Mexico fills health needs for many Latino Americans
This article was produced as a project for the California Health Journalism Fellowship, a program of the Center for Health Journalism at the USC Annenberg School for Communication and Journalism.
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Pharmacies in Mexicali, Mexico are set up in the tunnel leading to the port of entry between Mexico and the U.S.
At 14 weeks pregnant, Delia Barajas faced the real threat of losing her baby. Bleeding that began overnight had gotten worse as she stood on her feet much of the day working at a La Quinta resort.
Delia and her husband, Jesus, of Indio had already endured one miscarriage and an earlier scare with this new pregnancy. They didn't want to take any chances.
Weeks earlier, after waiting 45 minutes in the emergency room at Desert Regional Medical Center in Palm Springs, Delia said medical staff told her they could not detect the baby's heartbeat and that she needed to call her doctor because there was nothing else they could do. After days of waiting in fear, she was able to see her doctor and was told the baby was alive.
For the second scare, instead of driving to the emergency room minutes from their home, or one of the other two nearby hospitals, Delia told Jesus to head 100 miles south to a hospital just across the U.S.-Mexico border in Mexicali. After little waiting, doctors examined her and prescribed progesterone, a hormone supplement used to try and prevent miscarriages.
"Up to this day, I feel like because of him prescribing me that, I didn't lose my pregnancy," Delia Barajas said. She continued to see doctors in Mexico and the U.S. for the rest of her pregnancy. Her son, now 2, was born in Palm Springs.
Thousands of people in the Coachella Valley head to Mexico every year for health care. Often they seek deals on prescription drugs or dental care. For others, Mexico offers easy access to primary care that is cheap and convenient despite being a country away.
Latinos, who make up a majority of people living in the eastern valley, rely more heavily on Mexican health services. With generally lower incomes, they see a greater benefit in Mexico's lower prices. They also use Mexico as a workaround to the shortage of primacy care doctors and dentists in the east Coachella Valley, and their cultural familiarity means there's no hesitation with seeing a doctor or dentist outside the U.S.
The health care providers that do operate in the east valley know they can't compete with Mexico's prices, so they focus on convenience and their ability to work with U.S. insurance companies. Meanwhile, they say the Affordable Care Act appears to have had minimal effect on people choosing Mexico over local providers.
A 2013 survey of Coachella Valley adults found that more than 10 percent, or an estimated 36,419 people, had gone to Mexico in the previous year for health care or prescription drugs. The survey, conducted by the local nonprofit Health Assessment and Research for Communities, found people going to Mexico tend to have lower incomes and less education.
Who's going to Mexico?
A 2013 survey of Coachella Valley adults found that about 10 percent had gone to Mexico in the previous year for medical care or prescription drugs. Latinos were far more likely to have gone to Mexico than other ethnic groups. People in all income and education levels said they had gone to Mexico, but the likelihood decreased as income and education increased.
Source: Health Assessment and Research for Communities Chart: Robert Hopwood, The Desert Sun
Nearly a quarter of Latinos said they had traveled to Mexico, compared with roughly six percent of white adults. A similar difference was found between people who live in Indio and areas farther east compared to middle and eastern valley cities, which tend to be more white.
Rosa Diaz, 65, of Indio went to a Mexicali dentist for bridges because it cost a quarter of the price. Originally from Nicaragua, Diaz makes regular trips to San Felipe to purchase cheap prescription drugs and supplements while enjoying the beaches and warm water.
"If you make a trip out of it, it just makes financial sense," she said.
Delia and Jesus Barajas both grew up in Mexico and have dual citizenship and local jobs. Long waits and poor care have made them dissatisfied with local emergency rooms. Once when they took their son to a nearby ER for a sore throat, doctors couldn't pinpoint what was wrong. The Barajases left and drove to Mexicali where they said doctors identified an infection and prescribed an antibiotic right away.
Months later a bill for the first ER visit came asking the couple to pay more than $400. That's compared to the $70 per visit the Barajases say they pay to see the pediatrician in Mexicali.
“We pay for health insurance, but we don’t use it here,” Delia Barajas said. “We just have it in case of extreme emergencies, like that time with my son.”
Medical offices here tend to close promptly at 5 p.m., but in Mexicali, she said, patients can be seen sometimes later than 8 p.m.
"I feel like there's not enough doctors and not enough nurses and not enough hospitals," she said. "For the size of this valley, to only have two hospitals that do (baby) deliveries, that's just ridiculous."
Deals on pills
Mexicali, a city of nearly 700,000 a two-hour drive east from San Diego, is among the largest border cities catering to medical tourists, along with coastal Tijuana and Los Algodones, a city nicknamed “Molar City” near the California-Arizona state line. All eagerly advertise to foreigners shopping for cheap prescription drugs or medical care.
Farmacia Love is one of four pharmacies that greet people entering Mexicali from the U.S. It’s a narrow building with a long counter in front of a wall decorated with pills.
Strip malls near the border are filled with medical offices — cardiologists, dentists, oncologists, dermatologists. Buildings advertise plastic surgery and gastric bypass.
A sign advertises medications outside a pharmacy in Mexicali, a Mexican border town that attracts Americans seeking deals on health care.
Among the most popular pills sold in the pharmacies are those treating erectile dysfunction, hypertension, pain and inflammation. Some, like Captopil, require a prescription but others, like Viagra, do not. All of them are substantially cheaper than they are north of the border.
For example, four 50-mm blue Viagra pills cost 65 pesos or $3.25. Captopil, used to treat high blood pressure, costs 145 pesos for a bag of 100. Diclofenac, used to treat inflammation, costs 70 pesos for a pack of 50.
