More Americans seeking foreign health care

Randy Wilson of Houston gets new bridges fitted at the dental office of Dr. Ricardo Olivares in Progreso, Mexico, last month. Progreso has been catering to medical tourists for years, complete with criers outside of shops and signs hawking every imaginable service. less Randy Wilson of Houston gets new bridges fitted at the dental office of Dr. Ricardo Olivares in Progreso, Mexico, last month. Progreso has been catering to medical tourists for years, complete with criers ... more Photo: Sharón Steinmann, Houston Chronicle Photo: Sharón Steinmann, Houston Chronicle Image 1 of / 1 Caption Close More Americans seeking foreign health care 1 / 1 Back to Gallery

MONTERREY, MEXICO — Whipped by rising medical costs and spurred on by the globe-shrinking travel of our age, growing numbers of Americans are heading abroad to treat much of what ails them.

Uninsured, under-insured or just plain unhappy with American health care, they seek out a handful of foreign medical meccas, including Mexico, where they can get cut-rate deals on everything from face-lifts to root canals, heart bypasses to new hips.

It has been branded medical tourism, and many experts believe the trend will become one of the hottest niches in both global medicine and travel in the coming decades.

"This is about a global shift in health care services," said Josef Woodman, whose book, Patients Beyond Borders, offers how-to advice for Americans seeking offshore medical care

More than 1 million patients worldwide, including at least 150,000 Americans, crossed international borders last year and spent $60 billion in the process, Woodman and other industry analysts estimate.

Such travel has a long history in Texas and Mexico. A recent study by the University of Texas Medical Center in El Paso estimated that more than 20 million U.S.-Mexico border crossings are made for health care annually, including those of wealthier Mexicans traveling to Houston and elsewhere for hospital stays.

Americans seeking cheap medicines, dental care, cancer treatments and cosmetic surgeries have found them in Mexico. Dentists, doctors' offices and pharmacies advertising in English line the streets of booming Mexican cities along the Rio Grande like Nuevo Progreso, Reynosa, Nuevo Laredo and Ciudad Juarez.

But in recent years, many international health travellers have favored top-shelf hospitals in Asia for coronary care and orthopedic surgery as good as, but far cheaper than, what they could receive at home. Thailand alone treats 500,000 foreigners each year, industry analysts say, including more than 50,000 Americans.

Several Latin American countries have long been destinations for health travellers. Brazil and Costa Rica are noted for cosmetic surgery, Colombia for heart care. Panama and the Dominican Republic are pushing to attract health tourists.

Mexico pursues the market

Seeing the opportunities, hospital executives and government officials in several Mexican cities have decided to grab a piece of the major-surgery market for travelling patients.

The medical centers in Monterrey — the industrial hub that's a two-hour drive south of the Texas border and a 70-minute plane ride from Houston — are spearheading the push.

"What we offer is closeness, quality and cost," said Jesus Gonzalez, a Monterrey physician who is leading a push by the Nuevo Leon state government to attract foreign patients to eight city hospitals. "Our target is the American citizen."

A huge target it is. About 47 million Americans — including more than 6 million Texans — were uninsured last year, according to industry and Census Bureau statistics. Millions more carry inadequate coverage.

Many of the 12 million-plus Mexican-born residents of the United States are among the poorest and least insured. They, and millions more Mexican-Americans, maintain family ties and cultural affinities with Mexico that make hospital stays in this country a logical option.

"The majority come because they don't have any access to medical services at home," said Cynthia Gonzalez, a family practice physician in the border town of Nuevo Progreso. "Many times, even if they are insured, it comes out cheaper for them to get their care here."

Her standard consultation fee is $25, about the same as a co-payment required by some health maintenance organizations in the U.S.

Upgrades in the works

Monterrey's Christus Muguerza hospitals, which are majority owned by the Irving, Texas-based Christus Health, expect the same considerations to attract U.S. patients for more serious procedures like heart and orthopedic surgeries. The company has contracted with an Albuquerque travel broker to bring in American patients.

Christus Muguerza is upgrading its two older hospitals in Monterrey and two others in the northern Mexico cities of Saltillo and Chihuahua. The company, which has smaller hospitals under construction in Reynosa, across the Rio Grande near McAllen, and in Chiapas state, plan to expand across Mexico.

Christus' competitors, including the Dallas-based International Hospital Corp. — which owns four hospitals in Mexico — have similar plans.

Premiere Mexican-owned hospitals, like Mexico City's American British Cowdray and the Angeles group, are ramping up, too.

"We can give them service at prices that are comparable or better than those offered in other countries — India or Thailand — and that is much closer to the United States," said John Zipprich, the Houston-based senior vice president and general counsel of Christus Health.

If things go as planned, Christus Muguerza might one day attract international patients, including those from the Middle East, who have traditionally sought treatment at the Texas Medical Center in Houston or other U.S. institutions.

"Medical travel is going to be so important that it won't matter where you get care," said Arturo Garza, the chief executive of Christus Muguerza hospitals in Monterrey. "What will matter is the quality of care."

