# Non-ambulatory surgery at IMSS



## Gatos (Aug 16, 2016)

[Warning - very very long post]

Well I've been considering having surgery at IMSS for at least a year now. Prior - I was considering a different procedure but ending up getting that done privately because of the length of time it was taking to setup at IMSS.

On Wednesday of this week (the day before the procedure) we had to visit the clinica for the sole purpose of getting a stamp in my book as testament that I had coverage. On Thursday we reported at 5:30AM for a 6:30AM appointment. There were perhaps 100 of us waiting outside the locked gate which was opened shortly after 6:30AM. When that gate opened the stampede of people reminded me of a Black Friday sale in the US. When we got to the admission's widow we were number 1 in line.

Around 7AM the window opened, our paperwork confirmed and we were told to start another line where we would be brought upstairs for prep. There were perhaps 15 patients plus their family members and we were placed in another waiting room outside surgery. We were sent to the bathroom and told to strip and put on our gowns. They put blue booties and caps on us and we returned to wait. They had a problem with me because at 6'2" they didn't have a gown large enough but after a half hour or so that was resolved. 

My wife and I were separated from the crowd and sent to 2 seats in the surgery dept - told the anesthesiologist would be by to speak to us. We sat in those chairs for at least 2 hours waiting. At about 10AM the very nice guy came by and started describing what to expect. I am no novice to hospital procedures and if I were to count my operations they would number perhaps 10 or so. I have never had my anesthesia though my spine and most always were put out - but that is the way IMSS does it here.

About 10:30 I walked into the OR and placed on a table. There were at least a dozen people in the room; 2-3 doctors, 2 anesthesiologists; nurses and technicians. The equipment in the room was a little dated - but I was ok with that. The overhead lights didn't have much paint left on them. Someone turned on the stereo and they were playing nice English language music. 

After about 2 hours I found myself in recovery - let's say that was 12:30PM. Nice nurses and modern tracking machines measuring vitals etc. The spinal had totally killed any ability for me to even wiggle my toes. I regained that ability about 4 hours later - when they brought me to my room for the night.

All this while - from 10:30AM until about 6:30PM my wife had been waiting outside in the hospital and NEVER received any updates. She wasn't alone and formed at least a couple friends whose contact information she has come home with. We got to the room and they came by a short while with some food. It was pretty darn good - especially since I hadn't had anything to eat in over 24 hours at that point.

There were two other patients in my room. One patient with his wife were very nice (and quiet). The other patient was a 98 year old ex-professor who was suffering dementia. He kept us all up all night - repeatedly wondering how he could afford to pay for his stay - while his family member repeatedly told him it wasn't going to cost him a dime. I'd say they had that back and forth (very loudly) a couple hundred times - until the wee hours of the morning - when some kind soul finally medicated him.

My wife - who was required to attend to me in the room - was given a simple metal chair to sit on - nothing more. Ultimately she used my backpack as a pillow and my sweatpants as a blanket and laid down on the linoleum floor. 

We woke up about 4:30AM - our usual time. A doctor showed up around 7:30AM doing his rounds - nice guy. He said he would see what he could do to get us out as early as possible. Breakfast came around 9AM. It, also, was pretty good food. Lot's of typical Mexican food I had never had before but will have to try again. 10AM arrived and we were told it may be four more hours before we could be released. I had a nurse disconnect my IVs, grabbed my catheter bag and walked in my gown to the nurses station and said I had had enough and was checking myself out. They said I needed paperwork from the doctor for release and that wasn't ready. My wife walked to the chief of surgery's office and returned with the paperwork after about 10 minutes. It had been prepared already but no-one wanted to look for it. So we waked out of the hospital on our own and hailed a cab.

I had been told by the doctor who had come to the room at 7:30AM to just treat the catheter/bag as normal. Just take a shower and don't worry about anything. If the tape comes off just put on fresh tape. So I hopped in the shower and the whole thing kind of fell apart. It looked like the catheter was coming out - it also looked like the capillary action wasn't working any longer either . I panicked a little so we drove to the (ultra modern) Red Cross emergency room (about a half hour away) where a doctor put me back together (cost 165 pesos). That was about 2PM. She fixed me up much better than I was when I left the hospital.

