A Voice from Oaxaca
When I first gave up the practice of law in Toronto in favor of early retirement in Oaxaca, I assumed that the years I would add to my life by leading a much more stress-free existence in Mexico, would be lost by the inferior health care system to which I would be exposed, subjected and restricted. This is my assessment of the extent to which my presuppositions have been accurate, together with information and advice for both vacationers to and would-be expatriate residents of Oaxaca.
Aside from the small, private hospitals, often referred to as clínicas, there are four publicly funded and insurance-based hospitals in the city, as well as a hospital just outside of the city offering specialized treatment for a number of serious ailments. There is the Red Cross facility available to all, often used for emergency treatment only. The civic hospital provides free services or treatment at a modest cost based on a sliding scale respecting means. ISSSTE is a federally funded facility restricted to government employees who are members of a union. Finally, there is IMSS, a federal insurance program available to expat residents and Mexican citizens alike, with an extensive network of clinic doctors and a large hospital. Its funding is provided in large part by business owners. Aside from these hospitals, there are several, small, easily accessed clinics scattered throughout suburban and rural neighborhoods.
For the vacationer, and the expat with a VISA permitting residency in the country, the most common means by which to obtain emergency treatment is through the Red Cross, IMSS (which accepts patients without coverage on a pay-per-service basis) or a private hospital. However, the last of these three is the only one in which you can be reasonably reassured of being attended in a timely fashion by extremely competent and efficient personnel.
What To Do As a Vacationer
If you do not have out-of-country healthcare coverage, by all means go out and buy it before leaving for your trip. However, it’s advisable to first inquire of your credit card company, to ascertain if in fact you already have at least some coverage simply by virtue of, for example, having a gold or platinum card. You can then make a more informed decision concerned whether or not to purchase coverage and, if so, at what level. On the other hand, a broken leg, gastrointestinal problem or other non-life threatening ailment can be attended by a private doctor or clinic without breaking the bank. Of course for an outlay of more than $100, it’s nice to be reimbursed.
If you intend to make a claim to your private carrier, credit card company or government-funded health care plan, ensure that you not only keep all receipts, but request a written diagnosis and treatment plan, and that the prescriptions you are given indicate for what purpose each medicine is being prescribed (i.e. antibiotic, analgesic, etc.). Many doctors provide all required information simply as a matter of course. Accepted practice, at least except for when narcotic medications are being prescribed, is for the pharmacy to return prescription forms to you. Often medical plans require translations of each document that is presented to them as a prerequisite for processing and reimbursement. When in doubt, submit all documentation with your claim, making sure to determine if originals are required, and keep copies. Frequently, as is the case with Ontario, it’s a two step process. Treatment receipts and diagnosis is submitted to the provincial plan. Once you’re notified of the portion not covered, prescription receipts together with a request for reimbursement for the amount not covered by the province is submitted to one’s private plan. In theory, between the two plans, 100% reimbursement is achieved.
You can ask the manager of your hotel or bed and breakfast to do you a favor by translating each of your supporting documents, to save you the trouble upon your return home. Make a note of the then prevailing rate of exchange, and submit a calculation to your plan with your documentation, to more easily facilitate payment. When a member of a clerical staff is processing your claim, he’ll be less inclined to put yours aside for another day or week if it already contains all the necessary and relevant data, organized in a readable format.
Concerning where to go in the event of illness or emergency, your accommodations host should be able to make recommendations for English speaking physicians with private practices, and for private clinics. Regarding competency of the former, while there is a medical school in Oaxaca, many doctors travel out-of-state for their post-graduate training such as to universities in Mexico City or the U.S., and regularly attend conferences and upgrading courses. Some travel abroad within the context of their specialization training. Indeed, the Oaxacan populace appears to take notice of and prefer those physicians who are able to display foreign diplomas.
Our personal experience with emergency treatment over the past ten years has been nothing but positive. I’m speaking for ourselves, our family and our guests, at hospitals Carmen and Molina, both downtown… in terms of competence, speed with which one is attended, and the presence of English speaking ER doctors. On the other hand, we cannot recommend the emergency departments at the civic hospital or IMSS because of delays in receiving treatment and, at minimum in the case of IMSS, unavailability of competent medical personnel 24 hours a day to attend to even a commonplace emergency (i.e. suturing). Having said this, many excellent surgeons with private practices perform surgery at the non-private hospitals where there tends to be the more state-of-the-art and sophisticated equipment.
The normal range in price for a consultation with a family doctor, specialist or dentist is $20 – $50 (all figures are stated in U.S. dollars and are approximate for 2008 unless stated otherwise).
Purely Elective and Cosmetic Procedures
Over the past several years, Oaxaca has become a popular destination for Americans and Canadians seeking both plastic surgery and extensive dental work. Word has spread of the competence and quality of work of both nip-and-tuck and dental surgeons, and of course of their extremely reasonable charges relative to those paid to hometown practitioners. Many foreigners, as well as Mexicans from Mexico City and other regions of the country come to Oaxaca for face lifts, breast reductions and augmentations, liposuction and other appearance enhancing procedures. A friend had plastic surgery in Oaxaca by a well-known plastic surgeon a couple of years ago. She recently commented that she had read an article in a Canadian magazine indicating the cost for the same procedure that she had performed for $500, was $3500 to $5000 at home. In effect, she had a free trip to Oaxaca, and returned home with extra money in her pocket.
