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Research Showcase - Sarah Horton, Anthropology


Anthropology Professor Examines How U.S. Health Care Crisis Affects Mexican Health Care

Sarah Horton, assistant professor of anthropology, spent six months of last year examining a growing response to the health care crisis in the United States—the outsourcing of health care to Mexico.

Horton is interested in the way that different groups—middle class Americans, U.S. insurance companies and U.S. Latinos—are able to maximize value and status by seeking care abroad. By crossing the border, these groups gain access to health care services and a quality of care they would ordinarily be denied in the United States.

"Seeking care in Mexico used to be either the refuge of the very poor or the privilege of the very rich, yet an increasing number of middle class Americans are seeking routine surgeries in Mexico," says Horton. "As health insurance premiums have increased at triple what Americans earn, fewer members of the middle class—and fewer of their employers—can afford insurance."

Over winter break, Horton took a graduate student to Tijuana to conduct interviews with both insured and uninsured middle class Americans who sought hip replacements, knee replacements, hysterectomies and weight-loss-reduction surgeries in a satellite of Mexico’s largest private hospital chain. "I’m examining the normalization of the practice of seeking care in Mexico, which once carried a heavy stigma," says Horton. "I’m also interested in the way that hard-pressed Americans facing a ‘middle class squeeze’—that is, facing reduced benefits and government support—manage to recuperate a sense of privilege only by seeking care in Mexico."

Hospital in Mexico The border has witnessed a boom in health care construction in the past decade, and middle class Americans are not alone in outsourcing their own care. U.S. insurance companies are increasingly encouraging beneficiaries to seek expensive surgeries abroad by offering plans with lower premiums and financial incentives.

Horton is conducting research at SIMNSA, Mexico’s first HMO, which offers cross-border plans to blue collar Latino workers in southern California. SIMNSA has more than 16,000 enrollees; it not only has its own plan but also contracts with HealthNet of California to manage their cross-border plan. Beneficiaries can receive care in both the United States and in Mexico, yet have lower co-pays when they seek care in Mexico.

With its digitized medical records, hundreds of contracted specialists and premiums of less than $50 a month, cross-border plans like SIMNSA’s offer Latino workers in the steel, food processing and hotel industries a status boost. And with health care reform’s mandate that all employers offer employees insurance, low-cost cross-border plans like SIMNSA’s may stand to gain hundreds of thousands of new beneficiaries.

While Mexican immigrants may have pioneered the trend of cross-border seeking, Horton’s research shows that this trend has increasingly become mainstream. "In short," says Horton, "in a globalized world in which people and corporations cross borders, we must examine health care delivery in a transnational framework."

Horton has written about her research on immigrant health and cross-border health for many academic journals, and her work has been referenced in The New York Times. She is currently working on a book on borderlands health care for the University of California Press’ series in public anthropology. She was awarded First Runner-Up in the UC Press Public Anthropology competition in 2008 and Second Runner-Up in 2009.

Reprinted from the 2010 issue of Pinnacle.