About 7PM I really wanted to pass water - and I was - but it wasn't coming out the catheter and was causing the weirdest sensation. So we returned to the Red Cross. The new doctor removed the catheter and found a blood clot about the size of a dime. Put in a new catheter and gave us some stuff to maintain it and hopefully prevent another clot.Came home and I slept like a baby.

The lower cost of medical care was one of the factors which caused us to choose Mexico. We could afford much more costly coverage than IMSS - but we were really trying to live Mexican. Now we might have to re-think our approach and use IMSS for routine lab work/physical exams/ and some prescriptions - but use private coverage for anything more serious. If there is a silver lining at least we learned this lesson on such a relatively trivial procedure.

I'm posting this for those of you who might have been like me a week ago. And finally - we live in one of the largest population areas in Mexico.


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## Perrier (Dec 18, 2016)

Sounds like a horror story to me. Glad you are back home and getting better.


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## AlanMexicali (Jun 1, 2011)

"My wife - who was required to attend to me in the room - was given a simple metal chair to sit on - nothing more. Ultimately she used my backpack as a pillow and my sweatpants as a blanket and laid down on the linoleum floor. "



Basically someone is there to be the "Nurse Call" button modern US hospitals have when a patient feels uncomfortable. needs something or feels sicker. The family member gets a nurse or an orderly. If they want they can help the patient to the bathroom but not required. They can find an orderly and they will help.


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## citlali (Mar 4, 2013)

Gatos
you say we were trying to live "Mexican"

I do not know about you but some of the Mexicans I know go to Houston for surgery not IMSS.. There are lots of different levels of care in Mexico and the better off people go to the US , some of simple surgery such as cataract others for cancer type ailments ...If you can afford better than IMSS it would not be un-Mexican to go to a top hospital..I was in the Los Angeles del Carmen hospital in Guadalajara last week in the ambulatory department it was all Mexican doctors and patients..
Mexico is a big country with very poor people, middle-class people and rich people and they are all Mexicans.
Mexican does not mean poor or lower class..


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## RickS (Aug 6, 2009)

Thanks for that feedback, Gatos. Your accounting pretty much duplicates what a friend of mine shared as to his experience with IMSS, also in a populated area... Guadalajara.


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## lagoloo (Apr 12, 2011)

Whether it's a Mexican IMSS "horror story", a private Mexican hospital "horror story" or a U.S.A. "horror story"........believe me; with rare exceptions ALL hospital experiences are horror stories. Both my husband and I have them from so-called "top" U.S. private hospitals.
I'll spare you the details. I'll just say I feel lucky to have survived it.

The problem for older expats (older than 65) is that private insurance is very expensive here; at a few years more, it's obscene. For pre-existing conditions......good luck. This leaves IMSS, Seguro Popular, flying back to the US to use Medicare and paying out of pocket for a private hospital. Not a lot of desirable choices. A big city public hospital in Mexico is comparable to the big city public hospitals in the U.S. Long waits for care, long lines and Spartan accomodations.
Thanks for sharing your details, Gatos. At least the food was edible! Hope you're feeling good now that the worst is over.


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## Gatos (Aug 16, 2016)

I hope my being so detailed doesn't gross anyone out - and I know a lot of people have gone through a lot worse things then I am or have in the past. Life is a little funny - there was a time in my past when I saw someone with an 'external fixator' on their wrist and I said to myself - gosh I hope that never happens to me. Well about 10 years ago I was trying to change the batteries on the boat and I fell backwards and landed on my wrist on the deck. I had a fixator on my wrist for about 2 months and was in rehab for about four more. The same thing with these catheters. Hope that never happens to me - and now I'm living it. At least mine only has a week or so to go...

Since writing earlier today we made yet another trip to the Red Cross. The urine was not flowing down the tube but flowing outside. They gave us a quart or so of saline solution and a big syringe. From now on when the catheter clogs up we will clean it out at home. 

All these life experiences... I'm the type of person who looks away when he has blood drawn 

I can't speak highly enough of the folks at Red Cross. They charge a 100 pesos for a visit plus whatever supplies they use. They don't do everything there but they handle emergencies and the wait time has only been about 5 minutes. They seem really knowledgeable.


