major medical care


The rising cost of health care in the United States is forcing an increasing number of U.S. citizens to turn their sights on Mexico for expert and cost-effective medical attention. But what about the health care for the elderly Americans who are already residing in Mexico? Should they be covered by Medicare in Mexico or should they have to fly back to America every time they need major medical care? Can the medical care providers in Mexico be trusted with the health of American seniors? Here’s an excellent read that recently appeared in a Mexican newspaper.

According to Paul Crist, the founder and president of Americans for Medicare for Mexico (AMMAC), a non-profit organization dedicated to bringing Medicare coverage to seniors living in Mexico, of the 800,000 American citizens living in Mexico approximately 200,000 are over 60 years old and thus are at or near eligibility for Medicare benefits.

Christ has lobbied 85 members of the U.S. Congress and prepared a 34-page proposal in which he outlines the pros of extending Medicare to Mexico. Medicare is now spending 6,700 dollars per year per beneficiary in the United States. For the same care in Mexico, Crist estimates that it will spend only 3,400 dollars, which translates to a very substantial saving.

Crist says that if Medicare is extended to Mexico, the program would only work with health care providers approved by JCI.

Although the health sector in Mexico is regulated and certified by the Mexican General Health Commission, the task of getting JCI certification for Mexico’s private hospitals is of prime importance.

One of the main reasons for pushing for certification is that the North American Free Trade Agreement or NAFTA obligates the Mexican medical system to be on a par with the United States and Canada, allowing for the free flow of patients from border to border and for fair trade, much like in other economic sectors.

But there is another huge reason for this interest in JCI certification and that is Medicare.

Crist revealed that ten hospitals in Mexico have JCI accreditation but another 23 are seeking approval. Among those already approved are the American British Padre Hospital and the Santa Fe Hospital in Mexico City and the Christus Muguerza Hospital and the Hospital Tec de Monterrey in Monterrey.

The approval of Medicare would greatly benefit hospitals such as Christus Muguerza, a Texas chain that now has seven hospitals under construction across Mexico. They have the advantage because their headquarters is in Texas, which gives Medicare a bit more confidence in the quality service they are going to provide.

In a recent interview with Forbes magazine, David Warner, a professor of health care policy at the University of Texas at Austin and a specialist on Medicare in Mexico, stated that an in-depth pilot project is needed to better understand the economics, determine whether Mexican heath care meets Medicare’s quality standards and determine if the payment system is sufficiently free of fraud.

According to Forbes, the U.S government is concerned that creating a Mexican medical exemption might be too complicated and costly to implement and would open the door for Americans in other countries.

Crist figures that if Medicare were accepted in Mexico, the 64 percent of American retirees currently flying back to the United States for expensive care would opt for treatment nearer their homes, cutting Medicare overall costs by a minimum of 22 percent.

Source: Guadalajara Reporter

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An excellent story appeared yesterday on NPR that talked about the Federal Employees Health Benefits Program or FEHBP – the health insurance program that insures 8 million federal workers, retirees and their families, and members of Congress. Below is the story of a 13-year old daughter of a federal employee who feels blessed to have the FEHBP coverage to pay for the costs of managing her Type 1 diabetes. Do you think other insurance programs in the country should model themselves after FEHBP?

“This is what keeps me alive,” says 13-year-old Toni Bethea, as she picks a tiny glass bottle off the kitchen counter of her home in Washington, D.C. The clear liquid inside is insulin. Toni has Type 1 diabetes.

“Your health is obviously not anything that you should play around with,” says Toni, a high-school freshman. She’s pretty, smiling and stylish — from her bangs angled across her forehead to her sparkly red fingernails.

“You should take it very seriously and when you have a chronic illness like what I have and other kids have, it’s very important that we take care of ourselves because there’s a lot of preventable stuff that can happen to us.”