Our personal experience with dental treatment has been extremely positive. Cost tends to be about a third to a half of U.S. and Canadian prices, for example, for crowns and bridges, implants, root canals, gum and bone work. While the use of nitrous oxide (laughing gas) has not yet arrived in most Mexican cities, a dentist with a gentle touch can more than make up for that lack of a temporary high while in the chair.
Resolving the Ex-Pat Conundrum
Get whatever coverage is made available to you both in your homeland and in Mexico, subject of course to affordability.
To my thinking, with IMSS coverage costing under $400 annually for a couple, why not go for it regardless of what other coverage you already have? Then supplement IMSS with international coverage for catastrophic injuries unless you have other similar insurance from another source. Our Oaxacan friends tend to disagree, but theirs is a different mindset where insurance in general has historically not been stressed or valued, be it for home, car or health.
Some American acquaintances swear by IMSS since it provides regular care including preventive procedures, all dispensed by government employed physicians including specialists, together with lab tests, medication and hospitalization. There are restrictions the first year of enrollment, and there are caveats. The level of cleanliness in the clinic environment tends to be below the standard to which most of us have become accustomed growing up in the U.S. and Canada. Many physicians have not received the quality of medical education of their private counterparts. The medications provided through the clinic pharmacy are often not the best available in the marketplace for treatment of a particular ailment, because of cost. Often the wait to see your designated doctor or for your lab tests can be long, requiring a half day commitment for each step in the process: visiting a general physician, going for one set of tests, then for another, and finally seeing a specialist.
So why bother with IMSS at all, with all these downsides? It’s a failsafe, another form of assurance that you’ll be cared for in the event of a lengthy and serious illness. As suggested earlier, often it’s the largest hospitals such as IMSS that have the best equipment, and surgeons with private practices who perform some of the surgeries. And there is no additional cost for hospitalization once you have full IMSS coverage. While attending a private clinic is more akin to your experiences before moving to Mexico, if you must remain in hospital for a lengthy period of time, the cost of doing so in a clinic could be prohibitive… just like back home.
Visiting private physicians, and even biting the bullet and getting your tests done at privately owned laboratories, reasonably assures you of a familiar quality of care. Coupled with IMSS coverage, you can now be confident that you’re covered in almost all respects. In the event of a protracted hospital stay, you can afford to be there for as long as necessary. The best locally available equipment will be used in your diagnosis and treatment, and you have a reasonable likelihood that attending surgeons are those who split their time between private practice and clinic work, and performing procedures in one or more large hospitals.
We maintain IMSS coverage, but rarely use it, preferring to tap our Oaxacan social networks for referrals to specialists to the extent they are required. And in any event, after having been resident in Oaxaca for a few years, those of us who are in our fifties or older have already been introduced to a broad range of specialists. As strange as it still is to be a Canadian and subscribe to the pay-as-you-play philosophy of medical care, it serves our purposes, with the IMSS safety net just in case.
Under certain circumstances, you may not want to rely on even the best Oaxaca has to offer. Indeed the stream of Oaxacans traveling to Mexico City flows briskly and wide. The middle and upper classes with contacts in the nation’s capital quickly seek out the best there in terms of physicians and state-of-the-art equipment, for diagnosis and for treatment of life-threatening diseases.
Even doctors working in Oaxaca at the IMSS and ISSSTE hospitals can make arrangements for patients to receive treatment not available here, to be attended in Mexico City or other larger centers. However, the process can be slow. We know of one case, that of a two-month-old baby with heart problems, who was finally sent to Puebla for surgery at ISSSTE, only to die before the procedure could be performed.
The solution, unless you have quality foreign coverage perhaps as part of your retirement pension plan, is to buy insurance that will pay for treatment in Mexico City, or better yet throughout the world, as long as you can make your way to one of the participating top-of-the-line hospitals. In my case, I have a low annual premium, with a high deductible, which is waived in the event of accident. Again, it’s a failsafe mechanism in the event of, for example, a serious car accident, or cancer, stroke, heart attack, or other catastrophic ailment which would otherwise not be affordable. Oaxaca has less than the best of diagnostic equipment and treatment facilities. My plan provides for a $10,000 deductible, $2,000 annual premium, with member private hospitals in Oaxaca, Mexico City and elsewhere in the republic, and of course abroad including the U.S., with the Mayo Clinic in Rochester being a participant.
In summary, my medical coverage and plan for treatment is the following. We have our regular family physician, who, along with our Oaxacan friends, refers us to specialists in whom we have the utmost confidence. We pay our family physician for each visit. The same holds true for dental treatment. We have IMSS coverage, which we reluctantly (because we don’t use it) renew on an annual basis, but believe it’s worth the price in the event we need extended hospitalization, or surgical procedures not available in private clinics. And I have my catastrophic coverage, which – hopefully – I’ll never need to access.
Medical care and coverage can be inexpensive, and just as easily it can be costly. It’s a matter of the individual or family having a philosophy, or set of priorities, before electing to move to Oaxaca. You have to determine how you want to lead your life in terms of balancing less disposable income as a result of medical and insurance costs, with having greater peace of mind in knowing that whatever is thrown your way will be looked after as best possible given your new life in a foreign land. If you cannot achieve a level of comfort in the resolution of these issues and decisions, then perhaps the move is not for you.