MEX­I­CALI, Mex­i­co-Tourists of­ten come to bor­der towns look­ing for some kind of il­lic­it ad­ven­ture, trot­ting among the bars, strip joints and seedy mo­tels that dot the streets. Here, though, the vis­i­tors are search­ing for some­thing more ba­sic, a root canal they can af­ford or surgery they have been putting off for months. Mex­i­cali has adopt­ed med­ical care as its pri­ma­ry tourist lure, and it has been at­tract­ing a grow­ing num­ber of health care com­muters from Cal­i­for­nia and oth­er near­by states. Hos­pi­tals of­fer op­er­a­tions for gas­tric by­pass, li­po­suc­tion and chron­ic back pain. Den­tists promise that ex­trac­tions, fill­ings and whiten­ing can all be done for less mon­ey. And oph­thal­mol­o­gists ad­ver­tise laser surgery and rou­tine ex­ams. Thou­sands of peo­ple are cross­ing the bor­der in search of care they ei­ther can­not af­ford or wish to get more cheap­ly. The in­flux has grown steadi­ly over the last sev­er­al years, at­tract­ing unin­sured Mex­i­cans who have made their lives in the Unit­ed States and des­per­ate­ly need af­ford­able care. But it in­creas­ing­ly in­cludes a small­er but grow­ing group of mid­dle-class pa­tients from all over the coun­try look­ing for deals on elec­tive surg­eries that most med­ical in­sur­ance will not cov­er. "At first, I was like, Mex­i­cali, where is that?" said Stephanie Rusky, a 26-year-old so­cial work­er from Perkins, Ok­la­homa, who paid rough­ly US$8,000 for some li­po­suc­tion, a breast lift and a tum­my tuck (a com­bi­na­tion known as a mom­my makeover) that would have cost about twice that in the Unit­ed States. "But I asked every ques­tion I could think of and even­tu­al­ly felt re­al­ly com­fort­able with it."

Such sen­ti­ments are sweet mu­sic to the ears of Omar Dipp, who over­sees tourism for the city. "There's a huge mar­ket for this," Dipp said. "We just have to pack­age it the right way. Every­one ben­e­fits: the ho­tels, the restau­rants, the lo­cal econ­o­my. We give them a rea­son to come, and they will be here." Last year, more than 150,000 pa­tients came to Mex­i­cali, pump­ing more than US $8 mil­lion in­to the city's econ­o­my, of­fi­cials said. There are some dozen hos­pi­tals that reg­u­lar­ly see Amer­i­cans, and many have a spe­cial ad­min­is­tra­tor to co-or­di­nate med­ical and trav­el plans. With near­ly 100 med­ical of­fices in a six-block ra­dius, the city hopes to cre­ate a spe­cial med­ical zone by im­prov­ing streets and side­walks and adding more ser­vices for tourists. Just across the bor­der in South­ern Cal­i­for­nia, the small city of Calex­i­co has strug­gled for decades. The area has one of the high­est un­em­ploy­ment rates in the coun­try. Many of the res­i­dents in the Im­pe­r­i­al Val­ley there re­ly on sea­son­al agri­cul­tur­al work and have no in­sur­ance. For them, com­ing to Mex­i­cali for care can seem ob­vi­ous. A few in­sur­ance providers have even ex­pand­ed some cov­er­age in­to Mex­i­co, en­cour­ag­ing their cus­tomers to seek the less ex­pen­sive care. A 2010 study showed that rough­ly 85 per cent of those who crossed the bor­der for med­ical care were Span­ish speak­ers, but Dipp said he ex­pect­ed more and more "blue-eyed Amer­i­cans" in the com­ing years.

