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Hospitals

Post by newinajijic on Mon Jan 12, 2015 2:24 pm

someday, maybe sooner than later I will need hospitalcare. looking for a web site on Guad hospitals and costs. My budget is limited and would like to do a bit of preplanning.

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Re: Hospitals

Post by Pedro on Mon Jan 12, 2015 2:56 pm

best to ask your doctor. the methodology of your research won't help you. if you are immss or seguro popular you can only go to their hospitals,in any event.
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Re: Hospitals

Post by gringal on Mon Jan 12, 2015 2:59 pm

Pedro wrote:best to ask your doctor. the methodology of your research won't help you. if you are immss or seguro popular you can only go to their hospitals,in any event.

Good advice, and for those thinking of using IMSS or Seguro Popular, I'd suggest going to the one you'd be using and looking over the situation. It might be more than you're ready to deal with.

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Re: Hospitals

Post by Jim W on Mon Jan 12, 2015 4:00 pm

newinajijic wrote:someday, maybe sooner than later I will need hospitalcare. looking for a web site on Guad hospitals and costs. My budget is limited and would like to do a bit of preplanning.

Pedro and gringal offer sound advice. We lived thru the IMSS experience when our friend ended up in GDL @ IMSS hospital. Deb made the bus trip from Lakeside to GDL daily for 3 months. Delivering TP, change of sheets, etc. Deb's Spanish is spotty but, she got the info and went on missions to farmacias looking for drugs required that IMSS did not stock. If you are going the IMSS route you should have a friend/translator to help communicate. Most of the MD's were fluent English, staff is pretty spotty....from Deb's experience.

I don't know what your medical experience has been, but, IMSS in GDL does not have showers in the rooms, no TV, no telephone, a couple bathrooms per ward. A couple years ago a expat patient posted it really wasn't bad.......his wife brought a sleeping bag and slept under his bed.

Do your research. good luck, Jim W
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Re: Hospitals

Post by newinajijic on Tue Jan 13, 2015 8:48 am

Thanks for the advice, I will do my research.

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Re: Hospitals

Post by gringal on Tue Jan 13, 2015 9:01 am

newinajijic wrote:Thanks for the advice, I will do my research.

As Jim's post suggested, they require that you have someone there with you to do "nurse's aid" duty at IMSS hospitals.

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An Interview with Dr. Hernandez: A Look at Guadalajara Hospitals

Post by Chapalamed on Sun Jan 25, 2015 4:19 pm

An Interview with Dr. Hernandez: A Look at Guadalajara Hospitals

-- Excerpt from the Dec. 2014 issue of the LAKE CHAPALA REPORTER ----

What’s the difference between a clinic and a hospital here?
There are certain criteria required for each level. A clinic (which is considered level 1), which is usually for primary care, has to have a crash cart for emergencies, containing a heart defibrillator and certain heart medications. And, you have to have someone there who is Advanced Cardiac and Life Support (ACLS)-certified. That can be a doctor or a nurse. The level 2s are usually the government-sponsored hospitals people get assigned to through IMSS and Seguro Popular. There are IMMS level 3 hospitals, though, like El Centro Medico Nacional de Occidente in Guadalajara. They have the latest technology and world-class specialists. They generally are best equipped to handle and do handle the most challenging cases—like pediatric cardiology, brain surgery and transplants.

There are a lot of rules here in Mexico. Whether they’re enforced is another thing, though, and that’s true across society. It’s true for enforcing traffic laws as well as conducting health inspections. Sometimes the health inspections aren’t as thorough as we think they should be, like checking whether health providers have cedulas (licenses) or not. People like massage therapists and chiropractors tend to congregate in areas where there are a lot of expats, like here at Lake Chapala. They’ll say they’re licensed in the US, and most people just believe them, and let them go to work on them. Legally, that shouldn’t happen.  Even in Guadalajara, there are doctors who do dermatological work, like administer Botox injections, without a license or formal training. There are some general practitioners who do breast implants. They may have taken a course. I got an email, myself, offering a course in Puerto Vallarta for $10,000 to do breast implants. It’s a 2-week course. Real plastic surgeons spend years and years of formal training, including internships, residency in surgery, plastic surgery and then a fellowship or 2 for a total of at least 6-10 years.

What are some recommendations you can give to expats about hospitals?

