TIJUANA, Mexico -- There are world-class hospitals in San Diego, not far from where Luis Gonzales lives. But when he or a member of his family needs routine health services, they drive 50 miles south to a clinic in Tijuana.
The Gonzaleses are members of a Blue Shield of California HMO that provides the family's nonemergency care in Mexico. They are among 20,000 California workers and dependents in plans that cost 40 to 50 percent less than comparable care in the United States because doctor's visits are outsourced south of the border.
With healthcare costs in the United States continuing to rise, many employers in Southern California are turning to insurance plans that send their workers to Mexico for routine care, plans that are growing by nearly 3,000 people a year. And Gonzales, for his part, is happy about it.
''They have everything I need," Gonzales said. ''They're clean. You don't see a difference between a doctor over here and over there."
The new trend has some medical professionals in the United States worried that care is being sacrificed to low prices.
''There are quality standards that we are developing and implementing in America that are not going to be implemented there for a long time," said Jack Lewin, who is the chief executive of the California Medical Association.
''In terms of specialized care, it's critically important that we look beyond just cost savings," Lewin added.
Five years ago, California became the only state to regulate insurance programs that require border crossing for basic healthcare. Since then, more than 700 non-agricultural businesses have offered plans requiring treatment in Mexico. Hundreds of farms offer similar coverage for about 120,000 migrant laborers.
In Texas, legislators explored the possibility of allowing health maintenance organizations to operate on both sides of the border.
However, physicians in south Texas lobbied against the changes, arguing that local doctors could not compete with the lower costs in Mexico.
Lower-priced labor, malpractice insurance, and overhead in Mexico mean basic and sophisticated procedures can be performed at a fraction of the cost. A hysterectomy that averages $2,025 in the United States costs $810 in Mexico, said Mary Eadson, director of legal compliance for the Western Growers Association.
The movement of US healthcare across the border has sparked a boom in hospital construction in and around Tijuana.
In several areas, clinics and pharmacies are opening a short walk from the border.
Francisco Carrillo owns a Mexican HMO plan for California workers called SIMNSA, and he owns the Centro Medico clinic, where windows face the border bridge many of his patients cross on their way to the waiting room.
On a recent day, half the cars in the parking lot bore California license plates. A new surgical center and a dentist's office are under construction.
''Things are moving very fast," Carrillo said in an interview. ''We're growing."
David Castillejos Rios has performed laser eye surgery on both sides of the border. At a small hospital in Tijuana, he charges one-third as much as he does in San Diego. ''The medicine is the same, and to me, whether I do it here or there, it's the same," Castillejos Rios said. ''Only the price changes."
The difference can translate into the kind of affordable monthly premiums most US businesses have not seen in a decade. At