I'd like to add a few anecdotes of my own here. They don't offer any ideas for solutions, but they support what you said.

Three years ago when I was visiting here in Ajijic, Mexico, I had an insect bite on my arm. It itched, I scratched it and broke the skin, and the next morning my arm was pink from wrist to elbow. I went to the local clinic (a small, 8-bed hospital with, I believe, one full-time doctor) without an appointment or any advance notice. I had to wait eight whole minutes before I finally got to see the doctor. He looked at my arm, looked where I scratched the bug bite, said "Yes, it's infected, this prescription will take care of it." It did. The bill was 200 pesos, about $15 US. The prescription was about $16 at the pharmacy across the street. I learned later that I could have gone a quarter mile down the road to the less "fancy" pharmacy and gotten it for $12. Next morning the arm looked no better, so I went back, was told that it would take another day for the antibiotics to knock down the infection, and he was right. He refused to accept any more payment "You've already paid," he said. He asked me to stop by the clinic one more time before I left, just be sure everything was OK. I did, everything was OK, and I had to force him to take a second $15 payment. Now, if this experience had taken place in my home town of Fairbanks, Alaska, I would have gone to the clinic (easily 20 times the size and staff of the one in Ajijic) and been told that yes, I could have an appointment, how about a week from this Tuesday. Had I still been alive then, I'd have shown up on time, and waited at least 45 minutes to an hour to see the doctor, who would have looked at my arm and said "Yes, it's infected, but we'd better run some tests to be sure." After $600 worth of tests he would have written up about $200 worth of prescriptions. The 10 minutes of actual visit time would have cost another $135, ditto for any followups. The same service in the US would have cost about 20 times as much as I paid in Ajijic (30 times as much if I hadn't insisted on making that second payment) with highly qualified doctors in each instance.

Second anecdote: Now that I have permanent residence here, we have set up a plan with a different clinic wherein for a flat fee of about $225 for each of us my wife and I have unlimited office visits for one year plus two home visits from the doctor. These doctors are not rustic witch doctors making sacrifices to the gods or anything like that. They are trained in the medical schools of Guadalajara which are recognized as being among the finest in the world. This is not to say that all services are covered by that $225. Things like MRIs and cat scans cost extra. SWMBO had an MRI of her sinuses at the request of her allergist, and the cost was something around $150.

The third anecdote is not first person, but taken from a local newspaper. A local man became hypoglycemic and passed out in the dining room of a hotel. The management called an ambulance which transported him to a hospital about 30 miles away where he was held 24 hours for observation. The hospital made accommodations so that his wife could stay in the room with him. The doctor assigned to him visited him several times, and nurses checked on him every hour. When he was released, he was presented with a bill for $400.

My wife and I have found the medical services here to be so good and so inexpensive that we don't submit the bills to our insurance company. When she was still working in California, she went to Guadalajara for dental work (two tooth implants) and the cost including the round trip plane tickets was less than her insurance co-pay would have been had she done the work in California. This was before we realized that our retirement insurance actually was valid in Mexico. It's too late now for getting the dental work paid for, and the other bills are so small as to discourage fighting with the insurance company for reimbursement, because the paperwork provided by Mexican clinics is...informal at best.

When I look at the cost and quality of Mexican health care compared to the US, I can only assume that someone in the US is making a great deal of profit.

tanstaafl.