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## citlali (Mar 4, 2013)

When my husband had gallbladder surgery in chiapas,he almost died and ended up with a catheter and a bag for the bilirubine to drain.. There were only catheterer bags available for the bilirubine which are way to heavy to be right so I went to the market and bought a bunch of plastic bags and scotch tape and a moral made of soft material that could be carried across the shoulder aso it could be carried under the shirt to change every day for a couple of months. When it came time to remove the catheter, they told me how to do it.. they also told me to give him his shots for pain but I drew the line there and hired a neighbor to do it.. Sometimes you have to improvise even with private insurance.. 
The surgeon asked me to bring back some lightbulbs for the headlight they wear in surgery from Guadalajara because they were not available in Chiapas..
I took one look at the hospital del campo and IMSS and thank God we did not have to go there.

It is tough for people who do not have private insurance in some areas, the hospital are overcrowded and need more beds so people are released early and it can be extremely uncomfortable or painful and I feel bad for the lack of service to the people who do not have any other choice.


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## Bobbyb (Mar 9, 2014)

We have friends who work for the Federal Government. They use the ISSTE facilities. Very good care and they have specialty hospitals all over Mexico. But I would never go to an IMSS facility for anything serious. Socialized medicine at it's worst.


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## citlali (Mar 4, 2013)

Well have friends who had several complicated surgery with IMSS in Guadalajara and are very happy with them so obviously the quality of the care varies greatly but then it varies greatly in private hospitals as well..


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## perropedorro (Mar 19, 2016)

Opinions vary, but Mexicans have an old acronym for IMSS: *I*mporta *M*adre *S*u *S*alud. Hope everything turns out well for you for you, Mr. Katz.


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## DiverSailor123 (Sep 17, 2016)

20* +*Years on and off of Cozumel ( _we got to know a LOT of people_ ) and there by , Playa del Carmen and to some extent Cancun and I had never heard anything from anyone, that gave me confidence in IMSS.. I only knew a very few who ever relied on IMSS .. No Business Owners be they Mexican or Expats... NO Fellow Dive Instructors or Boat Captains , maybe a couple Dive Guides and 1st. Mates and Restaurant employees .. No One with any money. That said I did know 2 old drunks from Texas living on Cozumel drinking themselves too death that only had IMSS.. ( _Your Experiences May Be Different Those are Mine_ ) 
I visited people in Private Mexican Hospitals and I, was never impressed.. Our intent is to return to the USA for anything outside of Dental , Optical (glasses) or ER .. 
As for Big City Hospitals in Mexico and the US being the same?? No Way Jose! I have built too many Major Hospitals and I have done multiple Surgery Build-outs to buy that.. Welllll Unless your talking about 40 years ago or more and in the Bad side of Town in the USA, Compared to todays Mexican Hospital. I just went through ( 1 year next month ) Total Knee Replacement and it was NOTHING like was described. It was more closely likened to 2 days at The Hilton.. I agree with at least a few others here.. _Living in Mexico doesn't mean living.... dirt floor poor.. _IMHO *Going Native *is for when your 20 , 30 even 40.. Heck you can do it when your 60 or 70 but the Rolex is going to stick out like a sore thumb 




lagoloo said:


> Whether it's a Mexican IMSS "horror story", a private Mexican hospital "horror story" or a U.S.A. "horror story"........believe me; with rare exceptions ALL hospital experiences are horror stories. Both my husband and I have them from so-called "top" U.S. private hospitals.
> I'll spare you the details. I'll just say I feel lucky to have survived it.
> 
> The problem for older expats (older than 65) is that private insurance is very expensive here; at a few years more, it's obscene. For pre-existing conditions......good luck. This leaves IMSS, Seguro Popular, flying back to the US to use Medicare and paying out of pocket for a private hospital. Not a lot of desirable choices. A big city public hospital in Mexico is comparable to the big city public hospitals in the U.S. Long waits for care, long lines and Spartan accomodations.
> Thanks for sharing your details, Gatos. At least the food was edible! Hope you're feeling good now that the worst is over.


