Tucson hospitals investing in Mexican health care
Idea is to keep foreigners out of American ERs
SUSAN CARROLL
Arizona Republic Tucson Bureau
NOGALES, Son. – Tucson hospital administrators say they have an innovative way to save money: spend money to upgrade the care available in Mexico.
Health-care officials in Tucson and Nogales, Ariz., strapped with millions in unpaid medical bills from Mexican patients, say investing in new equipment and better training in hospitals south of the border has reduced the strain on Arizona’s urgent-care system.
With private donations from the community and a $365,000 grant from the U.S. government, doctors at the aging slump-block Hospital General here can treat critically injured patients in Mexico instead of routinely sending them to Tucson emergency rooms. The trauma clinic also is taking on a growing number of illegal immigrants who are being sent back to Mexico for care.
“It’s a win-win for everybody,” said Barbara Felix, international patient services coordinator for University Medical Center in Tucson. “It gives us the opportunity to use our funding in a more efficient manner on both sides of the border.”
But some administrators question why the U.S. government would invest in Mexico while U.S. hospitals are struggling. Hospitals along the Southwestern border paid about $190 million for the emergency care of illegal immigrants in 2000, according to a study commissioned by the nonpartisan, Washington, D.C.-based United States/Mexico Border Counties Coalition. Newer figures are not available.
“We see our system being decimated, and we see that services are diminishing in the area, such as closing down maternity units, closing down skilled-nursing facilities,” said Jim Dickson, chief executive officer of Bisbee’s Copper Queen Hospital in southeastern Arizona. “And then people want to put money on the Mexican side? So it’s kind of, like, you put all that money over there, but what about here?”
Program expands
Nearly a decade ago, Tucson hospital administrators started exploring the possibility of improving medical care in Mexico to help cut their own costs.
The experiment started small, with the addition of a neonatal clinic in 1999 in Agua Prieta, a border town south of Douglas. Since the clinic opened, UMC has not received any premature babies from Agua Prieta, said Greg Pivirotto, UMC’s chief executive officer. He said UMC and Tucson Medical Center continue to support the clinic with $25,000 each annually but estimated the savings to be “many, many times” greater.
Encouraged by the results in Agua Prieta, administrators sought help from the U.S. government to expand the program to include a wider range of services and more border communities.
The Nogales trauma center is the most ambitious project so far, funded with a $365,000 grant from the U.S. Agency for International Development and thousands in private donations raised by the two Tucson hospitals, Carondelet Holy Cross Hospital in Nogales and Mexican business leaders. The U.S. Department of Health and Human Services also has pledged to deliver a donated CT scanner to the Nogales hospital within the next few months.
Dr. Enrique Contreras Duarte, who has worked at the Mexican hospital for seven years, said the program has changed the way administrators handle serious cases and even some routine injuries. The triage unit now includes two operating rooms, an obstetrical-care area and an intensive-care nursery. The hospital also bought incubators, neonatal monitors and surgical instruments.
“In the past, we had to send a lot of patients to Tucson. Now that very seldom happens,” Contreras said in a recent interview. “We can take care of them here or send them on to Hermosillo,” the capital of Sonora, which has a higher-level trauma center. By Mexican law, the hospital in Nogales provides low-cost or free services to all patients from Mexico.
The doctor stood at the bedside of Gloria Romero-Herrera, 35, from Michoacán, Mexico, who had broken her ankle jumping from the towering steel fence that separates the United States from Mexico. After initial treatment in a Nogales, Ariz., hospital emergency room, she was transported to the Mexican hospital for surgery.
“Before, we wouldn’t have been able to help her because we didn’t have the right equipment,” Contreras said.
Struggling with costs
Federal law requires U.S. hospitals to treat all patients needing emergency care, regardless of their citizenship or ability to pay. In Arizona, the cost of caring for foreign patients has increased substantially over the past decade as the U.S. government cracked down on illegal immigration in California and Texas.
Dickson, who runs a 15-bed hospital in Bisbee, said that in 1998 the hospital had $30,000 in unpaid bills for foreign patients, some who entered the country legally with visas and others illegally. Last year, the cost topped $400,000, roughly the amount it would cost Dickson to replace increasingly outdated equipment.
“You can see how this is growing,” Dickson said.
Congress approved legislation as part of the 2003 Medicare bill that will return at least $1 billion over the next four years to hospitals across the United States.
Patrick Walz, interim chief financial officer for Yuma Regional Medical Center, said investing in Mexico is “definitely the right approach.”
“We can’t turn patients away,” he said, “so the alternative would be help them out, to provide as good of health care (in Mexico) as they can get up here.”