In the U.S., a single Viagra can cost $25. Captopil can be $150, and Diclofenac can be as much as $116 for 100 pills.
A pharmacy worker in her 50s said erectile dysfunction drugs are big sellers, but so are pills for pain, inflammation and high blood pressure. She did not want to give her name because she wasn’t sure if her boss would be OK with her talking about the pharmacy’s pills.
“We do get a lot of people from the other side, but if the store is too crowded they just keep walking and go to other pharmacies,” she said.
A few blocks east of the border several pharmacies offer medical border passes to customers. The program, in existence since April 2012, grants travelers returning to the U.S. from Mexicali access to a special medical lane at the border crossing, allowing them to bypass the hours-long wait to cross back. The lane is available to U.S. residents traveling by car and who received a pass from their medical provider or pharmacist.
The Mexicali Committee on Tourism and Conventions, which tracks the use of the pass, counted 10,409 vehicles using the medical lane during the first three months of 2016, a 4 percent increase from a year earlier.
One of those pharmacies, Discount Pharmacy, has a four-foot sign that advertises “SEX POWER: VIAGRA The Best PRICES.”
The shop also gets a lot of customers from the U.S., said a young woman working there.
“They come on the weekends. They come from Coachella and as far as Phoenix,” she said.
Impact of health reforms
While no hard numbers exist to definitively say so, major changes in the U.S. health care system stemming from the Affordable Care Act likely had little impact on the number of Americans seeking medical care in Mexico or other foreign countries. The U.S. Department of Health and Human Services, which implemented the law's reforms, has looked into what it has meant for medical tourism, a spokesman said.
The law is clearly reducing the number of uninsured Americans — its primary goal. A 2015 survey by the Centers for Disease Control and Prevention found 9.1 percent of U.S. residents lacked health insurance, down from 16 percent in 2010, the year the Affordable Care Act, sometimes called Obamacare, was signed into law.
The uninsured rate among Latinos also has declined, although it remains above the national average. The CDC reported one in five Latinos lacked insurance in 2015, down from nearly one in three in 2010.
Experts say people who’ve recently acquired health insurance may still find it more economical to get care in Mexico. Plus they note that many high-dollar elective procedures that draw people to Mexico, including oral and plastic surgery, typically aren’t covered by insurance.
Steve Wallace, a professor of public health at UCLA who has studied Californians going to Mexico for health care, said the Affordable Care Act has likely cut into the low-end market — people traveling for more routine and inexpensive needs — but that's likely not enough to see sweeping changes.
“My guess would be the ACA has reduced the number of people going to Mexico in the ‘I need it but I can’t afford it group,’” Wallace said. He explained that whereas a person without insurance before the Affordable Care Act might head to Mexico to see a doctor for a general ailment like the flu, new insurance could make a U.S. doctor more affordable.
A study Wallace authored in 2009 based on a 2001 survey of California residents found the number of people going to Mexico for some kind of health care was approaching 1 million. More than half of those were Mexican immigrants.
The Borrego Health clinic in rural Oasis, Ca. is a double-wide trailer offering people access to primary care doctors and specialists including pediatricians. Staff say many of their patients also get care in Mexico because the prices are hard to compete with and the service is often better.
“They make you feel more welcome,” said Sergio Barajas, a physician's assistant at the Borrego clinic who trained in Mexico. “You don’t have to wait as long, you don’t have to fill out all of these forms. You’re not just a number. You’re a real person.”
Physician assistant Sergio Barajas works at the Borrego Health Oasis Clinic.
Barajas also sees a downside. For a child with a runny nose, he might suggest ibuprofen and plenty of fluids. A clinic in Mexico may overtreat and instead give the child a shot of an antibiotic even if the kid is battling a viral cold or the flu.
The patients "associate that injection with the fact that they’re going to get better,” he said.
Borrego's staff said they cater to patients who can’t make the trip to Mexico for a doctor’s appointment, or undocumented immigrants who don’t want to risk crossing the border. For patients with insurance coverage, Borrego can work with those plans, although staff said the bureaucracy of the American health care system and denials by insurance companies are major reasons some people prefer to go to Mexico.
“In Mexico they don’t have the culture of having medical insurance like us,” Barajas said. “Everything is pretty much you pay as you go. The access is right there if you have the money.”
Borrego Health hasn't studied how many patients it loses to Mexico, said V. Manuel Pérez, the network's head of government and public affairs. But he said the expansion of Medicaid, called MediCal in California, under the Affordable Care Act has led to a steady increase in their patient rolls.
Of Borrego's roughly 200,000 patients in Riverside and San Diego counties, Pérez said about 80 percent are MediCal enrollees. Those are low-income Californians who may have avoided the U.S. health care system before the Affordable Care Act came along.
"Our belief is if we have quality care and people feel comfortable about the care they receive then they're going to come back to our clinics," Pérez said.
Bill Erickson of Palm Springs is one case where the Affordable Care Act did change in what country he saw a doctor. The retired artist began going to Los Algodones more than a decade ago while living in Southern California part-time, unable to get enrolled in private health insurance.
“Now with the Affordable Care Act, they couldn’t deny me for a pre-existing condition, which happened to be a blood-pressure thing,” Erickson said.
Medications that before would have cost him $300 in the U.S. now require only a small co-pay. It’s a better deal than before he had insurance.
“Back then I would drive to Los Algodones and get months worth of medication for next to nothing,” he said.
He and his partner still go to Mexico for deals on eyeglasses. He now has dental insurance and sees a local dentist although it may not be saving him money compared to Mexico.
“I’m not going there now for dental, but I’m thinking about it,” he said.
[This story was originally published by The Desert Sun.]
[Photos by Omar Ornelas/The Desert Sun.]