When I first quit the practice of law in Toronto and only early retirement in Oaxaca, I assumed that the years I’d enhance my entire life by leading a much more stress-free existence in Mexico, will be lost by the inferior medical care system to that we would be exposed, subjected and restricted. This, then, is my assessment of the extent to which my presuppositions have been accurate, along with information and advice for both vacationers to and would-be ex-patriot residents of Oaxaca.
Apart from the small, private hospitals, often referred to as cl? nicas, there are four publicly funded and insurance – based hospitals in the city, as well as a hospital just outside the city offering specialized treatment for many serious ailments. There is the Red Cross facility offered to all, often employed 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 open to ex-pat residents and Mexican citizens alike, with an extensive network of clinic doctors and a large hospital. It? s funding is provided in large part by companies. Aside from these hospitals, there are many, small, easily accessed clinics scattered throughout suburban and rural neighborhoods.
For the vacationer, and the ex-pat with a VISA permitting residency in the country, the most typical means by which to obtain emergency treatment is through Red Cross, IMSS (which accepts patients without coverage on a pay-per-service basis) or a private hospital. However, the last of those three is the only one in which you can be reasonably reassured to be attended in a timely fashion by extremely competent and efficient personnel.
HOW TO PROCEED AS A VACATIONER
If you don’t have out-of-country healthcare coverage, go ahead and venture out and buy it before leaving for the trip. However, it? s advisable to first ask your charge card company, to see if in reality you already have at least some coverage by simply virtue of, for example, having a gold or platinum card. After that you can produce a more informed decision concerned whether to buy coverage, and if so at what level. Alternatively, a broken leg, gastrointestinal problem or other non-life threatening ailment may be attended by a private doctor or clinic without breaking the lender. Needless to say for an outlay greater than $100, it? s nice to be reimbursed.
If you wish to claim to your private carrier, charge card company or government funded healthcare plan, make certain you not just keep all receipts, but request a written diagnosis and treatment plan, and that the prescriptions you are given indicate for what purpose each medicine has been prescribed (i. e. antibiotic, analgesic, etc.). Many doctors provide all required information simply as a matter of course. Accepted practice, at least aside from when narcotic medications are being prescribed, is for the pharmacy to return prescription forms for you. Often medical plans require translations of every document that’s presented for them as a prerequisite for processing and reimbursement. When in doubt, submit all documentation with your claim, making sure to determine if originals are needed, and keep copies. Frequently, as may be 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 along with a request for reimbursement for the amount maybe not included in the province, is submitted to one? s private plan. Theoretically, between the two plans, 100% reimbursement is achieved.
You can ask the manager of your hotel or bed and breakfast to accomplish you a favor by translating all of your supporting documents, to save you the problem upon your get back home. Jot down the then prevailing rate of exchange, and submit a calculation to your plan along with your documentation, to more easily facilitate payment. Whenever a person in 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 can make strategies 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 because of their post-graduate training such as to universities in Mexico City or the usa, and regularly attend conferences and upgrading courses. Some travel abroad within the context of their specialization training. Indeed the Oaxacan populace seems to prize and prefer those physicians who are able to display foreign diplomas.
Our personal experience with emergency treatment over the past 10 years has been nothing but positive for ourselves, our house 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 as a result of delays in receiving treatment, and at minimum in the case of IMSS unavailability of competent medical personnel 24 hours a day for attending a good commonplace emergency (i. e. suturing). Having said this, many excellent surgeons with private practices perform surgery at the non-private hospitals where there is often 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 US dollars and so are approximate for 2008 unless stated otherwise).
PURELY ELECTIVE AND COSMETIC PROCEDURES
In the last many years Oaxaca has become a popular destination for Americans and Canadians seeking both plastic cosmetic surgery and extensive dentist hilliard work. Word has spread of the competence and quality of work of both nip-and-tuck and dentist hilliard surgeons, and of course of these extremely reasonable charges in accordance with those paid to hometown practitioners. Many foreigners, as well as Mexicans from Mexico City and other parts of the country come to Oaxaca for face lifts, breast reductions and augmentations, liposuction and other appearance enhancing procedures. A friend who attended for plastic cosmetic surgery in Oaxaca by way of a well-known cosmetic surgeon a few years ago, recently commented that she had read a write-up in a Canadian magazine indicating the price for the same procedure which she had performed for $500, was $3500 – $5000 at home. Essentially she had a free of charge trip to Oaxaca, and returned home with more money in her pocket.
Our personal experience with dentist hilliard treatment has been extremely positive. Cost tends to be about a third to a half of American and Canadian prices, for example for crowns and bridges, implants, root canals, gum and bone work, etc. While the use of nitrous oxide (laughing gas) have not yet arrived in most Mexican cities, a dentist with a gentle touch can a lot more than make up for that lack of temporary high within the chair.