It helps that her mother, Rhonda Dorsey, has good insurance, which she gets as a federal employee. She’s covered by the Federal Employees Health Benefits Program, or FEHBP. It insures 8 million federal workers, retirees and their families — and members of Congress. That federal health insurance program has been held up — by the president, lawmakers and other players in the health care debate — as a model of the kind of good insurance that should be available to all Americans.

Dorsey and others who are covered under FEHBP do report high levels of satisfaction, but it’s not some kind of super insurance. It’s pretty much like most insurance people get through their jobs. Federal workers, too, sometimes complain about the rising costs of their premiums and co-payments and about the hassles of getting care.

The Option To Choose

Toni was five years old when she was first diagnosed with diabetes — as long as she can remember. “At five, I really didn’t know what was going on, but I remember having my mother and my grandfather holding me down to give me shots and prick my fingers. And I was scared, I was confused, and it wasn’t a good time.”

In those early, stressful days of her daughter’s illness, Rhonda belonged to a traditional HMO through FEHBP. She’d take Toni to see an endocrinologist, an eye doctor and one specialist after another. “I’d always have to get a referral. And sometimes I would forget and I’d get to the doctor’s office and it would be a mess. And so I’d be very apologetic and we’d have to call the pediatrician’s office, and it just was a waste of time in my opinion.”

There were limits, too, on the supplies she needed to manage Toni’s diabetes. Sometimes a prescription refill for needles or testing strips would be denied.

So Rhonda switched insurance companies. Her new plan allows her to keep taking her daughter back to the specialists who know her best. “I have the standard plan which means that I pay a little bit more up front,” she explains. “My deductible is a little bit higher, but I don’t have to deal with the referrals. I can go to any doctor.”

Federal employees get a lot of choice. That’s what makes the Federal Employees Health Benefits Program stand out compared to other insurance. In the Washington, D.C. area, there are at least 16 health plans to choose from. Across the nation, according to a new report by the Kaiser Family Foundation and the Health Research & Educational Trust, most companies offer only one health plan to their employees, and just one percent of companies offer three or more.

The federal Office of Personnel Management conducts annual negotiations with each health plan to set benefits and rates. That has allowed it to claim some success in constraining cost growth. But last year Blue Cross and Blue Shield — which covers about 60 percent of FEHBP enrollees — increased the premium for its standard option by 13 percent. As a result, the average for all federal plans went up 7 percent. The year before, the annual premium increase was just 2.1 percent.

Toni’s Life Depends On It

For Dorsey, an information specialist at the Nuclear Regulatory Commission, her insurance through FEHBP has been central to keeping Toni healthy. “In order to live a healthy life with Type 1 diabetes or any kind of chronic illness,” she says, “it’s so important to have good insurance. And I tell Toni all the time how blessed we are because we’ve met a lot of people who don’t have insurance at all.”

Still, even with good insurance, it’s expensive to manage diabetes. Toni pricks her calloused fingertips several times a day to check her blood sugar levels. Rhonda pays a little more than $200 a month for supplies.

Toni wears an insulin pump — it’s the size of a cell phone and it’s pink. “It had to be pink,” Toni says with a laugh. Adds her mother, “Pink is definitely her style.” The first pump cost $5,000. Insurance paid all but $500.

Toni knows she’s fortunate. This summer, she went to a summer camp for kids with diabetes. And she saw what kids do when they don’t have good health insurance. “At camp they provide you with supplies, but I’ve seen kids who have saved their needles and taken them with them,” she says. “Even though you weren’t like supposed to, they would kind of sneak them just to make sure they would have something when they got back home.”

Toni and Rhonda know that when people don’t have good insurance, they’re so desperate they will even reuse a needle. “It gets dull. And so it really hurts. But you have to have insulin, just like I said,” Rhonda says. “I mean, without insulin, Toni would die. So you, take the pain in order to live.”

Toni listens to her mother and adds, “I do feel very grateful for all that I have, because that could be me.”

Source: NPR, by Joseph Shapiro

For those without health insurance or poor health coverage, there is medical tourism (as well as domestic medical tourism) to help them afford the costs of major medical care. Read more about these on Healthbase.

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