Healthcare, Insurance

Why is Medical Care So Expensive in the US?

Healthcare Costs

In January, a 20-year-old posted his $55,000 hospital bill for an appendectomy at a hospital in Sacramento, California on Reddit with this comment: “I never truly understood how much healthcare in the US costs until I got appendicitis in October. I’m a 20 year-old guy. Thought other people should see this to get a real idea of how much an unpreventable illness costs in the US”.

What followed was a firestorm of response with 10,729 comments posted to date. Even with coverage through his father’s insurance policy, this young man was saddled with over $11,000 in debt that will take him years to repay.

I think we can all agree that emergency procedures like appendectomies are not only essential, they must be handled quickly and near home. But why is it so expensive to have what is a routine surgical procedure in the U.S? Many would argue that it is because of the quality of the care provided. The implication is essentially “you get what you pay for.” But is that true? For example, in Mexico medical care costs a fraction of what it does in the USA. Does that imply that the quality of care is lower? Exactly why is care less expensive in Mexico?

While there are many reasons why quality care is less expensive in Mexico, here are a few that illustrate the differences.

Doctors can get a free or low-cost education. Mexico offers high school graduates who can pass the required testing what is essentially a free (just a few dollars a year) world-class education at UNAM (National Autonomous University of Mexico). Many graduates leave school with no debt burden. The starting salary for a physician is only $12,000 per year, but this is a living wage.

Doctors own their own practices. Unlike the US where many doctors contract with HMO and PPOs, most doctors in Mexico are not employed by corporations that control every aspect of their work, set quotas on the number of patients seen and demand a quarterly profit. There are no middlemen between the patient and the physician in Mexico and this means that doctors can spend more time with patients and offer the care they feel is appropriate.

Doctors don’t go into medicine for the money. Many physicians in the USA are attracted to the profession because of the high salaries ($120,000 is the national average starting salary). The drive for high pay continues to be a motivation throughout the career for many US physicians. With a starting salary of only $12,000, the money seldom motivates doctors in Mexico.

Mexican physicians can have multiple sources of revenue. The public health sector hires many doctors and gives them both a modest salary and a pension for what by US standards would be part-time work. Many of these doctors also have private practices. There are also many private hospitals in Mexico that are owned by physicians.

While the examples cited above are just part of the whole picture, it should be clear that it is entirely possible to offer world-class medical care at affordable prices because well-trained physicians are paid less and there are no complex layers of corporate interests grabbing profits. And, while you have no choice where to get help when you need an appendix removed in a hurry, in many cases you do have a choice of where to go for healthcare–and more people than ever are considering medical travel as an option.

Monica Rix Paxson is an expert in the field of Mexico healthcare. She is author of the English Speaker’s Guide to Medical Care in Mexico, and co-author of The English Speaker’s Guide to Doctors & Hospitals in MexicoeBooks available for immediate downloadShe resides full-time in Mexico.


  1. Miriam says

    Mexico’s healthcare systems, either IMMS (for private working sectors) or ISSSTE (government) are really, really good. Like the article says, a lot of doctors will work there and also have their private practices. If G-d forbids you have an orthopedic problem, I recommend a hundred percent the Instituto Nacional de Rehabilitacion (National Rehabilitation Institue). Anyone can attend; they will give you a “level” number according to a social study and the consultations, drugs, therapies and whatever you may need will have a higher or lower cost (it is EXTREMELY cheap if you have a moderate income).
    Private hospitals are really expensive but I guess that’s why we all try to have medical insurance. Also, doctors my “adjust” to whatever your insurance company is willing to pay, so that you can end up paying a lot less after a procedure.
    Finally, I agree with Suzanne. the attention, technology and doctors are world class but it is also important to have expert translators for foreigners.

  2. Monica Rix Paxson says

    You might say that there are two English-speaking groups that are seeking care in Mexico: medical tourists who are here for a procedure and will return home to the US or Canada, and those expats who settle here either permanently or seasonally. Of these, it may actually be easier for the medical tourist because they will be dealing with the larger institutions where indeed the doctors and staff cater to the needs of foreigners and this includes speaking English.

    The bigger challenge is for the foreigner who arrives to live in some beautiful exotic place without knowing Spanish, without a network of connections, and often with little foresight about what they will do if some medical need arises. When it does, as it inevitably will, what might have been a simple problem is suddenly exacerbated by the fact they can’t speak Spanish and they don’t know where to go to find help in English.

    I have identified this as such a common problem that I am currently researching and will soon publish a directory of doctors and hospitals where English is spoken. It will be sold here at and will be introduced in the newsletter.

    In Mexico, where Spanish is the primary language, it is unreasonable to expect all medical professionals you might encounter to speak English. However there are many who do, at least the basics. It is, in my opinion, the responsibility of those who are new here to contact doctors for routine care and try them out. Are you able to communicate effectively? Don’t wait until there is a crisis to establish a relationship with a doctor. I also highly recommend that you learn some Spanish if you are going to make Mexico your home.

    For those that are simply traveling here or who are dealing with a medical crisis without preparation, my book The English Speakers Guide to Medical Care in Mexico offers many suggestions for finding care in English including contacting your hotel. They often have a house doctor who speaks English who will visit you in the hotel.

    Additionally, the book includes translations of basic medical terms and phrases in both Spanish and English that can easily be printed out (it is in a pdf format) and taken with you. You simply find the words and phrases that apply in English and show them to the doctor who can read them in Spanish.

    Personally, I have found that far more Mexicans speak English than the other way around, and as both Susan and John above testify, the level of care is very good to excellent and most of the people you deal with in medicine are generous and kind.

  3. Suzanne Salimbene says

    As a permanent resident in Mexico, I certainly agree that physicians and technology in Mexico are world class. However, as a specialist in helping hospitals and medical professionals in working with foreign patients, I feel they are far from ready for MT. A great number of physicians do not speak English, few nurses speak English, fewer receptionists speak English, and signage, intake forms, pre & post surgical forms and even billing are in Spanish only, and there are no trained medical interpreters! It’s a bit better in a few of the boarder states and the two “Gringo” conclaves, but I can tell you as a resident who speaks a bit of Spanish, making an appointment or getting any information in a manner that I can understand it, is really difficult!

  4. John Stephens says

    I’ve had two hernia surgeries, the first as an outpatient in NJ and #2 in Monterrey. I asked – do I go home, and here in Mx, the answer was, of course not, we have to watch you to be sure everything is OK. Quality of care and attention in Mx much better, overall outcome ~ the same. Cost in Mx = 20%, including two nights in hospital.

  5. Susan Cobb says

    Since moving to Mexico in 2006, my husband and I have undergone numerous surgical procedures, including lithotripsy, seven hours of reconstructive back surgery, a triple by-pass, colonoscopies, removal of hemrhoids, (I’m sorry I’m not spelling all these correctly) and finally a full face lift. We have been completely satisfied with the level of care and personal attention we have received, both at private hospitals and through the IMSS system. Doctors have usually given us their cell phone numbers, and then they’ve ANSWERED them when we have called, often coming to meet us on very short notice. I tell this to friends and relatives in the States, and frankly, they don’t believe me. I can see it in their eyes when they quickly change the subject. But it is NOT too good to be true.

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