Passport to Health Care At Lower Cost to Patient

"Things are moving very fast," Carrillo said. "We're growing."

David Castillejos Rios has performed laser eye surgery on both sides of the border. At a small hospital in Tijuana, he charges one-third as much as he does in San Diego.

"The medicine is the same, and to me, whether I do it here or there, it's the same," Castillejos Rios said. "Only the price changes."

The difference can translate into the kind of affordable monthly premiums most American businesses have not seen in a decade. At Health Net, the cost of insuring a family of four whose treatment was covered in the states is $631 a month. Using physicians in Mexico, the same family would pay $306 a month, company officials said.

At the Santaluz golf resort in San Diego, where Gonzales supervises golf course maintenance, workers can sign up for a Blue Shield of California plan called Access Baja. Their doctor visits are covered in the United States or Mexico, while their families are covered only in Mexico. Dale Standfast, the resort's controller, said several workers whose dependents were not covered switched plans to cover their families.

Offering Access Baja saves the resort about $1,000 per month in premiums, he said. This year the club used the savings to offer vision coverage to all employees for the first time, Standfast said.

Representatives of Blue Shield of California and Health Net, both of which offer cross-border HMO plans in California, said the quality of care is comparable in both countries. Their doctors are credentialed in Mexico, and the HMO operations are subject to California oversight. The insurance companies audit Mexican clinics themselves, and then report to the California Department of Managed Health Care.

Company officials emphasize the warmth of the Mexican medical culture.

"Mainly, the patients that come here are searching for more attention," said Juan Carlos Helu Vazquez, a gastroenterologist in Tijuana who sees Mexican and American patients. "They want the doctor to talk to them, be warm to them. There are a lot of patients who like the old-time medicine. They like the doctor asking about your family, your work."

Gonzales said he had better care in Mexico than in the San Diego region.

"I went to the doctor over here and he never cured the problem, he never gave me a good medicine, never sent me to a specialist. He never cared about my health," Gonzales said. "When I went over there, the first doctor I saw, he sent me to a specialist. He wasn't just going to say, 'Take this and go home.' "

Administrators at cross-border HMOs expect their plans to grow because the cost of health insurance in the United States is out of reach for an increasing number of working families.

That is what worries Lewin of the California Medical Association.

"It's understandable that lower-income workers are trying to seek health care they can afford," he said. "But these people are largely paying taxes and contributing some of their own financial resources to this country. It's high time we provided good care for these people through enlightened public policy."