Knee replacement in Mexico

It has long amazed me that the typical non-emergency medical intervention for an American does not start with a plane flight to a country in which medicine can be done efficiently.

“A Mexican Hospital, an American Surgeon, and a $5,000 Check (Yes, a Check)” (nytimes) is a story about a knee replacement that happens in the way that Econ 101 would suggest:

The hospital costs of the American medical system are so high that it made financial sense for both a highly trained orthopedist from Milwaukee and a patient from Mississippi to leave the country and meet at an upscale private Mexican hospital for the surgery.

Ms. Ferguson gets her health coverage through her husband’s employer, Ashley Furniture Industries. The cost to Ashley was less than half of what a knee replacement in the United States would have been. That’s why its employees and dependents who use this option have no out-of-pocket co-pays or deductibles for the procedure; in fact, they receive a $5,000 payment from the company, and all their travel costs are covered.

Dr. Parisi, who spent less than 24 hours in Cancún, was paid $2,700, or three times what he would have received from Medicare, the largest single payer of hospital costs in the United States. Private insurers often base their reimbursement rates on what Medicare pays.

Interesting, but it raises more questions than it answers, e.g., why aren’t all knee replacements done in a country where knee replacements can be done efficiently?

[Separately, note that the NYT informs us that Mexico is too dangerous for a caravan of Hondurans to dwell, which is why they need to continue across the southern border of the U.S. and claim asylum. But, on the other hand, the same newspaper tells us that Mexico is sufficiently safe and organized to serve as a meeting place for American surgeons and privately insured patients.]

14 thoughts on “Knee replacement in Mexico

  1. Basically, no malpractice suits in Mexico & the doctor walked home with what he would have otherwise had to give to lawyers. Take away the legal fees & everything becomes free. The alternative solution is not to get fat.

    • Therein lies the rub. Food industry lobbies Congress, Corn syrup is subsidized, added to all products. Dairy is subsidized. Meat is subsidized. Cheese was literally given away at one point. How about taxing unhealthy choices high in sugar and fat, and subsidize lettuce and broccoli? 1 cent per gram over 15 grams of sugar per serving. Same fat above 1/2 the US RDA per serving of food. We tax cigarettes to discourage use, why not unhealthy foods?

    • The orthopaedists get together once a year and “decide” the cost of a knee replacement in America. Price fixing. Add the malpractice insurance and no one is able to afford surgery. Insurance would rather you suffer through it, hoping you change jobs before they have to pay. The ultimate gamification, because the executives get paid on “cost avoidance”, a fancy term for not paying claims. The whole industry disgusts me. Insurance, doctor cartels, the government. Single payer would be better.

    • …or not play a lot of years of basketball and go on to another career of knee stressing activity…

  2. Note at the end a bit more about the author and how the article was written. Sort of a promotion for Kaiser IMHO.

  3. Your separate note about the danger/safety of Mexico applies also to the U.S. (and pretty much anywhere). The Hondurans weren’t flying into Cancun, for a stay in private hospital, then flying back out again with a $5K check in hand from their employer. Similarly, the surgeon and patient weren’t crossing the country on foot through a variety of communities. Not saying the Hondurans were necessarily in danger or that the surgeon/patient weren’t, but you’re positing a false equivalence which doesn’t really add much to your story.

  4. Does anyone bother to read the story? According to this, it actually involves *more* malpractice insurance than in the US:

    “NASH buys additional malpractice coverage for the American physicians, who could be sued in the United States by patients unhappy with their results.” It’s actually advertised as a selling point to patients!

    The cost savings come from the hospital room costing $300/night rather than $2000, and that Johnson & Johnson charges $3500 for the implant in Mexico and $8000 for the same thing in the US.

    My question with these things is what outcomes look like when something goes sideways. I don’t know what can go wrong in a knee replacement, how likely those outcomes are, and how much my prognosis is improved by being at Mass General when that happens versus Galenia, MX or a regional medical center in Alabama for that matter. If I get C. Diff. or MRSA I probably want to be in MGH, but my odds of getting it might also be higher there because it’s huge, full of acute patients, and maybe not cleaned as thoroughly.

    What I do know is I would have limited trust in large institutions (i.e. insurers) pushing something like this, simply because dead patients cost them very little.

    • Your prognosis may be better at a regional medical center in Alabama than at Mass General. Professional and ‘amateur’ college athletes fly in from all over the country to have their knees done here. My ENT friend flew in from Burlington, VT to have her ACL done here.

      The two most renowned Medicine texts have traditionally been Cecil’s and Harrison’s. Guess where Tinsley Harrison practiced and taught medicine?

  5. This isn’t rocket science guys. Let me explain it as simply as I can.

    Give a man a free fish and he will come back for more and be stuck onto you for life and generation. Give a man a free net to fish and he and his offspring may proposer for generations if he puts it to good use.

  6. Question (I didn’t read the article this time, so I don’t know if it was ‘covered’ there so to speak): if you have the surgery in Mexico and have the post-op physical therapy done later in the U.S. will insurance cover both? In other words, is a U.S. referral necessary and would the surgery done in Mexico cover the therapy once the patient returns to the U.S.? You don’t just walk away from a knee replacement – even the best patients will need some type of physical therapy.

  7. Seems like a lot of travel time lost for the surgeon. Do they schedule multiple procedures for him to perform on his Mexico trip? Otherwise, I would think he could still make more staying in the US and cranking out multiple surgeries in the time it would take him to travel to and from Mexico.

  8. I travel to Mexico often. I wouldn’t let them treat a hangnail. Knee replacement is major surgery, folks. And I wouldn’t trust a surgeon who goes there just to make more money.

  9. People travel to America daily to have medical procedures. Why would anyone in there right mind leave this country and its vast wealth of medical knowledge to have a medical procedure?

  10. These are very insightful comments…and this group has somehow managed to succinctly outline the major issues facing the corporate medical travel market. IndusHealth is the Raleigh based facilitator that manages the myriad of details to seamlessly enable the outstanding patient experience.

    NASH is one three Central American centers of Excellence in our network. We are able to achieve surgical outcomes better than the US at a fraction of the cost because we are not in the business of trying to extract the maximum amount of reimbursement from a presenting condition.

    All the sundry straw men were present :

    – MRSA is of more concern from incoming US patients who are carriers
    – Our length of stay can range from 8-12 days …so the patient cannot escape physical therapy
    – After more than 1,000 surgeries, there have been 0 readmissions, 0 infections and 100% patient satisfaction
    – Prices are surprisingly similar among Costa Rica, Cancun, Caymans, Panama and India…it is the US that is hyper inflated
    – Few of our patients have passports, they are forced to seek options as copays and deductibles are placing more and more surgeries out of reach

    And yes, the US has the best hospitals in the world. In fact, IndusHealth has a cardiovascular partnership with Cleveland Clinic, America’s #1 heart hospital for 25 years. But access to our best hospitals is not in any way uniform.

    We are essentially importing global competition for the worlds largest monopoly, US healthcare.

    Remember GM’ response when the first Toyotas began to arrive ?


    Tom Keesling

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