U.S. hospitals benefit, too

The Texas Medical Center, a collection of 46 institutions employing more than 110,000 people, serves at least 10,000 foreign patients a year. But those numbers have fallen dramatically because of the heightened visa requirements following the 9/11 attacks.

"The TMC hospitals are aggressively trying to maintain their business of treating wealthy foreign patients, which has suffered since the crackdown on terrorism," said Vivian Ho, an economist at the James A. Baker III Institute of Public Policy at Rice University.

Those with insurance will continue to seek care for major illnesses in Texas, she said.

"To the extent that the uninsured seek care in Mexico," she said, "this will actually lead to less uncompensated care being provided in Houston, which may actually be a financial benefit to us."

Christus Muguerza hopes its High Specialty hospital in downtown Monterrey will soon be the first Mexican medical center accredited by the Joint Commission International, a branch of the Chicago-based organization that certifies American hospital and clinics.

"The JCI gives Americans a good level of comfort," said author Woodman. "It's like the Good Housekeeping Seal of Approval."

Created a decade ago to vouch for health care quality overseas, the agency has certified more than 100 hospitals worldwide, though only a handful in Latin America. But as many as a dozen Mexican hospitals are in various stages of the accreditation process, said David Jaimovich, the agency's chief medical officer.

The Internet has proved key to the growing medical tourism trend, with Web pages dedicated to the emerging industries and health travel brokers offering their services online. Reviews of hospitals by patients and analysts offer a balance to the self-promotion of the health care providers, experts say.

"It's a buyers' market nowadays because the start-up clinics are going to be very careful not to screw up," said Christopher Jones, a global health care economist in Chicago who recently formed his own company to study medical tourism.

Hospital quality in many of the countries is spotty at best. While significant numbers of foreign physicians have been trained in the United States and Europe, nurses and other support staff have not. Record-keeping, facility maintenance and other key factors of quality care lag American standards, some experts say.

"Countries can tout medical tourism all they want, but they don't have the infrastructure for it," said Woodman. "It has to be a country that embraces a travel infrastructure. Planning a medical trip is not the time to be working on your Spanish or Chinese."

Many Americans harbor deep doubts about foreign health care, even some who use the medical services in Mexico.

"I've heard of these people going on vacation and getting liposuction or whatever. No way," said Jennifer Jackson of Houston, who traveled with her boyfriend, Sean Montano, to the border city of Nuevo Progreso, where he underwent dental surgery.

Questions of liability, regulations

Others seem less skeptical.

"As long as the doctors are respectable and you speak to a couple of people he has worked on, I'd have no hesitation to come down here," said Shirley Currie, 69, a Corpus Christi construction firm employee who has made the three-hour drive to Nuevo Progreso for years to obtain medicines and dental care.

Still, if things go wrong — as things invariably do with major medical treatment everywhere — international patients have recourse only to the legal system in the host country. Malpractice lawsuits often go nowhere in Mexico and other countries, and even when successful rarely pay anything close to what they do in the United States.

In addition, companies that arrange and manage for overseas care for clients operate in an unregulated environment.

Though Mexican hospital standards have improved markedly in the past decade, they have a long way to go, said Lawrence Meagher, the chief executive of the American British Cowdray, or ABC, Hospital in Mexico City.

To improve the ABC Hospital's standards, Meagher has established a formal relationship with The Methodist Hospital of Houston, and his hospital is matching its record keeping, patient care and other procedures to those of Methodist's. But that entails a lengthy and expensive process that few Mexican hospitals can take on.

'The things we are doing are to ensure patient security, patient care and employee safety," said Meagher.

Overcoming such hurdles will prove key to Mexico's ability to attract a significant share of the medical tourism market. Some hospital executives believe medical travel to Mexico will be unlikely to really take off until American insurance companies agree to pay for services here and in other countries.

That's already happening, if still haltingly.

Some insurance plans in California — Blue Cross/Blue Shield is one of them — already pay for medical care in Mexico, most either targeting immigrants working for U.S. companies or their families.

Self-insured companies and large insurance companies alike are looking at tiered programs that would offer lower premiums for plans that would include foreign medical treatment.

"Within a year you're going to see actual products offered to U.S. employers," predicted Peter Maddox, Christus Health's senior vice president for business strategy in Houston.

Maddox said that through the rest of the decade "there's going to be huge voting pressure on Congress" to include medical travel in a comprehensive health care overhaul.

"We see tremendous pressure on the whole system in the United States for the next 10 to 15 years," Maddox said.

Jones, the health care economist, believes that it will only take one large insurance provider to start writing less expensive policies for foreign care for medical tourism in Mexico to take off.

"It's a good thing for America if we can get insurance premiums to come down," he said. "We're getting more and more in terms of premiums and less in terms of care."

"This is really the democratization of global health care," he said. "It's freight train heading in one direction: Forward."

dudley.althaus@chron.com