Med­ical tourists

In strip malls and of­fice build­ings here, there are far more med­ical of­fices than any­thing else. Ho­tels of­fer spe­cial rates for pa­tients, and the lo­cal tourism of­fice has be­gun sub­si­dis­ing van rides from Las Ve­gas to bring in those who would rather avoid the dri­ve them­selves. And this year, the gov­ern­ment opened a spe­cial lane to al­low med­ical tourists to by­pass most of the wait on the Mex­i­can side of the bor­der, which can of­ten take as long as three hours. The doc­tors, with strong sup­port from the lo­cal gov­ern­ment, are hop­ing to at­tract more Amer­i­cans for elec­tive pro­ce­dures or more ba­sic care that they may not be able to af­ford at home. And many here be­lieve that the mar­ket will on­ly grow as health­care costs con­tin­ue to rise and more peo­ple, par­tic­u­lar­ly low-wage work­ers along the bor­der, are des­per­ate to find af­ford­able care. Juan Salas drove near­ly three hours from his home in Desert Hot Springs, Cal­i­for­nia, to have his 11-year-old daugh­ter, Abi­gail, fit­ted for braces. While he has med­ical in­sur­ance through his job as a restau­rant sup­pli­er, it does not cov­er den­tal work, so he has come here dozens of times. Sav­ing thou­sands of dol­lars will make up for the round trip of at least five hours he will soon be mak­ing a cou­ple of times a month, he said. "Sav­ing the mon­ey is as im­por­tant as the time," Salas said as his daugh­ter sat in the chair of the small of­fice, where the or­tho­don­tist ex­plained that he was us­ing the same equip­ment Amer­i­cans would. Salas's wife, Araceli, said that her fam­i­ly had come here for med­ical care since she was a child. When their el­dest daugh­ter was strug­gling with seizures, their lo­cal doc­tor could not see her for weeks. Anx­ious to get a di­ag­no­sis more quick­ly, they came here to see a doc­tor who of­fered not on­ly new med­ica­tion but al­so his cell­phone num­ber so they could call him for fol­low-up ques­tions.

Many of the fam­i­lies drawn to Mex­i­cali's med­ical of­fer­ings, like the Salases, at an or­tho­don­tist's of­fice, have lim­it­ed in­sur­ance. "At that point, pay­ing for the care didn't re­al­ly mat­ter," Salas said. "We were talk­ing about our daugh­ter's life, so we want­ed help right away and we had it." Here, many Mex­i­cans talk with pride about the easy ac­cess they have to their doc­tors, send­ing them fre­quent text mes­sages with ques­tions and ex­pect­ing calls back with­in min­utes. One oft-re­peat­ed anec­dote il­lus­trates a sign of more com­pas­sion­ate care, nurs­es will warm a pa­tient's hand be­fore stick­ing him with a nee­dle. But there are many oth­er con­sid­er­a­tions po­ten­tial pa­tients must take in­to ac­count. None of the hos­pi­tals in Mex­i­cali have been cer­ti­fied by Amer­i­can med­ical ac­cred­i­ta­tion teams. While the fa­cil­i­ties ap­pear clean and mod­ern, there are no pub­lished stud­ies mon­i­tor­ing in­fec­tion rates or oth­er risk fac­tors. Still, seem­ing­ly com­fort­able with the in­for­ma­tion they do have, peo­ple from the Unit­ed States flock here for surgery. Car­lo Bon­fante, an own­er of Hos­pi­tal de la Fa­mil­ia, where Rusky was a pa­tient, said the most pop­u­lar op­er­a­tions were gas­tric by­pass and gas­tric band surgery ("thanks to all the fries across the bor­der," he said with a laugh), but that he hoped more peo­ple would be­gin com­ing for pri­ma­ry care., "The peo­ple who live a few miles away from here but in an­oth­er coun­try can't af­ford the care," he said, "so we will pro­vide it for them for less, what­ev­er they need." Since the spe­cial med­ical lane at the bor­der opened at the end of April, doc­tors have is­sued rough­ly 1,600 pass­es, which are re­quired to use the lane. "We want to make it as easy as pos­si­ble, so that there is no hes­i­ta­tion to come," said Di­ana Co­ta, who over­sees in­ter­na­tion­al care at Hos­pi­tal Al­mater, where rough­ly 20 per cent of pa­tients come from out­side Mex­i­co. "Even be­fore the point where some­one says they can't pay for what they want in the US, we want them here." (New York Times)