MEDICAL TOURISM IN MEXICO. A Press Tribune report to be published within The Los Angeles Times

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1 MEDICAL TOURISM IN MEXICO A Press Tribune report to be published within The Los Angeles Times Transcription of the interview with Dr. Misael Uribe Esquivel PRESIDENTE MEDICA SUR November, 2008 Press Tribune: Before I start with specific questions about Medica Sur, I would like to make a general question. As I am sure you are well aware, in the last years the private healthcare sector in Mexico has gone through quite an important evolution. The quality of medical service in Mexico has improved and there has been a fast growth in the development of hospitals. In your opinion, why has the sector evolved so much over the last 25 years and what is the current condition of the services that people can find here in Mexico? Dr. Misael Uribe Esquivel: Well, there is almost a century of tradition in Mexico that health services should be provided mainly by the state (hospitalization particularly), like in a central oriented economy. This was the main way Mexicans had access to health care. However, since 30 years ago, it became clear that the middle and upper classes demanded improvements in quality and diversity of health care providers. This is up to date a general demand of all Mexicans. Mexico began a process to achieve world standards in health care both in government and non-government medical services. Therefore, part of this evolution began when medical staff and physicians were looking for training abroad, like in the United States or Spain (now Spain has become a very popular place for training). This generated the need to build third level medical centers; first government centers followed by private health centers.

2 Trained professional medical staff decided to work in the public sector because it was kind of a compromise (also because there were no private third level quality facilities). Social devotion today is still present and important; in fact many Medica Sur doctors, including myself, still play a role in dedicating our services to poor people covered by government services, which I find to be a moral commitment. Therefore, it is not surprising that our Mexican health system is a mixture of public and private enterprises. Medica Sur Foundation has this compromise, excellence and social devotion. Even Medica Sur, who has become one of the leaders in non governmental medical practice, is not an entirely private enterprise; 30% of Medica Sur stock belongs to the Sate and the other 70% belongs to the private sector. Professional integration is still diverse; I could say 50% of the doctors who work here are parttime, working and practicing both in the public and private sector at the same time. The other 50% are working full-time for private patients. I must say that all doctors in Medica Sur are accepted only after passing a rigorous selection process and signing code of ethics. I believe this is the only Hospital in Mexico that makes this careful selection. One of Medica Sur advantages is the academic orientation. We have become leader not only in providing the best medical service, but also achieving the goal of becoming a Leading School of Medicine (post graduate). Up to date we have 14 post graduate courses that enable more than 120 young doctors to become anesthesiologists, internists, neonatologists, geriatricians and some other specialties. Every year approximately 4000 students are registered in continuing medical and nursing educational programs. The current conditions in the country are requiring an even greater diversity of options for medical services; it is worth mentioning that in the past, people only had the option of public health providers. Now it is clear for most of us that the State should look after the roots of Medicine and establish how medicine should be practiced according to the medical by laws considering academic standards and ethics. The providers should be placed in an open competition (government and non government providers). When you are a patient in a competitive system, you are in the best position because you are entitled to choose who you d consider to be a really good doctor. In this way, you can receive the best service. The current trend is that people are demanding the best service and are willing to pay for it; more than 50% of the money that is spent in medical care in Mexico comes from patients pockets. I believe this means people are asking for diversity of providers, and they need them. On the other side, I understand that the government is making big efforts to build excellent third level hospitals. However, open competition will increase efficiency and cut down costs in order to improve an ethical practice. The results will be positive to achieve a better health system for both government and nongovernment sectors and patients will receive a much better service regardless of their social status.

