Medical tourism presents ethical dilemmas and has many downsides. The CDC does recognize that many people from the United States travel to Mexico for care and its website provides some guidance and warnings. Last week, members of a drug cartel kidnapped four travelers to Mexico and killed two of them. Safety along the US-Mexico border is not guaranteed and the mass migration north is partly due to local safety issues in central American countries. Medical tourism in Mexico is a big business, with more than a million Americans traveling there annually for medical care. Medical tourism there ranges from dental appointments to surgeries and chemotherapy. It is mostly dental and cosmetic. It is usually more affordable than care in the United States. What makes the care cheaper and which medical items are sought out pose ethical issues on both sides of the border. There are risks, but many hospitals in Mexico follow US standards.
People travel from the United States to Mexico for medical care because of affordability, a lack of care in their region (especially if they live in the United States along the southern border), cosmetic and other surgery not covered by insurance (including dentistry), and treatments not approved by the FDA.
Affordable Care in the United States
Health care in the United States is expensive. Some of it is not covered by insurance ― many people are underinsured. Even with insurance, people are encouraged to travel to Mexico for cheaper surgeries. For example, one patient was given a check to go to Mexico for knee surgery performed by an American doctor. The doctor received three times what Medicare would pay, and the patient received $5,000 from her husband’s employer (or employer’s insurance) for choosing the low-cost solution. The surgery was $12,000 rather than $30,000. North American Specialty Hospital pays US doctors to do surgeries in Mexico on their days off.
The area along the Texas border has a shortage of doctors. Therefore, people walk across to Mexico for basic care, pharmacies, and dentistry.
Ethical issue: Medical tourism is not all nefarious nor is it all good. The knee replacement example at a luxury hospital is not representative of the bulk of travel to Mexico for care.
When the person who traveled for medical care returns in poor condition, then who absorbs the costs? People tend to travel on planes soon after surgery, which increases risks.
Can the tourism be ethically problematic even if the doctor and customer are both satisfied? I argue people doing this travel are capitalizing on low wages. For example, nurses are paid significantly less in Mexico, averaging just around $15,000 a year.
Medicalizing Looks: Cosmetic surgery
Cosmetic surgery is a huge business in Mexico and the United States. It meets a consumer need and uses trained physicians to do so. Some may argue that doctors are a scarce resource and should devote their work to treating disease, while on the other hand, if people plan to engage in cosmetic surgery, they need and appreciate trained physicians. People travel from the United States to Mexico for cosmetic surgery. It is cheaper there and usually not covered by insurance. In one example a US woman was severely burned during a “Mommy Makeover.” Breast implants, tummy tucks, and Brazilian butt lifts all carry some risk wherever they are performed. The price difference is notable. One website lists the following:
|Breast Lift||3,500 – 5,500 US$|
|Lower & Upper Eyelids||1,850 – 3,200 US$|
|Lower Eyelid||1,250 – 2,250 US$|
|Upper Eyelid||1,250 – 2,250 US$|
|Full Facelift||4,500 – 8,500 US$|
|Mini Facelift||3,500 – 5,500 US$|
Ethical issues: Cosmetic surgery is a source of ethical dilemmas. People take risks for looks rather than to repair a medical problem.
Should countries devote significant medical resources to cosmetics?
A second is the deeper philosophical issue of what makes life valuable. How would cosmetic surgery improve one’s life? It may be an empty promise as happiness does not necessarily stem from any particular body type or feature.
How does society view and accept aging? Is society ageist? Do people who look younger have more job opportunities and more relationship opportunities?
Sometimes decisions are also distorted by one’s own perception of his or her own body. Body image problems contribute to cosmetic surgery. People also may have misperceptions about the role of looks in relationships. Most dating apps heavily favor looks over substance.
