Advocates for Evidence-Based Health Policy Speakers
Trading Places
Americans are often pre-occupied worrying about people entering the United States across the Mexican border. Ever wonder if Mexicans worry about the nearly 2/3 of the border population that enters Mexico for health care?
The 32 counties in Texas that border the United States-Mexico border are faced with a particular challenge of access to care. 47 percent of the residents lived below 150 percent of the federal poverty line in 2000, as compared to a national average of 21 percent. An estimated 42 percent of the border county population are uninsured, compared with the national average of 15 percent. Due to these economics, the authors sought to analyze the proportions of border residents who turn to Mexico for their health care needs. Prior studies noted that a lack of health insurance is one of the most significant predictors, but these studies included primarily small, nonrandom, and local samples, making the findings difficult to generalize.
Through a random sample telephone survey, the authors gathered data from more than 1400 Texas border respondents concerning their medication purchases, doctor and dentist visits, and inpatient care in both Mexico and the US. In order to analyze the level of substitution between US and Mexican products and services, they gathered data on explanatory variables including household income, health insurance coverage, fluency in Spanish, self-rated health status, perceived quality of health care services in the US, and demographic variables including race and ethnicity.
Over forty-nine percent of respondents reported having ever purchased medications in Mexico, with 43.3 percent of respondents reporting purchases within the last 12 months. Forty-one percent of respondents had ever visited a doctor in Mexico, with 36.9 percent within the last 12 months. Overall 63.4 percent of respondents had reported ever using at least one of the four types of health care services in Mexico. Females had a much higher chance of utilizing Mexican health care services than males (p<0.001). Increased age, lack of health insurance coverage and self-rated poor health status were associated with a higher probability of doctor visits (p<0.001). For medication purchases and doctor visits, the likelihood of utilization increased with higher levels of Spanish fluency (p<0.001).
Commentary
The authors are correct to point out that United States-Mexico collaboration may be necessary to address access and delivery of health care in the border areas. Such diplomacy concerning a multitude of social justice issues would be to both nation’s advantages. The unmet needs of the Texas border counties demonstrated by this study not only reflect a lack of resources for its citizens in the United States but also a lack of cultural competence surrounding those resources that are actually available. Working with our ally to the south may provide insight on how to provide more appropriate care. Border health and the specific needs of subpopulations within our borders are “hot topics” that provoke academic conversation but warrant little large scale public policy debate that would allow for corrective action. While frequent political debate centers on those individuals crossing into the United States by illegal means, little mention is made of our own citizens who find it necessary to cross the border in the opposite direction to obtain basic health care services.
by
Kameron L. Matthews, MD, Esq.
For more information:
- Mexico’s Seguro Popular is an attempt to bring universal health care to the country
- President Calderón of Mexico encourages medical tourism for Americans
- Medical tourism is a $20 billion dollar industry where at least 750,000 Americans travel abroad for health care each year