The most important thing is to establish a conversation right away with their primary doctor about their particular situation, and what they would like to have done if anything were to happen. At the very least, there should be an emergency contact person’s name and phone number given. It’s also important to be candid with their doctor about whether they have health insurance, and whether they have financial resources for each of the 3 levels of hospitals, and if they want to be hospitalized at all. For people with limited resources, they may be interested in signing up for Seguro Popular insurance. The website has a catalog of benefits. They’re heavily slanted toward children’s services because it’s in Mexico’s interest to protect their children first.

Culturally, Mexican hospitals expect that a patient has at least one family member or friend present around the clock. For instance, while level 2 hospitals provide food, they do not feed a patient. They MAY NOT not bathe the patient, either, or have the staff to help them to the bathroom. Nursing staff is kept to a minimum, and that staff is overworked and underpaid. A nurse in Mexico on average makes about $500 U.S. dollars per month. Nurses’ main responsibilities are to dispense medications and change IV solutions. There are maids who change the linens, too, but that’s pretty much it. And, the room is shared with 3 or 4 other patients, typically. This all changes somewhat, but not completely by north of the border standards, in level 3 hospitals. When I was practicing in the US, if there was a Mexican in the emergency room, 20 relatives would flock in. And they would all want to donate blood. If there was a non-Mexican, there would be one or two. So, people should designate and name to their doctor who their local friend or relative is who would assist in the case of hospitalization.

Another thing to keep in mind is that, in order to keep costs low, level 2 hospitals buy things in bulk. And those things are geared toward Mexicans. For instance, their knee replacements fit the stature of most Mexicans, who are shorter than many Anglo-Europeans. I ran into a problem where a patient of mine was in the hospital at an IMSS clinic for over two weeks with a broken hip. They did not have the new hip in her size, so they waited for an order from Europe for her size. There was no guarantee when it would arrive. So, I had her transferred to another hospital, and the prosthetics manufacturer representative showed up there with exactly what she needed. She had to buy it herself, of course. So, people who have limited resources may have to go through an experience of waiting longer than they would like for services and devices and supplies.

It’s important to aware that there are some hospitals which may reuse medical/surgical materials (after sterilization). The procedure that in my experience that I have found out this tends to happen is in interventional cardiology but I’ve seen it happen in others as well. For example, the leads and wires used in cardiac angiograms and stent placements come in a sealed and sterilized package from the manufacturer. After a the procedure is done, the guide wires should be discarded and incinerated but at certain hospitals they are recycled. (The name of the hospital that does this the most begins with a B). Why do they do this?  Well, they can offer procedures at moderate discount to the patient but the hospital’s profit margin will remain the same or increase. Is this safe? In my medical opinion, it’s not as safe for the patient in the long run as using brand new and non-recycled surgical materials.  I don’t refer my patients to these particular hospital(s) or the physicians who work at them. How can you identify these hospital(s)? This can be difficult but I have noticed that there is a trend and those that are owned by a particular group of doctors or when you notice a strong presence of doctors that are related is a red flag. But getting full disclosure from the doctor(s) can be difficult.  Being “Penny-wise but Pound-foolish” when it comes to health care usually tends to lead to poor medical outcomes. I recommend you take a closer look, do your homework and ask the appropriate questions to your primary care doctor or whoever is coordinating your hospital care. You may be think you are getting a deal on your procedure but the risks you may be taking may be potentially very costly. This is where getting a second opinion from another doctor in regards to the procedure and the particular hospital may really pay off in the long run.

It’s also good to talk with the primary doctor about which specialists and hospitals they work with. Most doctors will work with a range of hospitals, in terms of cost. For expats, the hospitals most like the ones up north are: Centro Médico Puerta de Hierro, San Javier, Real San Jose, and Ángeles del Carmen. They’re also the most expensive. They run about $200 per night for a room. It’s best to go with insurance to one of those. Even with insurance, some of them will ask for a deposit up front. I have noticed that some of them, like Del Carmen, have a different policy for EXPATS than for Mexicans. That’s because many EXPATS don’t have any assets in Mexico. They have them in the US, for instance. A couple of years ago, they were asking for $2,000 USD up front. Then after a few bad experiences, they’ve increased that to $5,000 USD. But, they have top-notch technology, they’re very nice and clean, they have staff that speaks English, flat-screen TVs in the rooms, and so forth. By the way, the only hospital I’m aware of that has an office just for working with foreign insurance companies directly is San Javier.


