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|April 9-15, 2009
A new reason to travel
Mexico has become the new destination for dental work
by Oscar Avila
The sales pitches start just a few steps after you cross the border into Mexico. They come in the same half-whispers familiar to tourists who have been offered time-shares and T-shirts.
“Excuse me, sir,” a Mexican man politely asks in accented English. “Are you looking for a good dentist?”
“Got one,” a silver-haired American says, not even breaking stride.
This is the kind of commerce that has turned a sleepy village on the U.S. border into the latest boomtown of medical tourism, the term for traveling abroad to get medical care. From face-lifts in Costa Rica to heart surgery in India, medical tourism has become a $60 billion enterprise by one estimate.
Los Algodones, population 4,000, is home to about 350 dentists geared to foreign patients, including snowbirds from Chicago and elsewhere in the upper Midwest. Their treatment comes at a huge discount — 70 percent or more — from what Americans pay at home, a reality that many patients call an indictment of U.S. health care.
But U.S. medical authorities warn that this desert outpost is a medical Wild West, an unregulated environment where substandard providers can hang their shingle without the same oversight offered in the United States.
Rubbing his jaw after getting a dental implant, Wisconsin native Carl Zeutzius downplayed those worries, saying he was pleased by the care and by a final bill 75 percent cheaper than in the U.S.
“We’re in favor of helping the economy in the United States, but we don’t want to be ripped off either,” said Zeutzius, who winters in Arizona with his wife, Chris.
Longtime dentists report that, two decades ago, there were only about a dozen dentists and the village drew only the occasional visitor looking for cheap trinkets or R-rated pastimes.
But as health care costs in the U.S. rose and Arizona began drawing retirees and snowbirds, more foreign visitors began coming for
dental care. The boom began in the late 1990s as dental offices began displacing cheap bars known as cantinas.
A recent survey reported about 350 dentists working in 160 offices. While pharmacies and eye doctors also share the sidewalks with quesadilla stands and souvenir vendors, dental care is the real engine. A Phoenix company, Dayo Dental, organizes van rides to make the three-hour run each way. TLC Dental has even opened a bed-and-breakfast adjacent to its dental office for visitors who want to make an overnight trip of it.
The consulting firm Deloitte found that two in five Americans would go abroad for medical care if they could save 50 percent of costs and were assured that the quality of care was comparable.
Another survey, by McKinsey & Co., said most patients travel in search of more advanced technology but that the industry’s growth potential lies in those seeking to reduce expenses, such as the patients in Los Algodones. Experts say increases in health care costs are outpacing the Consumer Price Index at the same time that health insurance is requiring higher deductibles.
McKinsey said a new international accreditation system that certifies a foreign provider’s adherence to U.S. guidelines for care will only boost medical tourism as patients feel more comfortable.
Experts say one reason for the cost disparity is that U.S. medical providers must guard against devastating malpractice lawsuits by securing expensive insurance, costs that are passed on to the consumer.
As much as those high costs are troubling, they are necessary to create a system in which a patient has recourse against an unethical or incompetent medical provider, said Kevin Earle, executive director of the Arizona Dental Association.
Earle said his member dentists have reported countless examples of having to fix problems in patients who have gone to Mexico for care. One patient came to the hospital bleeding heavily from the mouth — the Mexican dentist had ignored that he was taking the blood thinner Coumadin, Earle said.
“Our dentists worry about their patients,” he said. “They don’t want to see them harmed in any way.”
Patients in Mexico can complain to two main governmental bodies. The Federal Consumer Prosecutor’s office handles complaints about unethical billing and the like. The National Medical Arbitration Commission mediates disputes about substandard medical care. However, neither body has a full-time presence in Los Algodones or the ability to extract compensation.
Dr. Salvador Alvarado, general secretary of the arbitration commission’s state office in Baja California, said his group did not receive a single complaint from Los Algodones last year. But he acknowledges that the statistic is not a true indicator of the quality of dental care because U.S. patients likely would find it difficult filing a complaint in Spanish to an office 50 miles away.
The dental association in Los Algodones also polices its members and intervenes in disputes, said Dr. Edna Chavira, the group’s president. The association collects complaints from patients but acknowledges the group’s reach is limited because only about a third of the town’s dentists are members.
Many dentists and patients in Los Algodones point to Dr. Carlos Rubio as an example of what’s right with Mexican care. Rather than try to compete with cut-rate prices, Rubio said he wants to succeed on quality. The American-trained dentist’s office contains a digital X-ray machine and other high-tech devices.
In an office set aside from an air-conditioned lobby where American news channels blare on flat-screen TVs, Rubio said he worries that less-professional dentists will ruin the town’s reputation for everyone. He says it is common for Mexican dentists to move to Los Algodones from the interior to make a quick buck, especially as medical schools produce more graduates than there are jobs.
“Wherever you go — London, Canada, Chicago — you’re going to find the best, the average and the bad. We are no exception,” he said. “Sadly, there are too many businessmen taking advantage of this phenomenon, who will say: ‘Do you want to work with me? How well do you work — who cares?’ “
One of his patients, Kate St. Clair, said she thought friends were crazy when they suggested getting dental care in Mexico. Now she is a believer.
“I (initially) drove down here with the full expectation of walking in the door and walking right back out,” said St. Clair, of Prescott, Ariz. “But I’m actually happier than with the care I had in the States.
“The one sad thing of all this: What does it say that our health care system, for being the most affluent country in the world, is so abominable that we can’t provide the care we need?”
IF YOU SEEK A DENTIST IN MEXICO
— Pay a visit: Ideally, take time to visit the dentist in his or her office before committing to a procedure. Check to see whether the staff speaks English and make sure the dentist follows infection-control guidelines — clean surgical gloves, mask and sterilized equipment. Interview the dentist and ask for photos of similar procedures performed.
— Check it out: If possible, check out the dentist’s stated credentials. U.S. educational degrees can be verified with the institution. Also, make sure the dentist is certified by the Mexican Dental Association. The group has a registry (in Spanish) at adm.org.mx.
— Don’t be cheap: Don’t necessarily go for the cheapest deal. You often get just what you pay for.
— See a U.S. dentist first: Go see a U.S. dentist for an initial consultation. It will save time once in Mexico because you will know exactly what treatment you need. In Mexico, obtain a plan for treatment in writing.
— Ask around: The best resources are often the other patients. Don’t hesitate to strike up a conversation with other tourists in Mexico and ask about their experiences, positive or negative. Those evaluations generally are more honest than an anonymous Internet review.
Sources: American Dental Association, Arizona Dental Association, Dayo Dental
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