Bariatric surgery is under 5 thousand dollars in Mexico but is 20 to 30 thousand in the United States. Of the four people comprising the group abducted last week, the one purchasing a medical procedure was having a tummy tuck. A relevant ethical issue is one of diet and healthy lifestyle. With a diet that is appropriate, most people would not be overweight. A tummy tuck that is for fat deposits rather than excess skin is attributable to obesity and excess weight (Pregnancy or extreme weight loss can leave people with extra skin.) The ethical issues in obesity include corporate food supply, government and physician complicity in unproven dietary recommendations influenced by industry lobbyists, the role and degree of personal responsibility, medicalization (the expansion of the institution of medicine seeing societal problems through the lens of medicine) and access to fresh and healthy foods at a reasonable cost. The are many societal failures, poor priorities, public health ethical failures, and conflicts of interest that contribute to widespread obesity and incidence of being overweight.
Weight-loss surgery is especially popular in medical tourism. Brokers in the United States encourage overweight Americans to travel to Mexico where the gastric sleeve and other surgeries are cheaper. In one example of medical tourism gone wrong, a Mexico hospital botched gastric sleeve surgery and sent a bleeding patient to recoup in a Mexican hotel rather than keeping her in the hospital. She remained ill and weak, and, upon her return home and a visit to the doctor in the United States, she found out her spleen had been cut accidentally in the surgery. The quality of care, oversight, emergency follow-up, and diagnosis of the problem were compromised. In the United States agencies benefit from payments from the Mexican doctors, a cut of the business the agency brings the doctors.
Another patient, who used a Florida broker to schedule a Mexican gastric sleeve surgery, returned home feeling terrible, developed sepsis and racked up over $500,000 in medical bills. Her insurance company did not want to cover the medical treatment caused by surgery in Mexico.
Same as above, if the surgery is for looks.
Is the availability of weight-loss surgery an ethically good or bad thing?
If the US diet caused the harm, should Medicare, Medicaid, and private insurance be required to cover surgery?
What degree of personal responsibility contributes to poor diet and how can people improve their personal diet?
Is weight-loss surgery a form of medicalization (attacking a social and cultural problem by way of surgery) ?
Being overweight and obesity are distributed across the US population differently and correlate to socioeconomic status. Combined with the cheaper surgeries in Mexico, is medical tourism preying on people who have already been victimized by low wages and an inability to access healthy foods?
Other Types of Medical Tourism
Using pharmacies in Mexico can allow people to access opioids and other medicines without prescriptions from their local doctor. People in walk across a bride where they find pharmacists with the authority to prescribe or dispense without a prescription. And it is difficult to discern legitimate pharmacies from ones that sell drugs laced with stronger substances including fentanyl. Lower prices drive people to purchase medicines in Mexico. But the drugs are not always cheaper there.
Many Americans do not have adequate dental insurance. There are lots of ads for dentistry in Mexico and many organizations rely on medical tourism for customers.
Some people travel for care not approved in the United States or alternative cancer care.
Other incredibly ethically problematic practices like organ transplant tourism that preys on the very poor, who are often willing to sell a kidney for a relatively low price, is beyond the scope here.
Big-picture ethical questions from how society values and judges looks to exploitation of workers in a country where wages are lower make medical tourism a dicey arena. While some people travel from countries that lack the resources to provide world-class health care to wealthy countries with cutting edge hospitals, the bulk of medical tourism involves travel to countries where the best health care is devoted to tourists regardless of what care the locals can access. Mexico supports the medical tourism industry. Its healthcare system is ranked lower than the US system, yet people who do the due diligence may find modern facilities and upscale hospitals. All things considered, it is difficult to conclude that traveling to Mexico for care is worth the many risks, worth overlooking the serious ethical issues, or good for the Mexican healthcare system. Cosmetic surgery itself, and cosmetic surgery among those who cannot afford it in the United States, poses ethical issues. As a justice issue, the United States would do well to improve population health significantly so that weight loss is not a strong a driver of medical tourism. This post was meant to ask the questions, not resolve them.