Sunday, April 08, 2007

A Conundrum about Medical Care

While out to dinner last night with friends, the conversation turned to health care and how we would handle a medical situation here in San Miguel de Allende. Some of us have reached the age of Medicare and supplemental policies. In general, you can not get health insurance in Mexico after the age of 65 and your Medicare and supplemental policies from the USA have varying degrees of coverage which usually only means for emergency treatment and often with fairly low maximums in coverage. Before Medicare kicks in, your coverage will vary depending on your policy.

On Mexico Matters blog, there is a post that includes information about medical costs and he writes that you can get quality medical care for 50 to 70% of what it would cost in the USA. And he further writes that many people are coming to Mexico to get their medical needs met.

We know of two situations where people had medical emergencies that required major surgery. They went to the Los Angeles Hospital in Queretaro which is about 40 minutes away from San Miguel and they were extremely pleased with the care as well as the cost of the treatment....from what we can figure maybe even less than 50% of the cost in the USA. And we know of people who have had colonoscopies in Queretaro for about 25% of the cost in the USA. Extensive dental work seems to be about 25% of the cost in the USA.

I've not heard of anyone who has had cancer treatment in San Miguel or Queretaro. And I'm talking about serious cancer treatment not about the coffee enema "clinics" that exist outside of standard medical practices. In fact I've seen few Mexicans who look like they are in the midst of chemo treatments. I don't know if they stay close to home when they are in treatment or if the incidence of cancer and/or cancer treatments is less in Mexico.

Every time we go back to the United States it seems someone asks us about medical care in Mexico. We had started to feel pretty good about being to to get good medical care if we should have an emergency and even if our insurance didn't cover all of the cost or even any of the cost, we felt we could deal with it until we were stabilized and then if need be, we would go back to the USA to continue treatment under our Medicare insurance.

But today in the NY Times there was an article about the value of immediate treatment when a heart attack occurs. This level of life-saving care that can save the life as well as stop or prevent damage to the heart muscle requires that the care start within one hour of the attack, that the hospital have the skilled team and equipment to do the procedures and that the emergency room personnel is trained to recognize the artery blockage. Even in the USA not every hospital provides this level of care.

This gave me pause. The hospitals that we would go to in the Houston Medical Center, Dr. Debakey or Dr. Cooley's legendary heart clinics in Methodist or St. Lukes hospitals, would provide this kind of care but what is the level of expertise at Los Angeles in Queretaro which at best is 40 minutes away.

I was starting to wonder, what if one of us did have a major arterial blockage? Would we get to Queretaro in time? Would we receive the optimal care? Are we crazy for living here? While both of us have been well screened and tested for heart trouble up until now, who knows what the future holds. And that thought "who knows what the future holds" brought me back to reality. Should we give up our rich and interesting life in Mexico so that we can live near a hospital with optimal heart care when at this point we don't even have heart disease? If that is the case then I guess I would not go see my cousin in a small town in Tennessee or take a trip to Big Bend National Park to photograph with friends.

No, I don't know what the future holds so I think I'll live as full a life as I can now. I'll try to prepare for tomorrow but as Scarlett O'Hara said, I'll worry about it tomorrow.


Howard Grill said...

Billie, being a cardiologist, this is something I can (hopefully) make some useful comments on.

First off, what you say about rapid interventional procedures in the case of a heart attack is true (I personally perform them), but the fact is that the majority of hospitals in the US do not provide this type of emergency it is not just an issue of being in Mexico. It could very well be an issue in the US as well, depending on where you live.

So what happens in the US if you live outside the sphere of this type of emergency care? Typically, you would be given what is called thrombolytic therapy, that is to say an intravenous medication that breaks up blood clots, as most 'big' heart attacks occur when a blood clot forms on a narrowing that may or (more usually) may not be severe prior to the clot forming. This type of therapy, which I would assume should be available in Mexican medical centers, has also been shown to decrease mortality significantly in people with heart attacks, though not quite to as great a degree as interventional therapy (balloon angiolplasty and stents) and not as effectively in people with the most severe heart attacks and shock.

