Passport to Health Care At Lower Cost to Patient

California HMOs Send Some Enrollees to Mexico

TIJUANA, Mexico -- There are world-class hospitals in San Diego, not far from where Luis Gonzales lives. But when he or a member of his family needs a doctor, they drive 50 miles south to a clinic in Tijuana.

The Gonzaleses are members of a Blue Shield of California HMO that provides all of the family's nonemergency care in Mexico. They are among 20,000 California workers and their dependents in health plans that cost 40 to 50 percent less than comparable care in the United States because the doctor's visits are outsourced south of the border.

With health care costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year. And Gonzales, for his part, is happy about it.

"They have everything I need," Gonzales said. "They're clean. You don't see a difference between a doctor over here and over there."

Despite Gonzales's satisfaction with the quality of his family's care, the new trend has some medical professionals in the United States worried that care is being sacrificed to low prices.

"There are quality standards that we are developing and implementing in America that are not going to be implemented there for a long time," said Jack Lewin, chief executive of the California Medical Association. "In terms of specialized care, it's critically important that we look beyond just cost savings."

Five years ago, California became the only state to regulate insurance programs that require border crossing for basic health care. Since then, more than 700 non-agricultural businesses have offered plans requiring treatment in Mexico. Hundreds of farms offer similar coverage for about 120,000 migrant laborers.

In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border. But physicians in South Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico.

Lower-priced labor, malpractice insurance and overhead in Mexico mean both basic and sophisticated medical procedures can be performed at a small fraction of the cost. A hysterectomy that averages $2,025 in the United States costs $810 in Mexico, said Mary Eadson, director of legal compliance for the Western Growers Association, an agricultural organization that provides health insurance for California workers in Mexico.

The movement of U.S. health care across the border has sparked a boom in hospital construction in Tijuana, with clinics and pharmacies opening a short walk from the border.

Francisco Carrillo owns and operates a Mexican HMO plan for California workers called SIMNSA, and he owns the Centro Medico clinic, where large windows face the border bridge many of his patients cross on their way to the waiting room.

On a recent weekday, half the cars in the parking lot bore California license plates. On two of the clinic's six floors, a new surgical center and a dentist's office are under construction. The clinic's other floors were crowded with patients.