Health care in Mexico: How the IMSS works
By Michael
Forbes,
Guadalajara Reporter, Friday, March 04 2011The Instituto Mexicano de Seguro Social (IMSS) offers a low-cost
health care option for foreigners resettling in Mexico. The service, however, lacks
many of the comforts that users of HMOs or insurance plans in the United States
are accustomed to. In a sense, the IMSS is more comparable to Canada’s or Great Britain’s national health
systems.
The IMSS works on a three-tiered basis. On the first level (primer nivel)
there are Unidad Medicos Familiares (Family Care Clinics), where beneficiaries
must go for primary consultation with their medicos familiars (family doctors).
The quality of these clinics can vary significantly; some are much better
equipped than others and are able to do lab testing and x-rays. All include a
pharmacy on the premises. It is the duty of the family doctor to pass patients
on for specialist consultations, which take place at either regional clinics or
hospitals (segundo nivel) or medical centers (tercer nivel), such as
Guadalajara’s well-equipped Centro Medico.
Each local IMSS clinic is assigned a regional hospital, where patients are
sent for specialist treatment or hospitalization. For example, the
corresponding hospital for the Chapala IMSS clinic is in Tlaquepaque.
For emergency treatment, beneficiaries can go to any IMSS clinic or hospital,
although it is recommended that they use the one assigned to them if possible.
It should be noted that many family care clinics have restricted opening hours
and are not equipped for serious emergencies.
The state of Jalisco has 109 family care clinics, 15 second-level hospitals,
three specialist (third level) hospitals and 95 child-care centers. According
to the latest figures, 3.3 million Jalisco citizens are enrolled in the IMSS –
around 56 percent of the population.
Advantages of IMSS
The cost. The annual fee (as of 2011) for a person aged over 60 is only 3,472.10 pesos a
year. It is considerably less for younger people (see story left).
Insurance includes hospital, medical, surgical, eye, ear, dental care
(extractions and fillings only), prescriptions, lab tests, x-rays,
reconstructive surgery and mental health consultations. Cosmetic surgery is not
included.
Foreign enrollees must be in Mexico
on a FM2 or FM3 and have a Mexican address (and cannot apply under a Tourist Visa).
Third-level specialist medical treatment (for example at the Centro Medico
in Guadalajara) is equal to, if not better than,
most private hospitals in Guadalajara,
some local doctors say.
Most foreign residents enrolled in IMSS report excellent treatment by
staff.
Disadvantages of IMSS
Non-Spanish speakers will need an interpreter if a non-English speaking
doctor is assigned to them. Few nurses speak English.
Doctors can only prescribe medicines from a basic list, some of which may be
less potent than other patented drugs. Some IMSS drugs are often in short
supply.
Family doctors cannot be consulted by telephone. Substitution of doctors is
frequent, especially when family doctors are on vacation or on a course. Lack
of physician-patient rapport is commonly reported. Many IMSS doctors seem
permanently stressed, perhaps due to the heavy workload.
Patients may not choose the clinics or hospitals they attend.
Lengthy waits are common (even with an appointment) to see family doctors
and specialists.
Referral to specialists (in non-acute cases) can take up to as much as two
months.
Visiting times for patients at IMSS hospitals are strictly regulated.
It is unusual to be accommodated in a private room at an IMSS hospital.
Usually three to four patients share a room, with screen dividers.
IMSS coverage: How to sign up
The service isn’t always a model of efficiency, but the Instituto Mexicano
de Seguro Social (IMSS) is the cheapest way to receive across-the-board health
care in Mexico.
IMSS health coverage includes check-ups, hospitalization, surgeries, lab
testing, X-rays, basic dental treatment, specialist consultations and even
prescription medicine, as long as it is in stock in IMSS pharmacies, which
isn’t always guaranteed.
All private sector employees in Mexico are entitled to be insured
under the IMSS health-care system. Employers are obliged to register their
permanent staff and pay a premium equal to roughly nine percent of the worker’s
salary. The employee pays approximately three percent.
Self-employed Mexican citizens and foreign residents (retired or otherwise)
in Mexico
may also enroll in the IMSS under the program known as Seguro de Salud para la
Familia. All foreigners, regardless of immigration status, are
eligible to enroll, as long as they have a Mexican address.
Annual fees are calculated based on age. People aged 60 or over are in the
highest payment bracket and currently pay 3,472.10 pesos for a year’s coverage.
