August 30, 2004
A binational approach to health care:
To the untrained eye, public health conditions along the U.S.-Mexico border may seem discouraging. Many of its 12 million inhabitants live in poverty and medical resources are scarce. But where some see limitations, Professor David Warner sees opportunity. Using the classroom as a vehicle for research, Warner has investigated socioeconomic issues surrounding health care delivery in the region over the last 30 years. His findings show that binational policy approaches to dealing with the region's health issues could defray costs as well as open new avenues for economic development. Just as the flow of migration extends far beyond the limits of the border region, policies designed to treat border health problems carry broad implications for both countries.
Spurred by the North American Free Trade Agreement (NAFTA) and other binational economic initiatives, explosive population growth along the border has outpaced the region's already limited health care resources.
"As the U.S. and Mexico integrate further economically and demographically, it will be extremely important that they improve the integration of their health systems," said Warner. "And nowhere is that more important than at the border.”
Coordinating binational policies in the region is no small task. The region’s complex political structure comprises two sovereign nations, four U.S. states, six Mexican states, 44 counties, and 80 municipios. Its bilingual, bicultural and transnational features pose additional hurdles. While Mexico’s health care system is centralized to the federal level within several major agencies, public health care in the United States is a decentralized system that varies from state to state and between localities in its function and organization.
One aspect of Warner’s current research focuses on cross-border certification and training of health professionals as one effective way of dealing with workforce shortages in the U.S. health system. The scope of cross-border certification would reach far beyond the border region to cities such as Dallas and Chicago, where more bilingual and culturally sensitive health professionals are needed to serve rapidly growing Spanish-speaking populations.
In a broader sense, cross-border certification of nurses could also stem an impending nursing shortage that threatens the United States and is expected to worsen as the elderly population increases in coming years. A policy research project Warner directed in 2002 examined existing barriers to Mexican nurses’ becoming certified in the U.S. as well as educational exchange programs that could expedite the certification process.
“These programs would also respond to Mexico’s need for more technically advanced nurses,” said Warner.
Binational policies could also prove cost effective for the Medicare program as increasing numbers of beneficiaries retire south of the border. If Medicare reimbursed providers in Mexico, access to care could be increased and expenses potentially reduced.
"With the growing number of Mexicans who have worked here for enough years to have Social Security, a lot of people will want to return home for retirement,” said Warner. “In some ways, it would be much cheaper if they could just consume services in Mexico, instead of returning to the U.S. for tests and treatment."
The same holds true for growing numbers of U.S. retirees who are attracted to Mexico’s lower cost of living and mild weather. In the coming years, Warner will conduct a pilot program on Medicare portability that looks at issues of health care cost, quality and access for American beneficiaries in Mexico and compares those who can spend money in Mexico to those who cannot.
In the long run, extending Medicare benefits to eligible recipients in Mexico could spur new opportunities for broad-based economic development. In a 1999 report Warner presented to San Diego Dialogue, a policy research center, he projected that the development of retirement communities in Baja California could attract billions of dollars in investment. A principal constraint he identified was the lack of high-quality, affordable and proximate medical facilities.
“With at least partial Medicare coverage, it might be possible to develop such facilities,” he wrote.
Through the course of his work, Warner has demonstrated time and again that the United States cannot afford to ignore health issues along its shared border with Mexico.
"When I first moved to Texas in 1975 it was clear to me that the health of Mexican Americans, while understudied, was of paramount importance and would only become more important,” said Warner.
After leading a study in 1976-77 on a range of Mexican-American health issues in Texas, he expanded his research to include the Mexican side of the border. While his research agenda has covered a variety of health finance topics over the past 30 years, he has been consistent in his focus on cross-border health issues. His collaborations with such groups as the American Academy of Pediatrics and the Texas Department of Health have yielded a series of in-depth studies on subjects ranging from NAFTA and trade in medical services to the federal Border Health Commission Act of 1994. His most recent study on cross-border health insurance, which will be published in October, examines initiatives in California and identifies options for Texas.
While coordinating a binational approach to health may initially appear daunting, an integrated system is needed to address the unique health challenges along the U.S.-Mexico border. For Warner and other border health advocates, the hope is that more research showing the far-reaching potential of cross-border health policies will spark a higher degree of collaboration by policymakers at all levels in both countries.
Links to David Warner’s publications
Workforce Needs: Opportunities for U.S. Mexico Collaboration
Health Care Coverage for the Uninsured in Texas
Better Access to Health Insurance for U.S. Retirees in Mexico
You Paid For: Extending Medicare to Eligible Beneficiaries in Mexico
Technical Papers on a Research and Demonstration Waiver for Medicare Coverage
in Mexico (1999)
Health and Medical Care in San Diego and Tijuana:
Prospects for Collaboration
Trade in Medical Services Between the U.S. and Mexico
Border Health Authority: Issues and Design
Mexican President Vicente Fox visits UT Austin (November 10, 2003)
© Lyndon B. Johnson School of Public Affairs
30 August 2004
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