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## Bobbyb (Mar 9, 2014)

Diver salor: Although I agree with you re IMSS we regularly use a private hospital in HMO that is twinned to Baylor ( I think that is the name) in Dallas. I would put them up against any good hospital in say Arizona. The #1 Cath lab in Latin America. Huge Cancer care facility. Rooms like a newer Holiday Inn. Best care I have ever had. Surgeons who are certified by every top US org. Drs. who not only attend all the US seminars a few of them lecture as well. My Orthopedic surgeon even teaches once in a awhile in Indiana. Not IMSS prices. Specialist visit is 800 pesos. Internist usually 5 to 600. Surgery example: Rotator cuff completely torn; Total cost around $7200 USD. They wanted to get into Medical tourism but it is going slowly. BUT I have also seen private hospitals in Mexico that are horrible and rip offs. Usually in tourist areas with a sign that says" We speak English". I think those Gringos that are loudly supporting the IMSS system are using their wallets instead of thinking. You get what you pay for. Everyone knows horror stories about any hospital . Even in the USA. But just talk to a Mexican and see what they have to say about the IMSS. If you are proactive and have a serious problem it is often possible to have the IMSS send you to a private facility. Being Mexico there is lots of corruption. I know a contractor who goes to his physician through the IMSS. If he needs a specialist or an operation a few hundred dollars gets an outside specialist to see him or operate at the IMSS hospital. Procedures are at either the IMSS facility or a private hospital. Cost is zero other than Mordida. It is not unusual for private Drs. to sometimes work at an IMSS facility but the poor never see these people! They just die waiting for help !


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## Gatos (Aug 16, 2016)

The problems with IMSS are not the professional staff but the administrative staff. If I have a concern with the professionals it is that they are not always on the same page. Perhaps that is due to their differing training. But if you ignore the occasional arrogant (god-complex) individual - which you can find NOB and SOB - I have no problem with the doctors and nurses at IMSS. Many are better than those in our UnitedHealthcare or BCBS plans up north. The same guy that performed my surgery on Thursday is the same guy who would have done it at a private hospital recommended by friends. Only the accommodations would have been different.

The fact that IMSS makes you jump through hoops to accomplish something is the problem. Appointments are scheduled months into the future. 20 people are given the same appointment time. There is no official queue. You show up and place your book on the desk. Half the people place their books on the top of the pile, the other half on the bottom. No concern is given to the severity of the patient's condition.

One day you finally get to see a specialist (day 1). He requests you get lab work done (day 2) and an ultrasound (day 3), then a chest xray (day 4), then you have to donate blood (day 5) and visit an internist for his blessing (day 6) - and on and on.

The one thing I can tell you it has nothing to do with discrimination. Last year I had say an 8AM appointment with a cardiologist - me and about 20 other people. We were one of the first people there. After five ours or so we asked for my book back and left. On Thursday, sitting in the prep room for surgery, the woman sitting next to me was the same woman who kept me waiting 5 hours to see the cardiologist. It was her fourth time (since August) that she was trying to get her surgery performed. It keeps getting cancelled for one reason or other.


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## Gatos (Aug 16, 2016)

Bobbyb said:


> Diver salor: Although I agree with you re IMSS we regularly use a private hospital in HMO that is twinned to Baylor ( I think that is the name) in Dallas. I would put them up against any good hospital in say Arizona. The #1 Cath lab in Latin America. Huge Cancer care facility. Rooms like a newer Holiday Inn. Best care I have ever had. Surgeons who are certified by every top US org. Drs. who not only attend all the US seminars a few of them lecture as well. My Orthopedic surgeon even teaches once in a awhile in Indiana. Not IMSS prices. Specialist visit is 800 pesos. Internist usually 5 to 600. Surgery example: Rotator cuff completely torn; Total cost around $7200 USD. They wanted to get into Medical tourism but it is going slowly. BUT I have also seen private hospitals in Mexico that are horrible and rip offs. Usually in tourist areas with a sign that says" We speak English". I think those Gringos that are loudly supporting the IMSS system are using their wallets instead of thinking. You get what you pay for. Everyone knows horror stories about any hospital . Even in the USA. But just talk to a Mexican and see what they have to say about the IMSS. If you are proactive and have a serious problem it is often possible to have the IMSS send you to a private facility. Being Mexico there is lots of corruption. I know a contractor who goes to his physician through the IMSS. If he needs a specialist or an operation a few hundred dollars gets an outside specialist to see him or operate at the IMSS hospital. Procedures are at either the IMSS facility or a private hospital. Cost is zero other than Mordida. It is not unusual for private Drs. to sometimes work at an IMSS facility but the poor never see these people! They just die waiting for help !


