MANAGED CARE: U.S. Exports Health Care ‘American Style’
With the Latin American middle class growing "increasingly disenchanted" with the region's socialized health care systems, many employers are offering insurance from U.S. health care giants as a method for competing for skilled workers, the Miami Herald reports. But as Aetna, Cigna and Blue Cross Blue Shield are "responding to the demand" by rushing to sign up obstetricians and pediatricians in Mexico and other Latin American nations, the quality of care provided remains an issue because the regulatory framework of medical care in Mexico is in its infancy and malpractice litigation is virtually unheard of. Harvard School of Public Health professor William Hsiao said, "These new plans are very attractive to the increasingly affluent middle class in Mexico and elsewhere, because the state systems are just no good."
While the more affluent Mexicans pay cash for health care in the U.S. or at prestigious hospitals in Mexico City, the Mexican middle class, while unable to afford luxury health care, are demanding care in clean, efficient hospitals rather than state-run clinics. Enter American managed care plans: The push into Latin America comes at a time when the companies' reputations are faltering at home. Although the number of Mexicans using American HMOs is small compared to the population, U.S. companies have enrolled almost 200,000 members, mostly in the "more Americanized" northern cities. For example, Aetna's Mexican venture, Aetna de Mexico C.V., has a network of 4,300 doctor-providers and 390 hospitals and boasts having 3.3 million members in seven Latin American countries. Cigna International has 1.5 million members in five Latin American countries; in January, it allied with a Mexican company to offer coverage to an additional 14,000 people. Blue Cross plans in California, Texas and Arizona are currently planning an HMO network in Tijuana. While the new plans vary somewhat, they basically "follow the American managed care model." As such, "doctors get more patients," and managed care companies collect the premiums. Notably, the Mexican market for health care is "huge." The Mexican national health system, IMSS, only provides "bare-bones care," and recently has been hit hard by government funding cutbacks. Regardless of the enthusiasm for American HMOs in Mexico -- viewed by some as "a real step up in quality" -- experts are viewing the plans with caution. Hsiao notes, "[T]here are truly no regulations on these companies or on the doctors or hospitals who work with them. And when you are asking companies to self-regulate, it is most definitely buyer beware" (Schrader, Los Angeles Times News Service/Miami Herald, 11/12).