3 Press Tribune: How would you assess the services that can be found in the top medical institutions in Mexico? How would you compare them internationally? With Europe or the United States, for example. Dr. Misael Uribe Esquivel: In Mexico there are maybe 10 or 15 hospitals or Mexican medical complexes that can provide the best medical services, comparable to the best worldwide global quality. Press Tribune: So moving on, Sir, I would like to ask you a little bit about the history of Medica Sur, especially since you are one of the founders of this institution. It was established in 1982 and in approximately 24 years it positioned itself as one of the leading and most modern private hospitals in Latin America. So could you tell us about the vision you had of the hospital when it was created. Dr. Misael Uribe Esquivel: At the very beginning, the concept of Medica Sur was a mere dream. It was almost unbelievable that a small group of 17 well trained, young doctors full of enthusiasm, but with limited resources were able to move society and create what nowadays is Medica Sur, a complex which on daily basis attends to 5000 patients in procedures, medical interviews, or hospitalizations. It was only an aspiration of a young group of physicians, a vision and it also was necessary. Most of us were just coming back after training in the United States or in Europe. We felt frustrated and unable to practice with the high quality medicine standards that we were trained for. By that time most of the non-government hospitals in Mexico were inefficient, without technology neither a social compromise or humanitarian philosophy nor values (to practice medicine without values is like an empty glass). For us, doctors, values are the main content in this career. We wanted to provide the best of the public health system and to apply it with the best of the organizational and financial practices from the private sector, so the patient felt as the center of our organization. This became the main target of our effort; this became the philosophy, principle and commitment of Medica Sur. Since then, our philosophy in Medica Sur is that we work for people and our projects are directly oriented to people. The ideas for new areas of development came from an excellent group of physicians and administrators who joined our group, and also believe in our concept of trying to provide the very best practice for the patients. The common feature of Medical Directors is that they are also in active medical practice. Even myself, this afternoon I have about 6 patients to attend to. Any medical director here should also practice medicine. I recently traveled to the United States where I met the CEO of a very large hospital; he is just an administrator and is not taking care of patients. I know his job must be more difficult than mine (our hospital is small compared to those very large U.S.A. Hospitals), but I think

4 perspective and experience is not the same when you do not directly take care of patients. You probably miss the feedback and feeling you get when you have direct contact with your patients, it is extremely valuable to improve every hospital process. Press Tribune: Would you say that the level of service and care provided to your patients are two of the most competitive advantages of Medica Sur? Dr. Misael Uribe Esquivel: I think the main value is that we do not see medicine as a business; we see medical services as a social enterprise. We do recognize that to achieve quality is a continuous process with two main players: human capital manpower and high-end technology with adequate processes and organization and the consequence of that satisfied patients, producing enough return to maintain competitive salaries and updated technology. By achieving good results we are able to buy new equipment; pay adequate salaries to doctors and personnel; furthermore we need to have some return to sustain the quality to continue working and growing. Better said, if we do the right things with moral principles, values and ethics, then the economic development, and the hospital success will follow. It is not the opposite. You cannot expect a sustainable project if people have a bad perception of you or if they have no choices to select. We want to take care of people because they are ill, they need a doctor and good medical service; we feel that is our moral and social obligation to help by doing what we learned during our largest career from the history of the best schools of medicine; and around the world working under the same philosophy. Just look at excellent success examples like the John Hopkins Medical Institution or Mayo Clinic in USA, different models but sharing the same target: excellence. Press Tribune: Medica Sur has a reputation for being a specialized hospital that offers highly specialized services with some of the most modern technologies available in Latin America. Would you tell us about the specialization level and technology available here? Dr. Misael Uribe Esquivel: I would say the strongest areas of medicine are also the main problems of this generation; they are oncology, neurology, general surgery, orthopedic, diabetes, cardiology, now obesity and the consequences of obesity and trauma. Trauma in Mexico City is also becoming a very big issue. Therefore, we have very large groups of physicians working in these areas; we are very fortunate to have equipment for helping those services; we have an updated NMR, gamma knife, 64 slice CT scan, PET-CT, angiography rooms and so forth. We also have very modern geriatric facilities. Excellent updated infrastructure plus top ranked physicians and nurses.

