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	The Connection	By Patrick Osio

Choosing Right Affordable quality health care available in Baja California In response to a recent column discussing the attractiveness of Tijuana’s medical services to many San Diegans and others from Southern California, a reader commented that it was wrong to promote a service at the expense of local doctors. Another declared medical care in Mexico was not at par with local standards and people were at risk by going to Mexico. And of course the presently popular warning that one risks one’s their very life crossing into war-torn Tijuana. The biggest promoter for seeking medical services in Tijuana, and indeed all of Baja California, is the high cost of medical services for millions of Southern Californians, especially the seven million who lack coverage of any type. Even the 17 million who are covered often face harsh limits such as high deductibles and co-payments for services and medications. Those costs themselves sometimes keep people from seeking services. The un- and underinsured who turn to medical services in Baja, with Tijuana being the central point, are finding prices 40 percent to 80 percent less than those in Southern California. Among the insurers seeking these patients as customers is Blue Shield’s Access Baja HMO Health Plan. It requires clients live within 50 miles of the border and covers most of San Diego and Imperial counties. In Baja, just like in California, the quality of medical treatment is dependent on the quality of the medical practitioners. Blue Shield investigates and contracts with medical providers in Tijuana, Tecate and Mexicali to assure the quality of health care along with the contractual obligation on costs and co-payments charged to members of the program. HMOs offering services to state residents are governed by the California Knox Keene Act of 1975. The act was amended in 1998 requiring HMOs offering services out of the country be licensed and regulated by the state of California. In 1998 a number of Mexican medical facilities applied for such a license, but only one was actually granted. The company, SIMNSA, is thriving. It owns its own medical facilities and has on its staff about 200 physicians covering more than 50 specialties. It has its own dental, vision and complete lab services and contracts with leading area hospitals for inpatient care as needed. SIMNSA is the only out-of-country HMO licensed to sell group insurance in California where the insured members can only obtain the service in Tijuana or the SIMNSA facilities in Tecate and Mexicali. Every year SIMNSA undergoes a state audit on services, complaints, costs, etc. Like Blue Shield, SIMNSA also is also restricted to offering the insurance within 50 miles of the border. Separately, insurers Aetna and Health Net have made deals with SIMNSA. Since SIMNSA is the owner and operator of its own facilities in Baja, both Aetna and Health Net offer medical group insurance within the 50-mile restricted region offered to companies with a high percentage of Hispanics employees. The savings can be significant. For example, a group premium covering a family of four can cost $1,000 a month. The SIMNSA premium is around $400, with no deductible and in most cases no co-pay. Delta Dental offers dental group insurance on a 50-50 coverage and co-pay. A crown in California is around $800. At Denti Center in Tijuana, a Delta Dental approved source, the cost is $400. The amount that Delta Dental pays thus covers the entire bill, saving the insured $400. At Excel Hospital in Tijuana, cardiovascular surgery is performed by Dr. Jose Hernandez, renowned on both sides of the border for his skills. An open-heart surgery that can cost up to $100,000 in California costs around $20,000 in his state-of-the-art hospital. Similar high-percentage savings are realized on many other treatments, for example, such as weight loss, plastic surgery and hair transplant. As always, care must be exercised in choosing the right doctor, regardless the side of the border. Patrick Osio Jr. can be reached at posiojr@aol.com. The veteran consultant has participated on writing scripts for documentaries on Baja California real estate, medical services, and retirement information at TransBorderCommunications.com. This article first appeared on the May 2009 issue of the San Diego Metropolitan Magazine.
Patrick Osio, Jr. has written a short but intensive manual on the Mexican perspective on numerous issues between our two countries. The manual is an in depth primer on the culture and protocol for better understanding Mexicans that in turn allows establishing personal and business relationships, and how to avoid the most common faux pas that can ruin relationships and business deals. About the author Table of Contents Excerpts from the manual The manual is available through Electronic delivery for $9.95 making it possible to download the manual for save on your hard drive, printing its entirety or particular sections while reaping considerable savings over printed copies.