I also like to tell patients about mid-level options. The one where the specialists I like to work with like is Santa Margarita. They have brand new operating rooms. Then there’s Holy Trinity(SANTISIMA TRINIDAD), Santa Maria Chapalita, and Mexico Americano hospitals. That last one is the only one, interestingly, that’s certified by the international joint commission. That may have some bearing for insurance purposes. That is, they may have financial arrangements with some foreign health insurance carriers. That’s worth checking into. But these three hospitals are really very good. They have good intensive care units (ICUs). They usually have a religious affiliation, like being run by nuns. They’re kept nice and clean. What I like about them is that they have what people need, although they might not have what people want. They have rooms that cost from $70 USD per night up to $150 USD per night, which are their luxury rooms. Most people are very happy there. I had a patient who had a cardiac angiogram at Puerta de Hierro, but he was also very happy with the care he got for a knee replacement at Santa Margarita. What was important there was that the knee surgeon was very comfortable working there. He knew the staff and the surroundings, and was very familiar with the procedures there. That’s an important consideration—much more important than whether the hospital has room named Venice or Rome or Egypt.

Then, at the bottom of the list are the outpatient clinics. They may call themselves hospitals, but they’re really outpatient surgery centers. Things like removal of cysts or tumors—small things can be done within a day, and maybe one overnight stay. I particularly was impressed with a fairly new surgical center called INNOVARE which primarily does plastic surgery. Other good ones are Hospital San Pio and Clinico del Pilar. I’ve sent patients to these surgical centers and I would certainly go myself there or send my family members there for surgery that isn’t considered major. There’s always an ambulance around the corner in case something goes very wrong and the patient needs a full-service hospital. That’s just a 5-minute trip.

The cost for reserving an operating room varies quite a bit for these various places. For Puerta de Hierro, for instance, it could be 4,000 or 5,000 pesos. At another place, it could be 1,500 pesos. So, these are good things to discuss with the primary care physician, too.

Also, keep in mind that if prosthetics are purchased through hospitals or other facilities, they’re going to cost more. Hospitals mark these up—sometimes up to 30%. Here in Mexico, unlike up north, people have the option of paying the medical device company directly. They’ll come by after the surgery, and ask you whether you’d like to pay for that by cash, check, or charge card. They prefer cash. By the way, a device that’s good for one patient might not be good for another, so I always cringe when people start comparing what their hip device cost. Much depends on the age of the patient, how much bone loss there is, whether the patient has osteoporosis, and whether it’s made with titanium or stainless steel. There’s no one-size-fits-all.

I always say, a doctor, in some ways, is much like a waiter. They can show people the menu of what is available, the risks and consequences, and people can then choose options based on their resources and their comfort level with the risks.

What I also like to tell patients is that in Mexico (when using PRIVATE HOSPITALS), doctors are independent contractors of patient, not of the hospitals. The hospitals care about collecting the fees for their services and for the use of their facilities. As doctors, we’re left on our own to collect fees from our patients. We can go through the hospital, but they’ll mark up those fees, too. So, people should discuss a payment agreement with their doctor in advance. Many doctors, I’m one of them, will negotiate a promissory note with a payment plan with them, if resources are tight.

The most important take-away here is that people need to speak candidly to their primary physician before hospitalization is needed to figure out some logistics based on their current health, their genetic probabilities, anticipated needs, and financial resources.
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Re: Hospitals

Post by Trailrunner on Sun Jan 25, 2015 8:21 pm

Thank you for posting this.
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Re: Hospitals

Post by martygraw on Mon Jan 26, 2015 9:23 pm

I had a heart problem 2 years ago and spent 4 nights at Santa Margarita. The room was aprox 1000 mp per night, had its own b/r, 40'' color tv, and a separate room for someone to stay in if needed. Meals were ok, and the room was cleaned twice a day. The opp room state of the art. and the care was great. Would highly recommend.
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Re: Hospitals

Post by Pedro on Mon Jan 26, 2015 10:43 pm

martygraw wrote:I had a heart problem 2 years ago and spent 4 nights at Santa Margarita. The room was aprox 1000 mp per night, had its own b/r, 40'' color tv, and a separate room for someone to stay in if needed. Meals were ok, and the room was cleaned twice a day.  The opp room state of the art. and the care was great. Would highly recommend.
i agree-spent some time there too but opted for a smaller room and tv. it was less than 1000p
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