Choosing emergency medical services isn't something most folks take more than a second to think about, until they need it. With the press of providing first aid to someone the first thoughts are often acted on, and are often not the right decision. Discuss with your family what the emergency phone numbers are, even if you are just visiting. If you live here part or full time know doctor's locations and hospital locations, the closest ambulance and where you want to be taken. If you have any forethought for your medical care the following story will be illuminating...
"Doc in the Box" was a term which I first heard, referring to the emergence of private medical clinics in strip-malls. I made my first and only visit to one more than two decades ago. I was absolutely stunned when I was charged $100 to be prescribed an antibiotic for strep throat, when at the time $50 for a doctor visit was the norm. I'm sure it has become even more painful today. Well, the "doc in the box" plague as come to Mexico as well, pushed by the long and greedy arm of American health care. And just to be clear... being more expensive does not intuitively mean better health care.
An American Held Hostage by a 'Doc in the Box' Hospital
A recent story in world media told the story of an unfortunate visitor to Cabo San Lucas, a young man in his late 20's, Craig Liebelt, visiting Cabo with his wife to celebrate his birthday. While enjoying a day of swimming on the Cabo beaches Craig was stung by a jellyfish, resulting in a severe reaction and he was rushed to OneWorld Hospital by Saint Luke's in Cabo where he was placed in ICU on life support. The bill mounted daily, 10, 20, $50 thousand dollars! The hospital wouldn't let Craig leave until the bill was paid. With intervention from the US consulate and his family, the bill was reduced to $30,000USD and Craig's family was allowed to take him back to the states. Although American's wouldn't be that surprised by a hospital bill of $30K or $50K, here in Mexico that is an absolutely enormous bill!
Not Evil, Just Expensive?
In fairness to the hospital and the insurance company that owns it, we should assume that the $50K bill was not fraud, but the list price of the services provided, a price set to accomplish profit goals of a US based insurance company, billed to Americans and their insurance companies that find nothing unusual in a $50K ICU stay. Also, let us grant the hospital/company kudos in thinking that knocking $20K off the bill was a significant act of compassion. And finally, since we don't know the cost of the treatments provided, the hospital does have the right to protect it self from 'theft of services' by allowing someone to leave the country without securing a financial agreement.
But we could be being far too kind to assume all this, as there are other over-charging complaint to pop up against OneWorld.
Quality Public Healthcare in Mexico
I can not attest to the hospital conditions on the Mexican mainland, but here in Baja we have some excellent medical services at our disposal, at the government hospitals. Believe it or not it can be done right with public health care. Just a few years ago we opened a new hospital, with then President Calderon in attendance who said it was "One of the most advanced in Mexico." The new Salvatierra Hospital is located at the south end of the new civic zone, near the intersection of Forjadores and Collosio. (see map)
I speak Spanish, and my wife is Mexican, I have some medical training and come from a hometown with one of the best doctor to patient ratios in the US, so I know good care when I see it. As a result I have had plenty of experience with both the local private and public hospitals here in La Paz, assisting friends in need. I can tell you that 20 days on life support in a private ICU did not cost as much as Craig's $50,000USD four day bill.
There are three major factors that make Mexican public healthcare costs about 1/10th that of the states 1) What doctors expect to earn 2) Lawyers are almost entirely cut out of the loop, don't expect glorious malpractice settlements in Mexico 3) The government of Mexico pays to take care of its populace. Private hospitals miss out on two or even all three of these benefits..
Branded Hospitals are Specifically Geared Toward Tourists
Like OneWorld Care by St Luke's, there are a number of these private hospitals, particularly in tourist areas of Mexico, and some may in fact, offer excellent levels of care. North Americans apparently feel comfortable with a "known brand name" and flock to these facilities, thinking they will receive an American level of care. Yes, these doctors speak English but you will find they also bill much closer to a 'state'-side' rate. Aside from the financial horror story, I have heard some medical horror stories for both the public and private, so don't go to the more expensive private hospital presuming you will receive better care than you would in a public hospital.
Covering the Gap with Travel Insurance
Unfortunately, when the need arises you may not have time to 'select' emergency health care. Like the wife of Craig Liebelt, who had to make split second decisions to save a life. To help protect yourself from financial ruin in travel medical costs I will give a plug here for medical travel insurance. Sometimes even the best laid plans become useless in a moment ad that is where being covered by a travel medical insurance can help prevent having your life's savings wiped out on holiday in Mexico.
Here are some tips for obtaining the best Baja healthcare...
As a preamble I will say that you will find that MANY medical specialists speak English as part of their medical training and many have even studied/practiced in the US. Many general practitioners and dentists speak English too, at least enough to communicate a medical situation at that level. There is a "but", see below...
As an additional note, the prices I mention in this article may be slightly higher, since the time of my specific interaction or in Los Cabos, where everything costs a little more.