5 So these are the areas in which I think people in the United States must be very interested: replacement of cardiac valves, cardiac treatments and cancer. Even the pharmaceutical drugs for biological problems, which are very expensive in the States, are cheaper in Mexico. Of course the costs of hospitalization and the cost of doctors in Mexico are lower this can represent a saving of at least 40-60%. Mexico City is not too far away from the United States. It is around 2 to 5 hours distance, unlike places such as India or Singapore. Press Tribune: Have you experienced high demand from United States citizens looking for medical services here in Mexico? Dr. Misael Uribe Esquivel: There are mainly two kinds of foreigners looking for medical services in Medica Sur; probably the same happens in other large Mexican hospital complexes. One who pays out of his pocket and the other one who has an insurance policy but is not happy with the service in the United States and looking for a warmer and more personal care. Foreign patients do not want to be just a number, they want to be treated as individuals, so they come to Mexico and pay for the service out of their pocket. I am missing another group of North Americans which are submitted by the companies where they work and they are mainly workers and employees who live in Mexico working for American or European companies. For them it is important to attend a hospital certified by the Joint Commission, which is why we are already working on this. At the end of this year, we expect to achieve this accreditation. Once we have it, it is our understanding that all the insurance companies from the United States may allow patients to receive medical service here. It will be very convenient for them due to the fact that they will pay less than what they are paying in the United States right now. Patients will receive super medical treatment and will rank us at the very top. In my opinion, President Obama is very concerned about health. It is my understanding that he is planning universal health coverage for USA citizens, a kind of a social security like the Mexican style or better like the Canadian health system. The plan should meet peoples expectations to avoid long waiting lists for services, some of these health systems are already facing problems like in the social medical system of Canada, although people favor the system. They do have free service, but for example, for a hip replacement people need to wait larger periods of time than in the United States to have the surgery. I think President Obama is right, everyone should have universal coverage but my expectation is that American patients should be entitled to select from a variety of providers including foreign providers like Mexican hospitals to have competition between them so people may be able to choose and be satisfied with their selection.

6 Press Tribune: Does Medica Sur have the capacity to receive and take care of all these patients immediately? Dr. Misael Uribe Esquivel: The number of Americans seeking health care is increasing, but we should not expect that millions will suddenly arrive. Our current capacity is about 300 hospital beds, besides there are a large number of out-patient procedures than can be performed here with the similar professionalism and medical advances like in any other state of the art medical center. This includes the use of gamma knife: a radiation specifically used to treat brain tumors and cerebral vascular disorders; the group of diagnostic units to detect and provide follow up of patients who have cancer using machines like multi-slice CT, PET- CT, linear accelerators in radiational sciences (oncology) and updated NMR, the best tools to detect, treat and give proper follow up to cancer with 40 % off from the costs offered in the US or Europe. Our cancer center offers a cost/benefit advantage. There are new areas which are ahead from some hospitals in the United States. Like the liver unit which has a group of world class hepatologists with more than 400 research papers published and diagnostic tools like Fibroscan, a machine similar to ultrasound able to establish liver stiffness making unnecessary, in many cases, to perform an uncomfortable and in some cases risky liver biopsy, up to date is the first one in Latin America. In NMR we have a very advanced machine called Ex-Ablate; it was designed for ladies suffering from a uterine benign tumor (myomatosis). The machine may be able to make unnecessary the surgical uterine extirpation (hysterectomy). Also we can provide help in replacing damaged knees, problems in the vertebral spine, cardiovascular surgery, optical surgery (day care unit) and a special program for patients suffering from obesity and its consequences. The obesity team include nutritionists, nurses, psychologists and highly trained surgeons and endocrinologists to perform the most advanced and scientifically proved treatments. Press Tribune: Would you tell us about the variety of services Medica Sur is able to offer, going from the simplest to the most advanced treatments? Dr. Misael Uribe Esquivel: This question was partially answered previously, but I would say that we are the only hospital (in Mexico) with a large service of Geriatricians. We have a group of gerontologists that take care of aging problems including reconstructive plastic surgery and orthopedic correction for aging patients. The neurology science unit provides diagnostic treatment to epileptic patients and to those who suffer from migraines, Parkinson s disease and mental disorders, and a large group of neurological diseases. We also have a huge preventive medicine department which provides annual check ups in a tailored fashion and helps to prevent a large number of diseases or control those with existing problems, it is worth checking our home page to get more information in English.

