombia for speciality medical care

When it comes to healthcare in these popular destinations, access, cost and quality vary, with impacts on travellers and insurers alike. ITIJ asked Josef Woodman, CEO of Patients Beyond Borders, to share his thoughts on the quality of healthcare in the Caribbean.

“With few exceptions, quality of care in the Caribbean is lacking. In fact, Caribbean patients who can afford it usually head to nearby destinations such as Miami in Florida or Medellín or Bogotá in Colombia for speciality medical care,” he highlighted. “Some notable exceptions are Doctors Hospital in the Bahamas, Health City Cayman Islands (HCCI), and Barbados Fertility Centre, which are all Joint Commission International (JCI) accredited.”

Woodman said that in Mexico, on the other hand, there is a wide array of options for specialist care in key destinations such as Cancun, Mexico City and Guadalajara: “Some 10 medical centres and clinics throughout Mexico are now JCI accredited, providing cardiology, orthopaedics, bariatric, fertility, stem cell treatments and more. Mexico is best known to patients seeking safe, affordable elective procedures, such as complex dental care (implants, full mouth restorations, reconstructions) and cosmetic treatments.”

Managing healthcare costs

Insurers prioritise the effective management of healthcare costs for international patients in Mexico and the Caribbean, where challenges include balancing healthcare quality and cost and preventing fraud. Dr Griselda Werner, Chief Operations Manager at Logimedex, said that one of the biggest challenges is the overcharge from some healthcare providers when treating international patients. “This can typically be seen, and unfortunately expected, in the main tourist destinations in Mexico and Caribbean. While there are fairly good healthcare providers that try to justify their high prices with excellence and quality in care, on the other side, there can also be healthcare providers with lack of medical resources and infrastructure from which overbilling can be received,” she stated. “Overbilling can be found in several ways: commonly with price lists that exclusively apply for international patients and/or international insurers, or through third-party administrators (TPAs) managing the international billing for the hospitals and other providers.”

A key challenge concerns suppliers with practices that are not the most ethical both in terms of usage as well as billing

Federico Tarling, Chief Service Officer at Assist Card, said that, unfortunately, suppliers with questionable practices can be found in these regions. “Mexico (particularly its Caribbean beaches) and the Caribbean as a whole are probably one of the most popular destinations for tourists worldwide and, amongst those, as far as I’m concerned, the most difficult areas to handle medical assistance services,” he told ITIJ. “A key challenge concerns suppliers with practices that are not the most ethical both in terms of usage as well as billing. This requires insurance/assistance companies to have the ability to steer clients to their preferred suppliers as much as that is possible. This is not always easy, as many suppliers have business relationships with the hotels, so they will direct their passengers to these suppliers.”

Soraia Arroyo Lynch, VP of Business Development and Client Accounts at GMMI, noted that a lack of transparency in pricing can cause problems. “In many regions, there is no standardised pricing for healthcare services, which can make it difficult for patients to compare costs and make informed decisions,” she highlighted. “Additionally, extra charges for medications, consultations, or lab tests may not be disclosed upfront.”  

ITIJ also spoke with Pablo Castillo, Chief Executive Officer of MedBrick, who said that another challenge commonly faced by payers concerns private hospitals and clinics clamouring in tourist areas to find and bring international patients to their facilities. “Nowadays, it is quite common to see local hospitals own or rent outpatient clinics and hire people at popular hotels in the same area with the purpose of referring as many patients as possible to their inpatient facilities, regardless of the nature of the emergency. The very high costs associated with this kind of practice are one of the insurer’s main concerns when dealing with healthcare providers in these geographic areas,” he asserted. “Once the out-of-country patient has been admitted, the next challenge for the insurer is to be able to fully understand and monitor the services and overall care that will be provided. As of this stage of the admission, a highly competent assistance team is required on the insurance side to be in control of the care to be offered to the patient until discharge.”

Lynch believes that one of the most significant challenges is the coordination of care across borders, especially when patients are transferred from the Caribbean or Mexico to the US or Europe. “Ensuring continuity of care, obtaining timely medical records and managing the logistics of patient transfers can be complicated by differences in healthcare practices, legal frameworks and even time zones,” she pointed out.

Cost containment strategies

Indeed, transfer to EU territories in the Caribbean may represent an attractive option for containing costs, but this requires careful consideration due to the inherent complexities. “This has to be carefully assessed and done on a case-by-case basis due to the fact that many of these smaller islands may not have the adequate infrastructure and health resources (e.g. specialists and/or technology) to deal with complex admissions,” highlighted Castillo. “Another way to contain costs by evacuating the patient from a tourist area is to bring them to a different city within the same country to continue their admission at an in-network, qualified and more affordable facility.”