It depends a lot on the quality and clout of your GP at IMSS. As I mentioned above I was not able to get in to see a cardiologist at IMSS in a reasonable amount of time. My GP went up the chain of command and actually had a well-respected (non IMSS) specialist from DF brought in and I had a meeting with him at another private hospital in our town. All for the cost of our regular IMSS coverage. That was extraordinary care.


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## lagoloo (Apr 12, 2011)

And finally, it gets down to the question of WHY does the U.S. have the most expensive medical care on the face of planet Earth while it is rated #27 in the WHO ranks for quality? What's the excuse? What is it that the #1 French do right, that the U.S. hospitals and doctors can't seem to equal?

As we watch the U.S. Congress prepare to dump the AHC Act, we might give credit for providing health care for all by the much poorer country, Mexico. IMSS and SP may be flawed, but at least they are there for the have-nots. The "haves" can always find quality care.


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## Gatos (Aug 16, 2016)

lagoloo said:


> And finally, it gets down to the question of WHY does the U.S. have the most expensive medical care on the face of planet Earth while it is rated #27 in the WHO ranks for quality? What's the excuse? What is it that the #1 French do right, that the U.S. hospitals and doctors can't seem to equal?
> 
> As we watch the U.S. Congress prepare to dump the AHC Act, we might give credit for providing health care for all by the much poorer country, Mexico. IMSS and SP may be flawed, but at least they are there for the have-nots. The "haves" can always find quality care.


At the same time - in a way it is the "haves" who participate in IMSS who help to keep it afloat. Like my wife and myself who pay in and our Mexican friends who are teachers, etc who pay into the system through deductions out of their paychecks.

I'm pretty sure the cost of health care in the US is so high because of the threat of litigation around every corner. That and the layers of bureaucracy which all suck out their cut like leeches.


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## lagoloo (Apr 12, 2011)

Gatos said:


> At the same time - in a way it is the "haves" who participate in IMSS who help to keep it afloat. Like my wife and myself who pay in and our Mexican friends who are teachers, etc who pay into the system through deductions out of their paychecks.
> 
> I'm pretty sure the cost of health care in the US is so high because of the threat of litigation around every corner. That and the layers of bureaucracy which all suck out their cut like leeches.


I agree. That litigation is way out of hand.
My spouse and I both pay for IMSS coverage, hoping we'll never have to use their hospital. We pay out of pocket for doctor visits and drugs. But, one never knows. A formerly "healthy" friend just rang up an incredibly high bill in a private hospital because of colon cancer. Luckily, he had insurance. A bill like that could be ruinous.


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## circle110 (Jul 20, 2009)

Gatos said:


> At the same time - in a way it is the "haves" who participate in IMSS who help to keep it afloat. Like my wife and myself who pay in and our Mexican friends who are teachers, etc who pay into the system through deductions out of their paychecks.


Teachers are government employees and so they are part of ISSSTE, not IMSS. IMSS is for workers in the private sector.


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## Gatos (Aug 16, 2016)

lagoloo said:


> I agree. That litigation is way out of hand.
> My spouse and I both pay for IMSS coverage, hoping we'll never have to use their hospital. We pay out of pocket for doctor visits and drugs. But, one never knows. A formerly "healthy" friend just rang up an incredibly high bill in a private hospital because of colon cancer. Luckily, he had insurance. A bill like that could be ruinous.


We have had IMSS coverage now for four years. In that time they haven't issued my wife as much as an aspirin. She hates needles and has her lab work etc done at an excellent lab and twice a year brings the results to our IMSS GP who enters the results into her records.

I have high blood pressure and our GP at IMSS has done an excellent job in medicating that. Last year I had a terrible case of sinusitis. I was going to let IMSS fix my deviated septum but their process to setup surgery was so long I paid an external ENT $700USD to fix it and that included the surgery/anesthesia/medicine/office visits/hospital room. That SHOULD have been the procedure I used to judge the quality of care inside an IMSS hospital - but I ended up using this week's procedure. If I had it to do over - I might wait for something more serious next time.

