Getting What You Paid For: Extending Medicare to Eligible Beneficiaries in Mexico (U.S.-Mexican Policy Report 10)




Warner, David C.

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LBJ School of Public Affairs


This volume is the result of a year-long Policy Research Project at the LBJ School of Public Affairs. It is the result of an ongoing investigation of the feasibility of extending Medicare coverage in some form to beneficiaries of the program who live in Mexico. This is the fourth in a series of research projects that have touched on this topic over the last nine years. The first project surveyed retirees in San Miguel, Guadalajara-Chapala, Mexico City, and Cuernavaca and also looked at hospitals and other facilities in these communities as well as surveying the literature on cross-border utilization. Our conclusion at that time was that such coverage would be advantageous to Americans living in Mexico and possibly could save the Medicare program funds as well. Subsequent research related to this study included an examination of the ways in which the U.S. and Mexico could cooperate in providing health services in the future and a study of NAFTA and trade in medical services between the U.S. and Mexico. Although the second and third studies were somewhat tangential to the issue one might legitimately ask why we have undertaken the current study. The reason is simply that in spite of our conclusions eight years ago, there has been no appreciable movement toward examining the issue of Medicare coverage in Mexico. It has also become fairly clear that the Health Care Financing Administration (HCFA) would be unlikely to undertake such a significant change in coverage without a trial, such as a demonstration project. Because of the dispersed nature of the potential beneficiaries, their limited sophistication regarding reimbursement and health policy matters, and the lack of knowledge about the Mexican health system and U.S. retirees to Mexico in Washington, it has become clear that further investigation and fact-finding would be necessary to get this issue to the discussion stage. This report is the first part of that process. During 1998-1999, a second project will take place that will include a conference at which these findings and suggestions will be presented to an audience that will include retirees, health insurers, HCFA, providers, and other interested parties. Our goal with this project and the one to follow are to provide the background and to identify the relevant issues so that one or more demonstration projects can be initiated to test the impact of alternative changes in reimbursement policy.



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