The fee is as low as 1,320 pesos for those aged 19 and under. For ages 20-39
the cost is 1,543.70 pesos a year; 40-59 year-olds pay 2,307.10 pesos.
Carlos Lozano, chief of the IMSS affiliation office in Guadalajara, says the requisites for joining
IMSS are:
1. A copy of your birth certificate.
2. Original and copy of official identification (FM-2, FM-3, passport).
3. A printed copy of the applicant’s official personal identification number
or Clave Unica del
Registro de Poblacion (CURP). (One’s CURP can be obtained from the Edificio del
Archivo in Guadalajara, Av. Alcalde 1855, ground floor, online at curp.jalisco.gob.mx,
as well as from some municipal offices, including Chapala city hall).
4. Two photos of the applicant, child size (“tamaño infantil,” available at
most places where instant photos for identification are taken).
All applicants must also fill out an IMSS questionnaire, in Spanish. The
purpose of the questionnaire is to detect any chronic diseases that would
preclude IMSS affiliation. Those include any chronic degenerative diseases such
as cancer, HIV, renal insufficiency, diabetes, heart disease and psychosis.
In the past, applicants were not usually subjected to a medical examination
as a requisite for IMSS affiliation. Nowadays, however, new members are
required to undergo a check-up with a family doctor in order to detect any
chronic diseases and to assess general health. If the doctor suspects the
presence of any chronic illness, he may order further tests, most of which will
be done in Guadalajara.*
The detection of such a disease in the first six months of IMSS affiliation
may lead to being rejected without return of the application fee. Should a
chronic disease develop after the first year of affiliation, an individual
should have no reason to be rejected from the institute.
Certain services, such as care for pregnancy, are not available during the
first 10 months of IMSS affiliation. There is also a waiting period of one year
for all gynecological surgery, and two years for orthopedic surgery.
Applications for IMSS coverage must be made at the sub-delegation office
corresponding to your address:
- Residents of Tlaquepaque,
Tonala and the Reforma and Libertad sectors of Guadalajara
must apply at office located at Calzada Independencia Norte 580, corner of
Juan Alvarez in Guadalajara.
- Residents of Zapopan
and Guadalajara’s Sector Hidalgo must go to the office at Avila
Camacho 1696, beside the Volkswagen dealership.
- Residents of Jocotepec and
the Juarez Sector of Guadalajara have to go the IMSS office at 16 de
Septiembre 868, in front of the Agua Azul park in Guadalajara.
- Chapala
residents can apply at the Chapala IMSS clinic at Calle Jose Navarro 95
(formerly Estacion), opposite CFE administrative headquarters from 8 a.m.
to 2 p.m. Take the stairs at left of clinic’s front door,to the Direccion
office located at right on the second floor. The secretary has the
application form with the attached list of requirements.
All payments (both first time and renewals) are only handled in Guadalajara at Calzada
Independencia Norte 580, from 8 a.m. to 2 p.m.
It is always a good idea to get there early to beat the line-ups. The room is filled with chairs and there are long line ups. It is not unusual to be there the whole day, only to be sent home as something is incorrect.
Note: Focus Participants, you will want to contact our Immigration Specialist to help you through the process to save your sanity! :-)))
Focus Alumni can sign up with Focus to receive all changes to Immigration as soon as they occur.
It is important that IMSS members do not let coverage lapse. It is
recommended that renewals be paid one month before coverage runs out. Making a
renewal requires you to bring last year’s payment receipt, your IMSS credential
and two identification photos. Costs for renewal are the same as first-time
membership.
If all this seems too much bureaucracy to
handle, there are service providers in Guadalajara
and Chapala who will carry out all the
paperwork for you.
* IMSS correction from the newsletter release:
Dear Sir,
A recent issue of the Reporter had an extensive article about IMSS that
included, “How to sign up.” One thing the article said was, “Applicants will go
through a medical examination with a family doctor to check for pre-existing
chronic conditions.”
Julia Vargas, our Focus Immigration Specialist says you have to go through IMSS for your medical
examination, etc., to determine if you can be covered under IMSS, and if
something is found to be wrong, your IMSS fee will not be returned.
Julie does suggest that you may want to go to your family physician before
applying to IMSS to find out first if anything is wrong. That way you will not
be out the fee if the tests determine that you have a pre-existing condition.
Karen McConnaughey, Focus on Mexico