7 Press Tribune: In Medica Sur there are doctors with similar preparation to American doctors, similar technology, even patients with longer hospital stays. Why is receiving medical treatment in Mexico a cost advantage? And, where do these cost savings come from? Dr. Misael Uribe Esquivel: It is a very tough question. Honestly I can only give my idea a thought. One reason is the purchasing power in one country compared to another. For instance, if a man earns let s say $10,000 (usd) a year in Mexico he would have the capacity to buy much more than he could in the United States; that makes a difference; purchasing power makes a difference. The second is that Mexicans are poorer than Americans and cannot afford to pay more than what they are paying now in Mexico, so if we do not have lower prices we are out of market, we need to be more efficient and reduce all costs. For example, my fee for a consultation is around $50 or $60 (usd). In the United States, similar doctors charge up to $200-$400 for half an hour consultation, and if you go beyond that, you are paying even $600. This makes a difference. Probably globalization in medicine is already going on because America is able to bring to the United States the best doctors in the world but they charge the highest costs in the world. We have the same procedures and same facilities at lower prices because the economy scenery is different. Therefore, generally speaking, our costs are 40-50% lower than those in the U.S.; that is an important issue. Press Tribune: In 2007, Medica Sur started a new stage of expansion with a constant modernization, better facilities and bigger investment. Please, tell us about the growing plans of Medica Sur in the near future. Dr. Misael Uribe Esquivel: Medica Sur has been able to consolidate itself as an Academic Medical Center and has been able to gain the people recognition as a referential center. We provide and offer honest and efficient medical services. The economic crisis has, so far, not had a major impact on the financial reports of Medica Sur, thanks to the loyalty and confidence of our patients. Hence our compromise of growth, since the initial sign of the economic crisis, we bought Medica Sur Lomas (formerly a Woman Clinic in the north of the city and in an expensive area of Mexico City). This facility has been remodeled to achieve world standards. The clinic will be ready next spring (2010). We also bought three large primary care centers since we also want to include our work in these areas, and recently (last week) we bought 500,000 sq feet of beautiful land next to Medica Sur (door to door) so we will be able to double our capacity and build a health science university, social areas like hotels and a convention center to diversify our services, covering any specialty of medicine in

8 an academic environment. In five years we expect to have 1000 hospital beds and at least 3 large medical centers to offer, without compromising our values, ethical practice and quality. Press Tribune: I ve seen your annual reports and you have quite healthy financial figures. Would you welcome investment from the United States for these future projects? Dr. Misael Uribe Esquivel: In general, we accept investors who do not want to be involved in operating the hospital or give rules for the practice of more profitable medicine. We need socially interested investors who agree on this. What our investors want is a transparent and honest administration feeling safe that their investment is productive. Their confidence helps us to grow faster and then we will be in a position to help patients to fulfill the medical requirements. In other words, we welcome foreign investment to help us to achieve a faster rate of growth and to attend the needs of the Mexican (and American) population. Press Tribune: I would like to ask a personal question, what is your background, as one of the founders of this Institution? Dr. Misael Uribe Esquivel: Like the rest of the founders, I was young when the project started as a sort of idealistic project. As we advance with both achievements and age, we maintain the original principles, still quite positive with plenty of idealism and willingness to deal with medical problems. Essentially we started to build what was only a dream in 1982 after I and some other doctors came back to Mexico. As a group, we were fortunate to be trained at the Mayo and Harvard so we shared dreams and knew leader groups in the U.S. We wanted to offer the best service to our patients and have the best colleagues to integrate our practice. After almost 30 years of constant effort, we are very fortunate to have developed what Medica Sur is today. The addition of five more acres will allow us to be probably not only the best but also the largest non government medical complex in Latin America within almost 11 blocks of medical services of all specialties. So the baby boomers generation will be privileged seeing their dreams coming true: leaving a heritage to the future doctors and patients. Press Tribune: As the President of this important institution, what gives you the motivation to move forward every day? Dr. Misael Uribe Esquivel: The answer may be similar to President Obama s phrase: yes we can. You know Mexico sometimes can confuse nationalism with rationalism. We do not

9 agree with politicians that do not recognize the importance of social investment from the American or other foreign countries. Many people do not realize that without investment, many people will suffer because of bad education, bad health or social problems like unemployment, untrained people, and people incapable of providing their family with food to survive. So, we must be more pragmatic, especially with the medical sector. We encourage the civil society to play an active role creating, investing and working in social projects like hospitals, particularly in those committed to best medical practices, education, research and innovation. Press Tribune: To finish this interview, I would like to invite you to send a message to our readers Dr. Misael Uribe Esquivel: Please transmit to your numerous readers in the United States and particularly to those in LA and California, many of them with Mexican ancestry, that they have a friendly, competitive and professional warm option for health care in Mexico, with Medica Sur. We are committed to providing the best medical service with the warmest and most individual care which is typical from Mexico. They will benefit from the highest quality and same supervision as they have in North America or worldwide. Our laboratories, our hospitals and doctors are all well prepared and trained to practice and provide the best service. Taking care of patients is the essence of our medical mission. Press Tribune: Thank you so much. END OF INTERVIEW

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