April 8, 2012
By Kellie Schitt
Migrant workers who split time between Mexico and Bakersfield could now have access to medical insurance on both sides of the border, thanks to a new plan targeting Kern County's large mobile labor force.
The plan, which Health Net started marketing in Kern County earlier this year, would provide medical care locally as well as in several Mexican border cities.
The Los Angeles-based health insurer has offered cross border plans for years in Southern California but the Kern expansion marks its most northern reach -- to a region that's a five-hour drive from Mexico.
"With rising healthcare costs in the U.S., employers are faced with difficult choices," said Christina Suggett, chief operating officer for SIMNSA Health Plan, the Mexican network of doctors with which Health Net contracts. "Our workforce is very interested in accessing care across the border."
These binational plans strive to offer lower healthcare costs for workers and employers as well as culturally sensitive care for an increasingly globalized workforce. Yet some consumer advocates question whether the options ensure continuity of care or provide enough quality safeguards for treatment received south of the border.
SALUD HMO Y MAS
Health Net, a publicly traded managed care organization, started its cross-border option in 2000 and has expanded it to San Diego, Los Angeles, Orange County and the Inland Empire. The company introduced it to Kern County in late February, and is marketing it to local employers. A company representative said he wasn't aware of any Bakersfield-area employers who are offering the plan yet.
But with the county's vast agricultural industry and high Latino population, Kern County seemed an appropriate place to expand the plan, said Brad Kieffer, a spokesman for Health Net.
Under the Salud HMO y Mas plan, employees can access about 100 primary care physicians and specialists in Kern County and more than 350 SIMNSA healthcare providers in Tijuana, Mexicali, Rosarito and Tecate for even lower copays.
Health Net is using the Hispanic Physicians IPA network to provide Bakersfield-area primary care doctors and specialists. But despite the name, medical director Daniel Dunkelman, an L.A. surgeon, said doctors won't necessarily have a Latino background or speak fluent Spanish. Still, the group trains all of its physicians in cultural sensitivity, and offers language interpretation services.
In his experience with the Salud y Mas plan in Los Angeles, most patients tend to stay in their local U.S. area, though having a choice to see a physician in Mexico is an added benefit.
Bakersfield workers might use the Mexican network if they have family still living in Mexico, or if they travel home during the weekends and need care. While there are no co-pays for Mexico hospitalizations under the plan -- compared to $250 in California -- people could be enticed to get procedure done there, close to family and friends. And while the plan aims to offer some Spanish-speaking doctors locally, employees may be more culturally comfortable with care in their home country, Suggett said.
"The care in Mexico is very different," she explained. "I think it's a huge factor, especially when you're talking about your own health condition."
While the patient's records won't be automatically shared electronically, the company will provide translation services and send records back and forth as needed, she said.
TRIMMING CARE COSTS
The plan appeals to employers, Health Net officials say, because it can trim about 30 percent off the cost of a full-service HMO, said William Reno, an insurance broker, who sells the product in the L.A. area.
The price savings come not only from the lower Mexico rates, but from having a "skinnier" network of stateside providers that agree to less expensive rates.
Reno works with one large Hispanic grocery store in L.A. that offers a full-network HMO that cost the company about $360 a person while the Salud Y Mas plan slashes that by nearly $100 monthly.
Those cost savings are what attracted Associated Produce Dealers and Brokers of Los Angeles to the plan nearly a decade ago, said Ron Bateman, the executive vice president.
While the company's workers can pay more for other plans, more than 75 percent opt for Salud Y Mas, even the non-Latino employees, who likely just take the U.S. option. In an era of cost cutting, the savings has allowed the company to keep offering quality healthcare, he said.
"This was a very creative solution to a difficult problem and it's worked," he said.
Cost savings might be enticing for employers but binational plans do raise some concerns in the medical community.
Bakersfield surgeon Dr. Jorge Enriquez predicts the plan would appeal to local Latinos who frequently travel to Mexico, especially given the shortage of Spanish-speaking doctors in Bakersfield.
Still, he worries about continuity of care if a patient receives a surgery in Mexico but might face with complications back in Bakersfield. It's one thing if you're living in San Diego, close to the border, but logistical problems increase the farther north one goes, he said.
"My advice is to stick with your own doctors in your own town," Enriquez said. "Continuation of care is very important."
Along with those issues, another concern is patients' ability to discern the quality of their doctors, said Laurie Sobel, a senior attorney with Consumers Union. While consumer information is available for doctors and hospitals in California, she questions whether patients could compare outcomes or research quality as easily with their Mexican providers.
"Even if they could, it wouldn't be apples to apples," she said.
Health Net points out that its Mexican network, provided by SIMNSA, is licensed by the California Department of Managed Care, the regulatory body that oversees HMOs doing business in California.
For a health plan like SIMNSA to be licensed by the state, it means the plan meets a series of administrative requirements, such as having a legal Mexican license; the department's jurisdiction only covers healthcare services in California, not Mexico, a spokeswoman said.
In Mexico, doctors aren't required to carry malpractice insurance, though the vast majority in the SIMNSA network do, said Suggett, who added the plan carefully vets its doctors. Health Net's Kieffer also emphasized that any complaints could be elevated to Health Net, which would ensure all issues are resolved appropriately.
Dr. Patrick Dowling, chairman of UCLA'sDepartment of Family Medicine, said recruiting quality providers in Mexico is important for the plan's success.
"As long as people are monitored there as they are here, it's a win-win," Dowling said. "There's good care at a lower cost, and you address language and cultural issues for Hispanics."
Health Net's expansion of the binational plan is part of a growing trend of globalized health care, not only for migrant workers but for other U.S. residents seeking more competitive pricing outside the country's borders.
Dowling points to private hospitals in Mexico that market to U.S. medical tourists, as well as people flying to India for less expensive hip replacements.
Health Net's binational plans might also hold clues for navigating U.S. health reform if the Affordable Care Act is upheld, said Chad Silva, policy director for Latino Coalition for a Healthy California.
The Sacramento-based organization is closely watching the implementation of plans like this as it considers what will happen to illegal immigrants unable to qualify for government-subsidized health care under the reform plans.
Connecting those workers with care overseas could be a way to cover migrant farm workers who are here legally but moving so much they can't obtain coverage. The idea would pose challenges for undocumented workers who'd have to travel back and forth, he acknowledged.
"We're getting guidance from counties like Kern who are starting to do something like this," he said. "We need to make better connections with the country to our south that is providing a lot of our agricultural workforce."
Source: Insurance News Net