Why would you want to get on a plane to get your health care? To save money, of course.

People come to Costa Rica for dental work, cosmetic surgery, hysterectomies, and joint replacement, to name just a few of the more common procedures. One of the most sought-after cosmetic procedures (in Costa Rica and elsewhere) is breast enhancement–in 2010 that surgery cost under US$3,000 in Costa Rica and over US$7,000 in the United States.

Doesn’t sound like much of a vacation? Maybe not. But if you know you’ll need elective surgery soon, you might want to surf, river raft, and soak in hot springs, then spend a couple of days visiting local doctors, private hospitals, and aftercare facilities, all in the San José area.

With new developments in U.S. health care, it looks as if fewer citizens will be completely without medical insurance. But there may be big deductibles, certain procedures that are deemed elective, and that necessity that seems to slip throughout he cracks: dentistry.

Heading for a country where healthcare is cheaper and lawsuits fewer means you can save bigtime (even after the airfare and hotel bill) on anything from crowns to lasik eye surgery. The private hospitals here are spotless and well-equipped, and the doctors are well-trained. Many have studied in the U.S., Canada, or Europe.

Before you come
–Bring your medical records with you so the doctors you consult can see them. Check the Center for Disease Control’s excellent guide to Medical Tourism; if you are considering cosmetic surgery or dental work, print out the questions the CDC suggests asking the doctors you consult.

–Research doctors and hospitals: check out the aftercare facility websites (see below) for which doctors they work with, find online message boards about surgery abroad, and take a look at the U.S. Embassy in Costa Rica’s list of recommended doctors.

While you’re here: Visit hospitals
There are three major well-regarded private hospitals in Costa Rica:
–Hospital CIMA San José, near the San José suburb of Escazu
–Hospital Clínica Bíblica. in downtown San José
–Hospital La Católica, in the San José suburb of Guadalupe

All three hospitals are aggressively marketing themselves to international patients, aka medical tourists. At a time when conventional tourism isn’t growing at the rate it once was, medical tourism is booming. These hospitals are going after their share of this $40 billion a year world industry, and they’ve created special web sites in English and toll-free numbers in the U.S. to answer questions about procedures and insurance. All three are accredited by the international recognized Joint Commission International.

Call or email ahead of time to arrange an English tour of the any or all of three major clinics/hospitals in San José. Also contact the hospitals’ billing department to talk about fees and payment options—all three hospitals accept several U.S. and international health insurance plans.

Here’s more on health care in general in Costa Rica.

U.S. senior citizens living in Mexico should have their medical care covered by Medicare, says Paul Crist, a former senator’s aid who now lives in Puerto Vallarta. In the current debate over health care, Crist’s idea seems to be gaining ground.

Right now, retired U.S. citizens cannot claim Medicare benefits for treatment received in Mexico—or Costa Rica, or France, or anywhere else in the world, for that matter–even though they paid into the Medicare system throughout their working lives.

Crist, a former aid to Sen. Paul Sarbanes, D-Md., recently founded the non-profit Americans For Medicare In Mexico, which has lobbied 85 members in the U.S. Congress to get Medicare accepted south of the border.

Estimates of how many Americans live in Mexico (and abroad in general) vary, but the influential Association of Americans Resident Overseas puts the figure at 1,036,300. Crist says perhaps 200,000 of the Americans living in Mexico are eligible for Medicare, with about two-thirds of those seniors returning to the U.S. for medical treatment.

Not only would extending Medicare to Mexico be the right thing to do—if you pay into the system, you should receive the benefits—but Crist maintains in a Forbes article that such a program would also save the U.S. government a lot of money. Studies show that health care services are up to 70% less expensive in Mexico than in the U.S.

In Mexico, a visit to a doctor’s office often runs between $30 and $40, according to MedToGo, while a hospital room costs $90 to $100 a night. Besides private health care insurance, the Mexican Institute of Social Security (which goes by the Spanish initials IMSS) provides affordable, if basic, health insurance for all Mexican residents, regardless of nationality.

If Medicare were accepted in Mexico, says Crist, many of the American retirees currently flying back to the U.S. for expensive care would instead opt for treatment nearer their homes, cutting Medicare’s overall costs.

Program would need controls

An article in the Guadalajara Reporter notes that if Medicare is extended to Mexico, the program would only work with health care providers with Joint Commission International (JCI) accreditation . The JCI provides a certification process for health care facilities throughout the world.

Crist says ten hospitals in Mexico already have JCI accreditation and another 23 are seeking approval. Among those already approved are the American British Padre Hospital and the Santa Fe Hospital in Mexico City and the Christus Muguerza Hospital and the Hospital Tec de Monterrey in Monterrey.

Mexico would no doubt welcome Medicare funding, just as they welcome the increase in medical tourism to their country.

Research done by the Association for Private Hospitals in Jalisco reveals that of the 21.5 million tourists who visited Mexico in 2006, about 160,000 – mostly Americans – came for medical attention.

Response from Congress

Crist say that response to his plan to bring Medicare to Mexico has been  “quite positive, especially on the House side.”

But Forbes reports that the offices of Reps. Jim McDermott, D-Wash., Carolyn Maloney, D-N.Y., and other sympathetic legislators have also told Crist that this year they have too much on their plate, and that it would be politically wiser to introduce a stand-alone Mexico-Medicare bill next year, separate from the complex health care reform package currently working its way through Capitol Hill.

There are also calls for an in-depth three-year Mexico-Medicare pilot project to determine whether Mexican health care meets Medicare’s quality standards and determine if the payment system is sufficiently free of fraud.

Photo by Linda Parker.