Anyway, what I am long-windedly trying to say, is that I suspect there is good therapy available where you are, though perhaps not the most invasive and emergent, which you might not get everywhere in the US anyway. By the way, getting thrombolytic therapy doesn't necessarily mean thats can buy you time to get transfered to a larger and more sophisticated medical center in the US or Mexico.

I would be glad to tell you more if I haven't already bored you out of your mind!

Billie said...

Howard, I was hoping you would comment. Having lived in Houston near the Medical Center with 2 teaching hospitals, our medical treatment expectations are high. But the more I hear about Los Angeles hospital in Queretaro the better I feel about being able to find care here if we have to. Why live my life as if I might have a heart attack when it might be more likely breast cancer since both my Mother and Sister had breast cancer. Or I could get hit by a car or......

And after rereading the article I realized that even in the USA, I might not get the angioplasty emergency care. So it is what it is.

And you know Howard, I think this live style is healthier than the way we lived in the USA. We walk everywhere. Seldom ever get the car out. I think we get food closer to where it is grown and eat more fruit and less meat.

Thanks for the reasurrance. I'm living my dream. How many people can say that.

Anonymous said...

Cancer treatments in Queretaro are among the best in the country, also the University of Queretaro is considered the third best university in medical stuff in the country.

Angeles Hospital is really good private hospital, and also the Hospital General de Queretaro which is public is really good and extremly affordable, since it is public.

The UVM university is building a new Hospital in Queretaro, also the San José is really good, there are many many options in Queretaro, in case of a heart attack I think San Miguel must have a good emergency hospital for that kind of stuff, at least they can provide the first aid and then translate you to Queretaro in an ambulance.

Howard Grill said...

Not many can say that. I certainly can't.

In general, and I suspect you already know this, there are a few things you can do to decrease your cardiac risk. Make sure your blood pressure is controlled, if you happen to be diabetic make sure your blood sugar is controlled, check your cholesterol and treat it if appropriate and, for heavens sake, please don't smoke (not saying you do....just making a general statement). Also, if you have no contraindications, an aspirin a day can be beneficial....of course, for legal reasons I have to temper that and say...ask your doctor. I take a baby aspirin daily myself.

Like you say, a healthful lifestyle and stress reduction is likely important as well.

Anonymous said...


"...I don't know what the future holds so I think I'll live as full a life as I can now. I'll try to prepare for tomorrow, but...I'll worry about it tomorrow."

This has been my credo, my tenet throughout life, and up until now it has only illicited shaking heads, rolling eyes, worried sighs and the under-breath "oh my."

At least I am glad you have finally come around to to my side.

The teacher now becomes the student. Welcome to the team.

Now go out and do something stupid...worry about it tomorrow.

Your son,

I think you know which one

Claudine said...

I LOVE this topic because guess WHAT was the one thing that scared me the most when hubby and I (with daughters ages 4 and 5) contemplated a move SOB? YUP, health care. I was so certain I was walking into a 3rd world country settlement without proper medical care (and yet I still came???). Wrong, wrong, wrong. Immediately I found great services for a more realistic price. So what if I didn't have health insurance (we do now) I could actually AFFORD to pay for what we needed. LEt me add, we have been treated very well in Dr's offices. Even a wisdom tooth extraction (about $25 USD) went so smoothly that I didn't need pain medication AFTER (oh yes, during I did).
By the way posted on my blog and I reponded with this note below. Putting it here to make sure you see it. BYE!

I have no sense of "distance" thanks for posting that. I knew you were somewhat in the area and even thought of you. Not sure if we will make it to your area (but we have done last minute excursions before...depends on the kids' moods these days ya know). EMail me your phone number please ( If we end up in your area, I would so LOVE to meet you - we have been corresponding online almost a year now through each other's blogs!!!!


Billie said...

Anon, thanks for information about Cancer treatment in Queretaro. I didn't know that.

Dear Son #3.....yes, indeed I could figure it out. I think we have come to a roll reversal. Now I'm the one running and playing and you are the one with the nose to the grindstone. Still I don't think I'll ever top your wild days. I'm not sure I even want to try. LOL

Claudine, I remember reading about your medical adventures with getting the girls their shots. I really do feel better about finding adequate medical care here in Mexico. Not everywhere but then I don't think it is everywhere in the USA either.