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Thursday, September 18, 2014         

NEW YORK TIMES


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Mexican city attracts tourists with tummy tucks, not tequila

By Jennifer Medina

New York Times

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MEXICALI, Mexico >> Tourists often come to border towns looking for some kind of illicit adventure, trotting among the bars, strip joints and seedy motels that dot the streets. Here, though, the visitors are searching for something more basic:a root canal they can afford or surgery they have been putting off for months.

Mexicali has adopted medical care as its primary tourist lure, and it has been attracting a growing number of health-care commuters from California and other nearby states. Hospitals offer operations for gastric bypass, liposuction and chronic back pain. Dentists promise that extractions, fillings and whitening can all be done for less money. And ophthalmologists advertise laser surgery and routine exams.

As the United States approaches the climax of a fierce national debate over the Obama administration’s health care law, which would significantly increase the number of people covered by medical insurance, thousands of people are crossing the border in search of care they either cannot afford or wish to get more cheaply. The influx has grown steadily over the last several years, attracting uninsured Mexicans who have made their lives in the United States and desperately need affordable care. But it increasingly includes a smaller but growing subset of middle-class patients from all over the country looking for deals on elective surgeries that most medical insurance will not cover.

“At first, I was like, Mexicali, where is that?” said Stephanie Rusky, a 26-year-old social worker from Perkins, Okla., who paid roughly $8,000 for some liposuction, a breast lift and a tummy tuck (a combination known as a “mommy makeover”) that would have cost about twice that in the United States. “But I asked every question I could think of and eventually felt really comfortable with it.”

Such sentiments are sweet music to the ears of Omar Dipp, who oversees tourism for the city.

“There’s a huge market for this,” Dipp said. “We just have to package it the right way. Everyone benefits: the hotels, the restaurants, the local economy. We give them a reason to come, and they will be here.”

Last year, more than 150,000 patients came to Mexicali, pumping millions of dollars into the city’s economy, officials said. There are more than a dozen hospitals that regularly see Americans, and many have a special administrator to coordinate medical and travel plans. With nearly 100 medical offices in a six-block radius, the city hopes to create a special medical zone by improving streets and sidewalks and adding more services for tourists.

Just across the border in Southern California, the small city of Calexico has struggled for decades. The area has one of the highest unemployment rates in the country.

Many of the residents in the Imperial Valley there rely on seasonal agricultural work and have no insurance. For them, coming to Mexicali for care can seem obvious. A few insurance providers have even expanded some coverage into Mexico, encouraging their customers to seek the less expensive care. A 2010 study showed that roughly 85 percent of those who crossed the border for medical care were Spanish speakers, but Dipp said he expected more and more “blue-eyed Americans” in the coming years.

In strip malls and office buildings here, there are far more medical offices than anything else. Hotels offer special rates for patients, and the local tourism office has begun subsidizing van rides from Las Vegas to bring in those who would rather avoid the drive themselves. And this year, the government opened a special lane to allow medical tourists to bypass most of the wait on the Mexican side of the border, which can often take as long as three hours.

The doctors, with strong support from the local government, are hoping to attract more Americans for elective procedures or more basic care that they may not be able to afford at home. And many here believe that the market will only grow as health care costs continue to rise and more people, particularly low-wage workers along the border, are desperate to find affordable care.

Juan Salas drove nearly three hours from his home in Desert Hot Springs, Calif., to have his 11-year-old daughter, Abigail, fitted for braces. While he has medical insurance through his job as a restaurant supplier, it does not cover dental work, so he has come here dozens of times. Saving thousands of dollars will make up for the round trip of at least five hours he will soon be making a couple of times a month, he said.

“Saving the money is as important as the time,” Salas said as his daughter sat in the chair of the small office, where the orthodontist explained that he was using the same equipment Americans would.

Salas’ wife, Araceli, said that her family had come here for medical care since she was a child.

When their eldest daughter was struggling with seizures, their local doctor could not see her for weeks. Anxious to get a diagnosis more quickly, they came here to see a doctor who offered not only new medication but also his cellphone number so they could call him for follow-up questions.

“At that point, paying for the care didn’t really matter,” Salas said. “We were talking about our daughter’s life, so we wanted help right away and we had it.”

Here, many Mexicans talk with pride about the easy access they have to their doctors, sending them frequent text messages with questions and expecting calls back within minutes. One oft-repeated anecdote illustrates a sign of more compassionate care: nurses will warm a patient’s hand before sticking him with a needle.

But there are many other considerations potential patients must take into account. None of the hospitals in Mexicali have been certified by U.S. medical accreditation teams. While the facilities appear clean and modern, there are no published studies monitoring infection rates or other risk factors.

Still, seemingly comfortable with the information they do have, people from the United States flock here for surgery.

Carlo Bonfante, an owner of Hospital de la Familia, where Rusky was a patient, said that the most popular operations were gastric bypass and gastric band surgery (“thanks to all the fries across the border,” he said with a laugh), but that he hoped more people would begin coming for primary care.

“The people who live a few miles away from here but in another country can’t afford the care,” he said, “so we will provide it for them for less, whatever they need.”

Since the special medical lane at the border opened at the end of April, doctors have issued roughly 1,600 passes, which are required to use the lane.

“We want to make it as easy as possible, so that there is no hesitation to come,” said Diana Cota, who oversees international care at Hospital Almater, where roughly 20 percent of patients come from outside Mexico. “Even before the point where someone says they can’t pay for what they want in the U.S., we want them here.”






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