Monday, March 29, 2010

Mexico the new dental destination - Chicago Tribune Archives

Americans flock to border town that takes bite out of high prices found in U.S. clinics


LOS ALGODONES, Mexico—The sales pitches start just a few steps after you cross the border into Mexico. They come in the same half-whispers familiar to tourists who have been offered time-shares and T-shirts.

“Excuse me, sir,” a Mexican man politely asks in accented English. “Are you looking for a good dentist?”

“Got one,” a silver-haired American says, not even breaking stride.

This is the kind of commerce that has turned a sleepy village on the U.S. border into the latest boomtown of medical tourism, the practice of traveling abroad to get medical care. From face-lifts in Costa Rica to heart surgery in India, medical tourism has become a $60 billion enterprise by one estimate.

Los Algodones, population 4,000, is home to about 350 dentists geared to foreign patients, including snowbirds from Chicago and elsewhere in the upper Midwest. Their treatment comes at a huge discount—70 percent or more—from what Americans pay at home, a reality that many patients call an indictment of U.S. health care.

But U.S. medical authorities warn that this desert outpost is a medical Wild West, an unregulated environment where substandard providers can hang their shingle without the same oversight that exists in the United States.

Rubbing his jaw after getting a dental implant, Wisconsin native Carl Zeutzius downplayed those worries, saying he was pleased by the care and by a bill that was 75 percent cheaper than in the U.S.

“We’re in favor of helping the economy in the United States, but we don’t want to be ripped off, either,” said Zeutzius, who winters in Arizona with his wife, Chris.

Longtime dentists in Los Algodones say that, two decades ago, there were only about a dozen dentists, and the village drew only the occasional visitor looking for cheap trinkets or R-rated pastimes.

But as health-care costs in the U.S. rose and Arizona began drawing retirees and snowbirds, more foreign visitors began coming for dental care. The boom began in the late 1990s as dental offices began displacing cheap bars known as cantinas.

A recent survey reported about 350 dentists working in 160 offices. While pharmacies and eye doctors also share the sidewalks with quesadilla stands and souvenir vendors, dental care is the real engine. A Phoenix company, Dayo Dental, organizes van rides to make the three-hour run each way. TLC Dental has even opened a bed-and-breakfast adjacent to its dental office for visitors who want to make an overnight trip of it.

The consulting firm Deloitte found that 2 in 5 Americans would go abroad for medical care if they could save 50 percent of costs and were assured that the quality of care was comparable.

Another survey, by McKinsey & Co., said most patients travel in search of more advanced technology but that the industry’s growth potential lies in those seeking to reduce expenses, such as the patients in Los Algodones.

McKinsey said a new international accreditation system that certifies a foreign provider’s adherence to U.S. guidelines for care will only boost medical tourism as patients feel more comfortable.

Experts say one reason for the cost disparity is that U.S. providers must guard against devastating malpractice lawsuits by securing expensive insurance—costs that are passed on to the consumer.

As troubling as those high costs are, they are necessary to create a system in which a patient has recourse against an unethical or incompetent medical provider, said Kevin Earle, executive director of the Arizona Dental Association.

Earle said his member dentists have reported countless examples of having to fix problems in patients who have gone to Mexico for care. One patient came to the hospital bleeding heavily from the mouth—the Mexican dentist had ignored that the patient was taking a blood thinner, Earle said.

“Our dentists worry about their patients,” he said. “They don’t want to see them harmed in any way.”

Patients in Mexico can complain to two main governmental bodies. The Federal Consumer Prosecutor’s office handles complaints about unethical billing. The National Medical Arbitration Commission mediates disputes about substandard medical care. However, neither body has a full-time presence in Los Algodones or the ability to extract compensation.

Dr. Salvador Alvarado, general secretary of the arbitration commission’s state office in Baja California, said his group did not receive a single complaint from Los Algodones last year. But he acknowledges that the statistic is not a true indicator of the quality of dental care because U.S. patients likely would find it difficult to file a complaint in Spanish to an office 50 miles away.

The dental association in Los Algodones also polices its members and intervenes in disputes, said Dr. Edna Chavira, the group’s president. The association collects complaints from patients but acknowledges the group’s reach is limited because only about a third of the town’s dentists are members.

Many dentists and patients in Los Algodones point to Dr. Carlos Rubio as an example of what’s right with Mexican care. Rather than try to compete on price, Rubio said he wants to succeed on quality. The American-trained dentist’s office contains a digital X-ray machine and other high-tech devices.

Rubio says he worries that less-professional dentists will ruin the town’s reputation for everyone. He says it is common for Mexican dentists to move to Los Algodones from the interior to make a quick buck, especially as medical schools produce more graduates than there are jobs.

“Wherever you go—London, Canada, Chicago—you’re going to find the best, the average and the bad. We are no exception,” he said. “Sadly, there are too many businessmen taking advantage of this phenomenon, who will say: ‘Do you want to work with me? How well do you work—who cares?’ ”

One of his patients, Kate St. Clair, said she thought her friends were crazy when they suggested getting dental care in Mexico. Now she is a believer.

“I [initially] drove down here with the full expectation of walking in the door and walking right back out,” said St. Clair, of Prescott, Ariz. “But I’m actually happier than with the care I had in the States.

“The one sad thing of all this: What does it say that our health-care system, for being the most affluent country in the world, is so abominable that we can’t provide the care we need?”

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