Healthcare in Mexico for Expats; What you should know before you begin

Cedula – Professional Designation

A cedula is a professional license to practice.  All attorneys, doctors, architects, accountants, engineers, notaries (NOTARIOS), dentists, nurses, chiropractors, etc must have one to legally practice. Some states issue for Real Estate Agents 

Mexico does have certifying boards for medical specialties. The cedula is a government issued document that certifies that the professional has completed proper studies for the licensure in the appropriate school. For doctors every one must have a cedula as a general practitioner and the doctors with specialties may have a second or even third cedula that certifies them legally for the practice of their specialty(s). However, that does not mean that a doctor is competent in what they do or claim to be specialized at.

Aside from the cedula, there are certification Boards for every specialty in Mexico. This is a different kind of certification which requires not only that you have legal documents (cedula) but also requires a Board exam of knowledge and of technical skill when it applies.  Board certification needs to be re-established every 3 or 4 years to ensure that specialty doctors are up to date. In order to get re-certification, a specialist needs to obtain a certain amount of points. Points are given for National and International Congress meetings, conference attendance, publishing, teaching, and other educational or continuing education participation.

Last, board certification is mandatory to work in most private hospitals and to be part of other medical associations/staff. Hence, for a patient, it is very important to know if their specialist is board certified and up to date. It is the only way to fight charlatans and fraud (doctors that say they are but they aren´t).

Boards in Mexico are known as “Consejos”, like: “Consejo Mexicano de Medicina Interna”, “Consejo Mexicano de Otorrinolaringología”, “Consejo Mexicano de Cardiología”, “Consejo Mexicano de Ortopedia”, etc….. and all databases can be accessed on line.

And, there are also expats including who will indicate they are professionals including Nurse Practitioner but have never proven their credentials in Mexico. And, they may not be certified in another country as anyone can print certificates. Once an expat is certified they apply at INM for permission to work. Some expats have bypassed this requirement as well.

So, the next time anyone including an expat state they are a doctor, engineer, architect, lawyer, chiropractor, dentist or any other professional designation ask to see their cedula. Then check it online to ensure it is real.  

https://www.cedulaprofesional.sep.gob.mx/cedula/indexAvanzada.action 

And if you know the Cedula number enter it here: http://www.buholegal.com/consultasep/

Healthcare Overview

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Seguro Popular has approximately 60 million members and many hospitals and hundreds of clinics throughout Mexico. 

When my husband was declined some time ago, I worked extensively with Seguro Popular’s main office in Mexico City. After doing so they agreed expats did not have to be a citizen. Seguro Popular is available to citizens and Temporary and Permanent Residents. At some offices where you sign up for membership, a copy of your birth certificate is required. 

If you have an emergency you go directly to the Hospital General for treatment.

At any time, if you have any problems at the hospital including billing, quality of care etc., you are advised to contact the Medico Gestor.

Coverage includes over 900 medical interventions including cancer including ovarian, esophagus, liver; X-rays; fractures; appendicitis; hernias; malaria; vasectomy; heart and lung transplants; autism; heart disease; electro-cardiograms; HIV; hemophilia; etc. That is over 90% of all medical issues. Dialysis is not covered.

Most medicines are given by the hospital/clinic, although if insurance does not cover those medicines, they are usually sold to you by the hospital at a very reasonable price. Based on my experience the Seguro Popular pharmacy may not have the medication you request but a generic may be offered. If you walk into the clinic with prescriptions expecting them to automatically fill them with no medical consultation they will not take kindly to you doing so.

There is no pre-existing conditions restriction; there is no age limit.

Your insurance starts immediately and is nation-wide. You should always present the enrollment approval form and number along with government-issued photo identification when needing care.

Fees for your policy and care depends on how you answer questions such as: do you own or rent, do you have cement, dirt or tile floor in your house; do you have a refrigerator and stove; how many TV’s and bathrooms; number of bedrooms; do you work; do you own a car; what is your level of education; your age; number of people in a family; are you a Mexican national vs a Temporary or Permanent Resident, etc? Your answers will also determine what you may be required to pay for example towards surgery. 