I will say this - the IMSS hospital in Mexico City goes by another name. EVERYONE we have spoken to about that hospital gives it the highest praise. A third party cardiologist told me - you ever have a heart attack, have them take you there - even if it is two hours away.


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## Gatos (Aug 16, 2016)

circle110 said:


> Teachers are government employees and so they are part of ISSSTE, not IMSS. IMSS is for workers in the private sector.


Our friends teach at Tecnológico de Monterrey - Mexico City.


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## circle110 (Jul 20, 2009)

Gatos said:


> Our friends teach at Tecnológico de Monterrey - Mexico City.


Ah OK, that's a private school so they would be under IMSS.


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## AlanMexicali (Jun 1, 2011)

circle110 said:


> Teachers are government employees and so they are part of ISSSTE, not IMSS. IMSS is for workers in the private sector.


ISSSTE is only for Mexican Federal Government employees and their families. IMSS is for private employees and state government employees and their families.


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## Gatos (Aug 16, 2016)

AlanMexicali said:


> ISSSTE is only for Mexican Federal Government employees and their families. IMSS is for private employees and state government employees and their families.


Didn't I read something around the end of the year that all the medical plans (SP/IMSS/ISSSTE) were pooling their resources to be more economical. For example - if an IMSS patient needed an MRI and there was a slot open at an ISSTE site, they would be sent there. That really seems like a rather good use of resources...


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## circle110 (Jul 20, 2009)

AlanMexicali said:


> ISSSTE is only for Mexican Federal Government employees and their families. IMSS is for private employees and state government employees and their families.


Actually, most states have their own version of an ISSSTE for state government employees (example - Instituto de Seguridad Social del Estado de Guanjuato, ISSEG, Instituto de Seguridad Social del Estado de Tabasco, isset.tabasco.gob.mx etc.), although I am reading that some states like Queretaro have made agreements with IMSS to partner in some fashion. So IMSS is by and large for the private sector but there is apparently some crossover into state employees in a few states.


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## Bobbyb (Mar 9, 2014)

Some states do cover their employees. Sonora has ISSTESON which is on par with ISSTE.


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## DiverSailor123 (Sep 17, 2016)

Litigation cost hahahaha BTW Top Cardiologist in the USA START at OVER $500,000.00 a year PLUS Benefits.. Those DR's come from All Over The World.. Mexico is seldom on the list.. Your Dreaming folks..


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## AlanMexicali (Jun 1, 2011)

circle110 said:


> Actually, most states have their own version of an ISSSTE for state government employees (example - Instituto de Seguridad Social del Estado de Guanjuato, ISSEG, Instituto de Seguridad Social del Estado de Tabasco, isset.tabasco.gob.mx etc.), although I am reading that some states like Queretaro have made agreements with IMSS to partner in some fashion. So IMSS is by and large for the private sector but there is apparently some crossover into state employees in a few states.


Some/a few Mexican states have medical insurance for state employees apart from IMSS and many states employees unions and municipal employees unions etc. have pension plans apart from IMSS but most use the IMSS for Medical Insurance. Teachers have their teacher unions pension plan. ISSSTE members have their own pension plan, etc. The total enrollment in Seguro Popular and IMSS equals about 85 -90% of the total population of Mexico at present.


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## AlanMexicali (Jun 1, 2011)

Gatos said:


> Didn't I read something around the end of the year that all the medical plans (SP/IMSS/ISSSTE) were pooling their resources to be more economical. For example - if an IMSS patient needed an MRI and there was a slot open at an ISSTE site, they would be sent there. That really seems like a rather good use of resources...


There is no talk of merging the 2 into one [IMSS & Seguro Popular] but sharing facilities where locations do not have treatments in an area which went into effect, I think, June 1st of last year. You only get referals from your system when it is not available in your area to go to either an IMSS, Seguro Popular or ISSSTE hospital for a specific treatment, if they treat it [not sure about ISSSTE, I forgot]. This is not merging just sharing. They share medicines between the IMSS and ISSSTE the same way as treatments between SP and IMSS does treatments also as of the year before last. Rural SP facilites where there is no IMSS close will see IMSS members and bill IMSS for treatemnt or services.