RESOLVING THE EX-PAT CONUNDRUM
Get whatever coverage is made available to the two of you in your homeland and in Mexico, subject obviously 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 until you have other similar insurance from another source. Our Oaxacan friends tend to disagree, but theirs is a different mindset where insurance generally has historically not been stressed or valued, be it 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, along with diagnostic tests, medication and hospitalization. You will find restrictions the initial year of enrolment, and you will find caveats. The level of cleanliness in the clinic environment is commonly below the standard to which just about everyone has become accustomed growing up in the us and Canada. Many physicians have not received the grade of medical education of these private counterparts. The medications provided through the clinic pharmacy in many cases are maybe not the best available in the marketplace for treatment of a particular ailment, due to cost. Often the wait to see your designated doctor or for the tests could be long, requiring a half day commitment for each step in the act: visiting a general physician, going for one pair of tests, then for another, last but not least seeing a specialist.
So why make use of IMSS at all, with all these downsides? It? s a failsafe, another kind of assurance that you? ll be looked after in case of an extended and serious illness. As suggested earlier, often it? s the greatest hospitals such as IMSS which may have the best equipment, and surgeons with private practices who perform some of the surgeries. And there is absolutely no additional cost for hospitalization after you have full IMSS coverage. While attending a private clinic is more comparable to your experiences before moving to Mexico, if you must remain in hospital for a lengthy time frame, the cost of doing this in a clinic could possibly be prohibitive? the same as 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, it’s simple to be confident that you? re covered in almost all respects. In case of a protracted hospital stay you can afford to be there provided necessary. The best locally available equipment will be used in your diagnosis and treatment, and you’ve got a reasonable likelihood that attending surgeons are people who split their time between private practice and clinic work, and performing procedures in a number of large hospitals.
We maintain IMSS coverage, but rarely use it, preferring to tap our Oaxacan social support systems for referrals to specialists to the extent they’re required. And in any event, after having been resident in Oaxaca for a couple years, those of us that are in our fifties or older have already been introduced to a broad range of specialists. As strange because it still is to be a Canadian and sign up for the pay-as-you-play philosophy of health care, it serves our purposes, with the IMSS back-up in the event.
Under certain circumstances may very well not desire to rely on even the very best Oaxaca is offering. Indeed the stream of Oaxacans traveling to Mexico City flows briskly and wide. The center and upper classes with contacts in the nation? s capital, there quickly look for the best in terms of physicians and state-of-the-art equipment, for diagnosis and for treatment of {life-threatening} diseases.
Even doctors in Oaxaca at the IMSS and ISSSTE hospitals could make arrangements for patients to get treatment not available here, to be attended in Mexico City or other larger centers. However, the method can be slow. We all know of 1 case, that of a two-month-old baby with heart disease, who had been finally delivered to Puebla for surgery at ISSSTE, only to die ahead of the procedure could possibly be performed.
The solution, unless you have quality foreign coverage perhaps in your retirement pension plan, would be to buy insurance which will pay for treatment in Mexico City, or better yet across the world if you can make the right path to one of the participating top-of-the-line hospitals. Within my case, I have a decreased annual premium, with high deductible which is waived in case of accident. Again, it? s a failsafe mechanism in the event of, for example, a serious car wreck, or cancer, stroke, heart attack, or other catastrophic ailment which may otherwise not be affordable. Oaxaca has less than the best of diagnostic equipment and treatment facilities. My plan offers a $10, 000 deductible, $2, 000 annual premium, with member private hospitals in Oaxaca, Mexico City and elsewhere in the republic, not to mention abroad such as the US, with the Mayo Clinic in Rochester being a participant.
In conclusion, my medical coverage and arrange for treatment could be the following. We now have our regular family physician, who, along with our Oaxacan friends, refers us to specialists in which we have the utmost confidence, and to whom we pay per visit. The same is true for dentist hilliard treatment. We now have IMSS coverage which we reluctantly (because we don? t utilize it) renew on an annual basis, but believe it? s worth the price in the case we need extended hospitalization, or to have surgical procedures performed unavailable in private clinics. And I have my catastrophic coverage which hopefully I? ll will never need to gain access to.
Health care and coverage could be inexpensive, and just like easily it can be costly. It? s a matter of the individual or family having a philosophy, or group of priorities, before electing to go to Oaxaca. You have to determine how you wish to lead your daily life with regards to balancing having less disposable income as a result of medical and insurance charges, with having greater satisfaction in understanding that whatever is thrown your path is going to be cared for as most effective given your brand-new life in a foreign land. If you cannot achieve a level of comfort in the resolution of the issues and decisions, then probably the move just isn’t for you personally.
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