ANMAC
AMERICANS FOR MEDICARE IN MEXICO
Paul Crist, Founder & President of Americans for Medicare in Mexico, is asking Congress to fund a demonstration project extending Medicare benefits to eligible retirees living in Mexico. The proposed 18-month project aims to show that allowing eligible Americans to receive treatment in Mexico will save Medicare money, due to significantly lower healthcare costs there than for comparable quality care in the States.
An estimated 200,000 American retirees live in Mexico either full or part time. These individuals have worked in the US, paying into the Medicare system for an average of 31 years. A survey on the issue found that amost two thirds either have, or would travel back to the US for a serious illness requiring hospitalization or extended care – not because of concern about the care available in Mexico, but to utilize Medicare coverage. If preventive care and doctor visits were covered in Mexico (Medicare Part B), at least some of that high-cost hospitalization would be avoided, saving money and improving health outcomes.
AMMAC is working to bring together the people, organizations, expertise, and resources necessary to promote and attain U.S. Congressional authorization for a Demonstration Project for Medicare in Mexico.
Demonstration Projects are the limited-scale experiments that Medicare undertakes to test innovations in Medicare Program design. Demonstration Projects are aimed at reducing costs, improving health outcomes, increasing Program efficiency, or decreasing bureaucracy and streamlining administration. Medicare does not make large Program changes without first conducting a Demonstration Project.
Medicare legislation provides authorization for Demonstration Projects to be developed and implemented within the U.S., but not in foreign countries. Congressional authorization and waivers of a number of provisions in the Medicare legislation will be required in order to implement a Demonstration Project for seniors living in Mexico.
We believe that a Demonstration Project for Medicare in Mexico will prove to be successful on a number of levels.
- Medicare Program savings will result, thanks to significantly lower health care costs in Mexico.
- Improved health outcomes for seniors living in Mexico, who are likely to access care earlier when symptoms arise, and to have more frequent preventive examinations and care.
- Stimulate and enhance improvements already underway in certain sectors of the Mexican health provider industry.
In 2009, there is currently the best opportunity yet seen to bring Medicare services to eligible retirees living in Mexico. This is due to a confluence of political and economic events in the United States and Mexico. The current focus on healthcare reform in the U.S. provides an opportunity to promote Demonstration Projects generally, while the need to find Medicare Program cost savings becomes more urgent each year.
While we are working hard to get a proposal introduced in Congress in 2009, we know from experience that legislation can move slowly. We are prepared to continue pushing this agenda until the goal is attained. Success goes to the persistent in the halls of Congress.
It is NOT the aim of Americans for Medicare in Mexico, A.C. (AMMAC) to advocate for wholesale changes or restructuring of Medicare administration. There are reasonable arguments that major changes are called for. It seems likely that changes are coming, as there is significant support in Congress for addressing the many criticisms of the program. But AMMAC is currently focused squarely on the issue of bringing Medicare benefits to eligible seniors in Mexico. To broaden our mandate would dilute our message, and make success of our central goal much less likely.
What does all this mean for Medicare beneficiaries in Mexico, and for the cost of health care services?
- Medicare will not agree – ever – to pay Mexican health care providers directly. This would be both politically impossible and administratively complicated due to:
- Language differences;
- Currency differences;
- Certification oversight for Mexican providers; and
- Managing fraud & abuse in a foreign country.
Thus, an intermediary will be required to manage the program in Mexico.
- Medicare will not agree to reimburse beneficiaries directly for expenses paid out-of-pocket. It would be impossible to control for fraud & abuse under this scenario.
- Tricare for Life/Tricare Overseas Program operates in this manner. That program covers health care expenses for military retirees and their spouses who live outside the U.S., but in Mexico, it is a very small program. Tricare reimburses between 500 and 700 claims per year in Mexico, with an average claim of about US$2,100. For a small program, the cost of developing and administering a fraud control program might cost more than it saves. For a Medicare Demonstration Project that covers perhaps 20,000 beneficiaries or more, controlling for fraud will be a program requirement.
- Health care providers that participate in the Demonstration Project may incur increased costs. This is because Medicare will only agree to work with providers that are certified, either by the Joint Commission International (JCI); Joint Commission on Accreditation of Healthcare Organizations (JCAHO); or at least by the Comisión Nacional de Certificación de Hospitales (Mexican certification). This is perhaps the strongest argument AGAINST bringing Medicare to Mexico. But the following facts mitigate the force of arguments against the program:
- Many Mexican hospitals and clinics are already working toward certification. This is largely being undertaken in order to compete for the lucrative medical tourism market, which comes mainly from the U.S.
- India, Singapore, Thailand, and Brazil currently have more certified health care providers, and more hospital beds per capita than does Mexico. These countries are aggressively pursuing medical tourism, and have health care costs roughly similar to Mexico, even with higher certification rates. Geographically, Mexico has an advantage in attracting medical tourist patients from the U.S., but needs to catch up in both quality and quantity of services. The Mexican healthcare industry is aggressively working to close these gaps.
- The Mexican Secretary of Health has set a goal that 80% of both IMSS and ISSTE hospitals (the public health system hospitals in Mexico) will be certified by 2012. This effort has been ongoing for the past 10 years. Currently about 45% of public hospitals are accredited under the Mexican system, and the next steps include plans for international certification of some public hospitals.
- The momentum toward certification of public hospitals is also pushing private institutions to get certified, as a means of competing for both national and international patients. In 2009, five private hospitals have achieved certification from JCI, and more are coming.
That means that one of the key requirements for Medicare participation is occurring anyway. Bringing Medicare to Mexico will only encourage adoption of reforms already underway in the Mexican health care system.
If you would like to become involved in our campaign to bring Medicare benefits to eligible seniors living in Mexico, please contact us at info@MedicareInMexico.org. There is much to be done!
