Healthcare Is Migrating South of the Border

California employers are steering Latinos to Mexico, where care is less costly but uneven.

Thousands of Latinos who live near the border are taking advantage of a benefit increasingly offered by their U.S. employers: cheaper healthcare in Mexico. About 160,000 California workers - farm laborers as well as working-class Latinos employed at hotels, casinos, restaurants and local governments in San Diego and Imperial counties - are getting their annual checkups and having surgeries through health networks south of the border, insurers say. The arrangement is cheaper for both employers and employees. In Mexico, healthcare costs are about 40% to 50% lower than in California, freeing some employers to offer services that they couldn't otherwise afford. "It's a win-win situation for me. I'm able to offer it to everybody, and my premiums went way down," said Mark Holloway, part owner of a department store in Calexico, Calif., who said he couldn't afford health insurance for his 50 employees until he enrolled them in a cross-border plan. He said he can sign up several employees, each at about $100 monthly, for about the same price as one employee in a U.S. plan.

Employees enjoy lower premiums and co-payments, typically $5, and the comfort and convenience of describing their aches and pains in Spanish to doctors who, they say, tend to take more time with them. "The rate is good, the service is good," said David Ouzan, a city councilman in Calexico, where about a third of the city's workers use dental and medical clinics in Mexicali, just across the border. "I myself have used dentists in Mexico."

Still, the trend has generated some misgivings among doctors and consumer advocates north of the border. Some worry about the quality of care in Mexico and limited regulatory control. Others say the cross-border plans represent a sad commentary on the limited access that immigrants and the working poor have to treatment in California. They represent a "positive turn of events for cross-border health coverage . but are another reminder about how sick our health system is in the U.S.," said Dr. Robert K. Ross, president of the California Endowment, a healthcare philanthropy.

Mexico has long been a low-cost alternative for thousands of people - many of them uninsured - who price-hunt among clusters of storefront clinics and small hospitals in Tijuana and Mexicali for treatment they can't afford in the States. And some cross-border health plans have operated since at least the 1950s, when Imperial Valley farmers started offering coverage to migrant workers. But the emergence in the last five years of cross-border HMOs, which must be licensed by the state of California, signals the growing acceptance of Mexican doctor networks by mainstream employers and insurers in the United States.....

Enrollees are typically Mexican citizens legally employed at U.S. companies, either living in Mexico or in the U.S. Many earn only $5 to $7 an hour and could not afford U.S.-based plans. But others are Mexican Americans, some of them in executive-level positions. "Employers are really surprised a bit by the quality, the cleanliness," said Peter Duncan, a vice president at Blue Shield of California, whose cross-border program is called Access Baja. "Often they had visions of squalor. It isn't Cedars-Sinai. But they find that the basic quality of care is really there."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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