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Seguro Popular has approximately 60 million members providing services through many hospitals and hundreds of clinics throughout Mexico. IMSS and Seguro Popular will become one over the next couple of years. Please ask how I may provide this healthcare coverage for you.
If you have an emergency you go directly to a Hospital General for treatment.
At any time, if you have any problems at the hospital including billing, quality of care etc., you are advised to contact the Medico Gestor.
Coverage includes over 900 medical interventions including cancer of the ovaries, esophagus, liver; X-rays; fractures; appendicitis; hernias; malaria; vasectomy; heart and lung transplants; autism; heart disease; electro-cardiograms; HIV; hemophilia; AIDS, etc. That is over 90% of all medical issues. Dialysis is not covered.
Most medicines are given by the hospital/clinic, although if insurance does not cover those medicines, they are usually sold to you by the hospital at a very reasonable price.
There are no pre-existing condition restrictions; there is no age limit.
Your insurance starts immediately and is nation-wide.
Fees for your policy and care depends on how you answer questions such as: do you own or rent, do you have cement, dirt or tile floor in your house; do you have a refrigerator and stove; how many TV’s and bathrooms; number of bedrooms; do you work; do you own a car; what is your level of education; your age; number of people in a family; are you a Mexican national vs a Temporary or Permanent Resident, etc? Your answers will also determine what you may be required to pay for example towards surgery.
These questions are normally asked in Spanish and are computer generated. It is important you answer these questions correctly. Otherwise, an error may result in over-charging. There is no chart showing all the variables, which establishes your annual fee and also what may be your costs when hospitalized etc.
In San Miguel de Allende, the Seguro Popular office is located on the north side of the Hospital General on Calle Primero de Mayo past the small traffic circle. The office is the third (last) building on the left.
Temporary and Permanent Residents in Guanajuato state and a few others, all pay a fee for Seguro Popular. That fee depends on how you answer questions and you will be given 1 year of coverage. Some states in Mexico have restrictions including limiting Seguro Popular to Permanent Residents.
Seguro Popular Client's Knee Surgery, Sept. 2017
Having never needed surgery, I was more than a little chicken to go for a knee replacement
I went for the needed first step, which was my appointment at the Seguro Popular clinic in La Lejona, San Miguel de Allende. Following that, my kind and very capable Dr.Castro set up a variety of health checks at the local Hospital General: blood work, X-Rays, cardio, etc. All was without charge.
After results were in, the local trauma staff checked on my health status. This was followed up with seeing a doctor at HOSPITAL REGIONAL de ALTA ESPECIALIDADES in Leon, Guanajuato. I arrived with my Seguro Popular policy, the requested documents and previous test results. During this meeting the doctor reviewed my case while giving me all the possible information and advice.
Following that visit, I was given the fee amount for my surgery scheduled for 10 days later. I deposited the 33,000 pesos fee. The date was confirmed. The surgeon would be Dr. Reyes.
I checked in Sunday at 3 pm. My surgery was to be the following day. When I arrived staff were kind and patient. Others were checking in. The process was amazingly professional. Never did I feel like a number.
I was provided a place to change and then taken by wheel chair to my room. The room is for 6 patients. It was clean, has a washroom with shower, comfortable.
Throughout my 4 day stay the attention from the entire staff was kind and totally professional. Medication checks were a minimum of every 3 hours
Monday morning I was wheeled down to the surgical waiting room. I was able to watch the hospital staff. All were very professional and attending to everyone in kindest manner giving me a good sense of comfort.
All staff who participated in my operation introduced themself. I was wheeled into the operating room where music was playing and next thing I knew, my surgery was a great success!
Thank you Dr.Reyes and staff !
I was somewhat comprehensive..but I cannot say enough good things.
Emergency Hospital Treatment and Billing
In Mexico, the Federal General Health Law (La Ley General de Salud) governs the rights and responsibilities of hospitals and patients. They key provisions of the law require the nearest medical facility must treat patients with emergency medical conditions, that patients receive complete information about their diagnosis and care and that patients authorize any treatment and where they will receive treatment. As well, hospitals may not retain or attempt to detain a patient, his/her passport or body to guarantee payment of medical services provided. However, the patient, family members or legal representative who authorized treatment is also responsible for arranging payment of the bill with the hospital administration and/or insurance company.
Mexico's healthcare system is divided into:
1: Private sector (you must have foreign insurance that covers you in Mexico, or Mexican insurance, or pay out-of-pocket).
2: Public sector, is sub-divided into:
a) Seguro Popular which will join with IMSS in time
b) IMSS (for insured private sector workers)
c) ISSSTE (for federal government workers, such as federal police officers, etc.)
d) other, local hospitals/clinics for government workers of that particular state.. for example, in Baja California, it would be: ISSSTECali... etc. (for local teachers, firefighters, etc.)
