Moving Towards a Decision

At first, my research on private bariatric clinics focused on Montreal. Healthcare in Quebec is more privatized than BC -- probably more than any other province. 

In BC, private clinics cannot offer services that are available through the public health system.* This is a good thing, and I don't want it to change -- but since the province has capped the number of bariatric surgeries, BC residents are left without other in-province options.

Quebec, the leader in privatization (not good) is also the leader in bariatric surgery (good). There are clinics with exceptional experience and results, for people who can afford it. Gastric sleeve surgery is $18,000; gastric bypass starts at $23,000. That's without airfare and other incidental costs. 

And I was actually considering this. Which shows you how badly I want this surgery. We are financially comfortable, but we don't have $20,000 sitting around.

Financing is available, and I started looking into and rationalizing the expense. I can rationalize anything, and I was well on my way to talking myself intothis.

Then I did more research, and started looking into Mexico.

I know: it sounds alarming. Many Canadians and Americans think of Mexico as a place where everyone lives in shacks and walks barefoot, like one giant slum. That's just bias. I'm not saying that there isn't poverty in Mexico, but there's poverty in the US and Canada, too.

There is no shortage of sensational newspaper stories about people who had botched procedures in Mexico. It's a perennial of American journalism, and make good episodes on "House". We have no idea how prevalent those stories are, or how many botched procedures are performed in the good old U S of A. 

When it comes to reporting on health care, the American media has very low credibility. Everything Americans see and read about health care in Canada and the UK is wrong. Lies. Why would this be any different? Especially since many Americans think anyone who speaks Spanish is poor, ignorant, and untrustworthy.

Thousands of Americans travel to Mexico for treatments every year, especially from Texas, Arizona, and California. There are shiny, clean, modern hospitals, frequented by Americans who have been denied coverage by their insurance companies or who have no coverage. 

People also travel to Mexico for alternative cancer treatments that are not legal in the US. A former co-worker of mine had Stage IV breast cancer, went to Mexico, and was put into remission without surgery. Yes, I know that is merely one anecdote and not a scientific study. But she went to this clinic because of a preponderance of these stories. And she's still alive, with her body intact. A treatment that is unproven may still be effective.

In any case, one of the largest cancer facilities in Mexico is also a hub for bariatric surgery. At about $5,000 including airfare, the price tag is a lot more palatable.

It's not easy to find independent assessments of the Mexican clinics. I did find one study that looked at complications and outcomes in Mexico, based on 500 surgeries performed at one hospital over a period of 4.5 years.

The study found that in the well-established, high-volume Mexican bariatric clinics, the outcomes and rates of complications were comparable to similar hospitals in the US. There was no statistical difference.

This article looks at the cost to Canadian health care from complications from medical tourism. It profiles four cases of people who had bariatric surgery abroad, then had complications, and what the implications were for their provincial health systems. It doesn't compare complication rates from surgeries between countries. 

In the conclusion, it states:

Our limited, anecdotal impressions are that obese patients are poorly informed when they seek bariatric surgery as medical tourists. They do not consider the far-reaching implications of having complex gastrointestinal surgery for morbid obesity (a chronic disease) in a foreign country and they have made no plans whatsoever for appropriate, informed follow-up care.

I will not fall into that category. If I do this, I will be well informed, and I will absolutely have plans for follow-up care.

The article also includes this:

In terms of quality of care, there is certainly data to suggest that some overseas centers have equal, if not superior, results for certain procedures. The peri-operative mortality rate after coronary artery bypass surgery at the Escorts Heart Institute and Research Center in India is .8%, less than half the rate of most hospitals in the United States.

I'm sure many people would find that statistic surprising.

I would like to read more unbiased comparisons of safety, but so far I've only found the one. Most information is written by clinics -- either Mexican clinics saying how great they are (worthless) or American, for-profit clinics scaring potential customers away from Mexico (also worthless). A clinic in Dallas claims "Our doctors are highly educated and regulated, with national and state licensing boards ensuring everyone on the medical team is qualified for practice. Other countries might not have as stringent educational standards or be as thorough with regulations." That's just an unsubstantiated claim. Anyone "might" have anything.

I'm not sold on Mexico, but I'm leaning towards it.

* A decade-long lawsuit challenging this came to a close in February 2020. A Supreme Court decision is pending.