1) Know the best location in your region for care, here in Baja California Sur the best hospital in the state is Salvatierra in La Paz, it is where all tough cases eventually end up. Cabo San Lucas' hospital is reputed to have an excellent cardiac unit. Do not take the first advise you run across, as I know a number of gringos quite satisfied with being over charged for their medical care at private hopspitals.
2) If you have a specific health issue, and are here part or full time, find and become comfortable with a specialist for your health problem. Specialist consolatory visits should cost your $500-$600 pesos and can establish a connection. ($40-$50 dollars)
3) Antibiotics now require a prescription in Mexico. If you have a known infirmity like the strep throat I got all the time as a kid, or get cut and need tetanus shot you can usually find a medical professional on duty near a pharmacy area like the corner of Bravo and Revolucion in La Paz. There are offices of these prescription writers in Soriano's as well. These 'quickie doctors' can confirm your diagnosis and write you a prescription for the outstanding price of usually less than $100 Pesos. (yes, less than $8USD!) They will refer you on, should you need additional medical care. I have met one of these doctors which was a retired heart surgeon and another of whom I am certain just barely passed the final medical exam, so keep that in mind.
There are regular free programs of inoculation available at all public hospitals and health facilities. They include polio for kids, tetanus and seasonal flu vaccines for adults and even rabies shots, spay and neutering free programs (but these are for your pet!)
A visit to a General Practitioner is $50-$300 pesos, a specialist is about $500 pesos or more, a surgical consult is about $1000 pesos.
4) Watch your responding ambulance company. Call jumping is rampant, particularly in Los Cabos to calls at tourist resorts. I was told by a former front desk employee that he got a $100USD 'tip' from the ambulance company who then took the patient to one of the private 'cost more' hospitals. Many cities have volunteer ambulance services at no charge. Be sure you 'tip' them accordingly, $1000 pesos would be a good starting point if they saved your life, no? Cruz Rojo (Red Cross) is not what we North Americans think of as Red Cross, rather is one of these organizations providing ambulance service. Private transportation companies will be expensive, count on it.
Emergencies (Here is the "But...")
Many doctors and dentists in Baja speak English as part of their medical training, But...
In a minor emergency you can probably handle everything you need to communicate with gestures or your rudimentary espanol. As the level of the emergency rises, the need for someone who speaks well grows. In an ICU level emergency I highly suggest you have someone at your side that has espanol as a first language AND can communicate back to you in sufficient English. You WILL need someone who can finesse and push the staff, just as you would in the states and to clearly understand the course of treatment. You will be required to purchase medicines and even medical equipment, knowing where and how to procure these items is very helpful. A friend is best, if not I would find someone to employ; it is that important in your receiving the best health care.
Minor Emergencies: After many decades of safely using power tools, I hacked into my thumb with a circular saw. I was driven to the emergency room at Salvatierra, I refused to take a look at the injury, but the triage staff did, and immediately moved me to a room, ahead of maybe a dozen people. I was seen by a young doctor within minutes who suggested that I might have nicked the bone and should have an X-Ray, costing $200; he waited for me to respond. For a moment I thought, $200USD, I'll risk the bone chip. Then I realized he meant the X-ray would cost me an extra $200PESOS or about $17USD. Heck yes, brings it on! The ENTIRE process, X-ray, stitches, antibiotic injection, anesthetic shot and follow-on visit came to $700 pesos, about $50USD.
Absolutely have someone helping who speaks espanol well enough to understand and argue your case. If your emergency happens in Baja California Sur, you will likely be transferred to La Paz as soon as possible. La Paz has the best equipped government hospital in the state. In the most extreme cases or those requiring special surgery like the spine or brain, you may be transferred to the major hospitals of Guadalajara or Mexico City. It is important to have someone watching over you, at least to be sure the medicines and materials purchased for you are USED on you.
From personal experience, a public hospital does not hold you hostage. Unlike Craig's story, where the hospital would not release him until the bill was paid my experience was completely different. My friend was hospitalized unconscious in La Paz. His family wanted him taken back to the states, but we had no access to his funds, and although the bill was not extensive, it was more than we his friends could scrounge. A visit from the consular to Social Services, a few signatures and a handshake and my friend was on his way in a motor home to care closer to his family.
Mexican Health Insurance
If you are in Mexico, even part time on anything but a travel visa you can purchase health insurance. Seguros Popular is a baseline health insurance that covers just about as much as any employer health care I ever received in the states. Since costs are less, the cost of the insurance is dramatically less. My policy for two costs about $2000 pesos per year, or about $75USD a year. Seguros Popular does not cover everything, read your policy. There are optional items, like X-rays and MRI's that cost above the coverage of the policy. But other than the need for a brain transplant, your usual medical costs will not leave you penniless.
Why to these Private Hospitals Cost More?
That is a good question. One private hospital chains is part of an American insurance conglomerate. It isn't necessarily better care, I see the same doctor's faces at several hospitals and without examining their medical records you will find excellent surgeons at the public hospitals. I think the bottom line is the bottom line in the ledger, and they see you North Americans coming. They charge state-side rates because you didn't know any better.
Now you do.