As a foreigner, you may enrol in either Seguro Popular or IMSS.
Seguro Popular, the General Hospitals, are usually better staffed and equipped than the IMSS counterparts. Most university hospitals belong to the Seguro Popular network and it's where most research and patient-centric care is performed.
It also depends on what type of care you're seeking and where. If it's in the Mexico City metropolitan area and you have access to the national institutes (Instituto Nacional) they provide world-class medical care. Some require a referral, but if it's an emergency they do not. They're located in the Tlalpan district and they all belong to the Seguro Popular network. For example, at the Gea Gonzalez Hospital, you can be seen in the E.R. for a co-pay of 100 pesos and if they determine that it's a true emergency, they waive the co-pay. All hospitals have a "Trabajo Social" area and they'll do a sliding-scale evaluation of your ability to pay in case you require further evaluations, hospitalizations, surgery, rehabilitation, etc.
In summary: outside of the private sector, most prestigious hospitals belong to Seguro Popular. The federal Ministry of Health in Mexico City distributes funding to each state's healthcare branch of government to pay staff and equip the healthcare facilities. IMSS, on the other hand, is more centrally governed, with most of the funds staying in the big IMSS hospitals in Mexico City while the states receive a smaller share of proceeds.
IMSS is also a government healthcare program mostly for employees but some expats who are Temporary or Permanent Residents join. The annual fee is 7000 to 9000 pesos (increases with age) per person and renewed annually. For those with pre-existing conditions you are normally declined. First year's coverage is almost non-existent but second year is much improved and subsequent years provides full coverage. Part of the decision to join IMSS vs Seguro Popular is availability of hospitals and clinics and annual fee.
Most young doctors dream of working for IMSS because of the benefits offered. They eceive 2 months paid vacation a year, free housing in some areas, free "guarderia" for their kids, 0% financing and no downpayment housing mortgage, pensions, etc. So, competition is very strong and it's practically impossible to get in if you don't have a family member working for IMSS. This is how some IMSS doctors are able to live a very comfortable lifestyle with a mediocre public-sector salary.
There's also a weird salary system in place at the IMSS hospitals with some doctors working on an hourly basis (no set salary package) just to get the IMSS experience and hoping to get a stable position in the future. A doctor that works a 24 hour shift at the Seguro Popular (General Hospital) and comes to work for low pay at IMSS for another 12 hours - might not be in the best position to make sound clinical decisions.
Cedula - Professional Designation
A cedula is a professional license to practice. All attorneys, doctors, architects, accountants, engineers, notarios, dentists, nurses, chiropractors, etc must have one to legally practice.
Mexico does have certifying boards for medical specialties. The cedula is a government issued document that certifies that the professional has completed proper studies for the licensure in the appropriate school. For doctors every one must have a cedula as a general practitioner and the doctors with specialties may have a second or even third cedula that certifies them legally for the practice of their specialty(s). However, that does not mean that a doctor is competent in what they do or claim to be specialized at.
Aside from the cedula there are certification Boards for every specialty in Mexico. This is a different kind of certification which requires not only that you have legal documents (cedula) but also requires a Board exam of knowledge and of technical skill when it applies. Board certification needs to be re-established every 3 or 4 years to ensure that specialty doctors are up to date. In order to get re-certification a specialist needs to obtain certain amount of points. Points are given for National and International congress meetings, conference attendance, publishing, teaching, and other educational or continuing education participations.
Last, board certification is mandatory to work in most private hospitals and to be part of other medical associations / staff. Hence, for a patient it is very important to know if their specialist is board certified and up to date. It is the only way to fight charlatans and fraud (doctors that say they are but they aren´t).
Boards in Mexico are known as "Consejos", like: "Consejo Mexicano de Medicina Interna", "Consejo Mexicano de Otorrinolaringología", "Consejo Mexicano de Cardiología", "Consejo Mexicano de Ortopedia", etc..... and all databases can be accessed on line.
And, there are also expats including in San Miguel who will indicate they are professionals including Nurse Practitioner but have never proven their credentials in Mexico. And, they may not be certified in another country as anyone can print certificates. Once an expat is certified they apply at INM for permission to work. Some expats have bypassed this requirement as well.
So, the next time any one including an expat states they are a doctor, engineer, architect, lawyer, chiropractor, dentist or any other professional designation ask to see their cedula. Then check it on-line to ensure it is real. http://www.cedulaprofesional.sep.gob.mx/cedula/indexAvanzada.action
And if you know the Cedula number enter it here: http://www.buholegal.com/consultasep/
Farmacias Similares are found throughout Mexico and on Mondays there is a 25% discount. Prices are excellent. Often the medications they sell are made by the large pharmaceuticals and contrary to myths they are of high quality.