Evacuation to EU islands can be worth it in the case of hospitalisations that are expected to be lengthy

Dr Werner agreed that transfer to European Union (EU) associated islands is a potential option depending on the unique requirements and providing the receiving facility is suitably equipped. “It may be a worthy option if there is a correct analysis case by case,” she stated. “Sometimes the costs of the air ambulance, coverage of transportation and hotel stay for family members are higher than the expected cost of healthcare leaving the patient at the current facility for treatment; additionally there are other implications such as the risk of moving the patient.

“Evacuation to EU islands can be worth it in the case of hospitalisations that are expected to be lengthy, as long as the receiving medical facilities have all the necessary resources to treat the patient properly.”

Lynch agreed: “A key consideration when determining whether to transfer patients to these islands is whether the local facilities can provide the necessary level of care for the specific medical condition. Among the European territories in the Caribbean, Grand Cayman stands out as a top destination for patient transfers, offering high-quality medical care with a broad range of services and availability.”

Lynch reported that, beyond this, another key factor in deciding whether to evacuate patients is the overall cost-benefit analysis. “It’s important to factor in evacuation costs versus potential long-term savings on treatment,” she stated. “In some cases, evacuating a patient early to a facility with higher-level care can result in better outcomes and lower overall costs due to shorter hospital stays and fewer complications.”

Billing issues and fraud

Medical billing practices in Mexico and the Caribbean can present challenges to insurers, with TPAs inflating costs. “There are a number of hospitals in the region who have ‘sold’ their international patients’ handling to third parties, and these are the ones who inflate bills in a way that is beyond any reason,” Tarling underlined. “We’ve had a number of cases with these suppliers and there is very little we can do. They request immediate payment so we need to rush to make international wire transfers, and we’ve seen many patients being thrown to public hospitals after their insurance has been exhausted in just a couple of days. Of course, we try to avoid these hospitals, but that is not always possible.”

Challenges involve questionable tactics that are regularly put in place by the billing party

Dr Werner posited that the main challenge is that some hospitals won’t accept direct negotiation for medical expenses payment without a TPA’s involvement in the process. “This typically results in a higher billing and sometimes in a delay of medical information communication,” she highlighted.

Castillo also shared his thoughts on third-party billing and collection services. “These services have been part of the international healthcare industry for decades, but in recent years have morphed into something problematic for the payer due to the rapidly rising costs that accompany such practices,” he affirmed. “Many of these challenges involve questionable tactics that are regularly put in place by the billing party (e.g. harassing the patient for payment). Such practices affect the case management and the service to the customer in a negative way. Fortunately, there are proactive strategies that can be implemented by the insurer and its assistance and cost containment partners to minimise the risks associated with abusive third-party billing companies.”

Lynch said that an additional challenge with third-party billing companies is the lack of transparency in pricing and the potential for unexpected costs to surface later in the billing cycle.
“When these companies manage accounts receivables, they may tack on fees or charges that were not part of the original agreement with the healthcare provider,” she told ITIJ. “This makes cost containment more difficult and unpredictable.” She explained that GMMI works to mitigate this through direct negotiation with providers and careful oversight of billing practices to ensure fairness and transparency.

Another unfortunate hurdle is healthcare fraud which, like anywhere, is present in Mexico and the Caribbean. ITIJ asked Lynch how rife this is among healthcare providers. “The world, and particularly this region, has faced no shortage of challenges, from the global pandemic and subsequent economic turmoil to a continuous cycle of natural disasters and political instability. These conditions create fertile ground for fraud, waste, and abuse in healthcare,” she stated. “As healthcare systems evolve, so do fraud schemes. While traditional forms of fraud, such as overbilling or billing for services not rendered, are still common, more sophisticated schemes are emerging. These include upcoding (charging for more expensive procedures than those performed) or unbundling (charging for individual procedures that should be billed as a package). Such practices are especially concerning in regions with less stringent regulatory oversight.”

With rigorous auditing processes, the use of direct billing arrangements and partnering with reputable hospitals, insurers can mitigate these risks. Medical billing in Mexico and the Caribbean necessitates a considered approach to cost containment with acute awareness of the risks associated with overbilling, lack of transparency and irreputable practices.