These questions are asked in Spanish and are computer generated and asked by the receptionist. It is important you answer these questions correctly and I will do so on your behalf. Otherwise, an error may result in over-charging. There is no chart showing all the variables, which establishes your annual fee and also what may be your costs when hospitalized etc. Both Temporary and Permanent Residents are all paying an annual fee. Every week I work with clients to gain Seguro Popular membership totaling thousands of expats and Mexican citizens over several years. I also represent Seguro Popular at seminars for expats. 

Mexico has a quite complex healthcare system, that’s divided into:

1: Private sector (you must have foreign insurance that covers you in Mexico, or Mexican insurance, or pay out-of-pocket).

2: Public sector, is sub-divided into:

a) Seguro Popular (the General Hospitals for pretty much anyone that shows up)
b) IMSS (for insured private sector workers)
c) ISSSTE (for federal government workers, such as federal police officers, etc.)
d) other, local hospitals/clinics for government workers of that particular state.. for example, in Baja California, it would be: ISSSTECali… etc. (for local teachers, firefighters, etc.)

As a foreigner, you may enroll in either Seguro Popular or IMSS.

Seguro Popular, the General Hospitals, are usually better staffed and equipped than the IMSS counterparts. Most university hospitals belong to the Seguro Popular network and it’s where most research and patient-centric care is performed.

It also depends on what type of care you’re seeking and where. If it’s in the Mexico City metropolitan area and you have access to the national institutes (Instituto Nacional) they provide world-class medical care. Some require a referral, but if it’s an emergency they do not. They’re located in the Tlalpan district and they all belong to the Seguro Popular network. For example, at the Gea Gonzalez Hospital, you can be seen in the E.R. for a co-pay of 100 pesos and if they determine that it’s a true emergency, they waive the co-pay. All hospitals have a “Trabajo Social” area and they’ll do a sliding-scale evaluation of your ability to pay in case you require further evaluations, hospitalizations, surgery, rehabilitation, etc.

In summary: outside of the private sector, most prestigious hospitals belong to Seguro Popular. The federal Ministry of Health in Mexico City distributes funding to each state’s healthcare branch of government to pay staff and equip the healthcare facilities. IMSS, on the other hand, is more centrally governed, with most of the funds staying in the big IMSS hospitals in Mexico City while the states receive a smaller share of proceeds.

 

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IMSS

IMSS is also a government healthcare program mostly for employees but some expats who are Temporary or Permanent Residents join. The annual fee is 7000 to 9000 pesos (increases with age) per person and renewed annually. For those with pre-existing conditions, you are normally declined. First year’s coverage is almost non-existent but the second year is much improved and subsequent years provides full coverage. Part of the decision to join IMSS vs Seguro Popular is the availability of hospitals and clinics and annual fee.

Most young doctors dream of working for IMSS because of the benefits offered. They receive 2 months paid vacation a year, free housing in some areas, free “guarderia” daycare for their kids, 0% financing and no downpayment housing mortgage, pensions, etc. So, competition is very strong and it’s practically impossible to get in if you don’t have a family member working for IMSS. This is how some IMSS doctors are able to live a very comfortable lifestyle with a mediocre public-sector salary.

There’s also a weird salary system in place at the IMSS hospitals with some doctors working on an hourly basis (no set salary package) just to get the IMSS experience and hoping to get a stable position in the future. A doctor that works a 24-hour shift at the Seguro Popular (General Hospital) and comes to work for low pay at IMSS for another 12 hours – might not be in the best position to make sound clinical decisions.

Sonia Diaz 

Professional Expat Services

 

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2 COMMENTS

  1. Great article! I have a few questions:
    How can I find a list of what hospitals in Mazatlan work with IMSS or Seguro Popular?
    Are there reviews available?
    Would it be best to plan to go to a larger city in Mexico for either IMSS or Seguro Popular?
    Does the city or state of registration dictate where you can go for medical care?