IMSS and SP will not be duplicating complex/expensive treatments in urban áreas where they are not already there anymore. 

Example: if cáncer treatment is available at IMSS but not at SP someplace the SP will refer the members that need it to an IMSS facility close by instead of sending them to a SP facility that has cáncer treatment in another city, which is what they did before. IMSS will bill SP for it I am pretty sure.

IMSS and SP do not have dialysis treatment but large urban ISSSTE hospitals do. There was plans to install this treatment at either IMSS or SP but 2016 budget cuts put this on hold. There is no plans to share this as of yet with IMSS or SP at present.


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## Bobbyb (Mar 9, 2014)

Alan's last reply really spells out a Medical system that needs to be fixed. How can a socialized system not have dialysis clinics?? This is not high tech expensive medicine. especially in a country where Diabetes often goes untreated and they end up on dialysis. Are you sure they do not have dialysis clinics. We have friends who get dialysis treatment in HMO. They are poor so it is not at a private hospital.


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## AlanMexicali (Jun 1, 2011)

Bobbyb said:


> Alan's last reply really spells out a Medical system that needs to be fixed. How can a socialized system not have dialysis clinics?? This is not high tech expensive medicine. especially in a country where Diabetes often goes untreated and they end up on dialysis. Are you sure they do not have dialysis clinics. We have friends who get dialysis treatment in HMO. They are poor so it is not at a private hospital.


https://translate.google.com/transl.../prensa/archivo/201509/060&edit-text=&act=url


"The IMSS guarantees the medical services of hemodialysis for the period 2015 - 2019, for the benefit of more than 25 thousand rights holders 

No. 060/2015 

Recruitment for the next 4 years will allow the timely and efficient delivery of hemodialysis services to the benefit of more than 25,000 beneficiaries. 


• Savings of about 1,360 million pesos per year will be obtained from current prices. 

• The success of this process was based on a recruitment strategy that privileged quality, transparency and competence. 

Last Friday, the procedures for contracting hemodialysis services (intramural and extramural) were awarded to more than 25,000 beneficiaries; Under the highest standards of quality and reliability in the service."

A very small number get dialysis through the IMSS which contracts it to private facilities.


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## xolo (May 25, 2014)

This is a great thread, very informative.


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## citlali (Mar 4, 2013)

In CHiapas the IMSS and Seguro Popular are interchangeable and use the same facilities and the overcrowding and is very bad. Many of the patients are indigenous and come with the whole family , only one person is allowed and the rest of the people sleep on the street. 

One day an indigenous friend asked me if he could sleep at my house as his sister in law was going to the hospital for a cesarian. I said I had 2 beds , he told me "no we are more than 2." The next morning, I went to the hospital and 10 people had slept on the sidewalk..
I felt pretty bad as they could have slept on the floor in the house and at least be protected from the wetness and the cold. At 10 that morning the mother , baby and the whole family went home in a colectivo a couple of hours away...
The idea of driving in a colectivo for 2 hours after a c-section horrified me.....

In another instance, another indigenous friend went for a gallbladder operation in one morning and the family asked me if I could give him a ride the next morning..He walked out of the hospital, no wheel chair, he was bent in half with pain.. and since I had a car that time I was able to drive me home , driving slowly and trying to go very slowly over the topes..Again . I cannot imagine riding for 2 hours on a bad road the morning after surgery but that is the way it is out of IMSS /SP in San Cristobal.


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## citlali (Mar 4, 2013)

Yes the system is the beginning of a great idea.. many people I know do not get dialysis and for various reasons rather die than get treatment. Also the treatment for the well off on the kidney management is good, I know my husband is being treated by a great specialist but for the poor it is dismal. There is a great need for education and preventive treatment but the nutritionists are pretty bad in this country. 
I saw one for my husband and ended up using the DAVITA site that is fabulous and gives you a diet that is delicious and can be followed if you are determine to do it.There is no such thing for the Mexicans and the diet for kidney and diabetes is really technical and difficult if you do not get help. The Mexican diet is so bad for the kidneys that it is difficult to get around it unless someone could teach people how to cook and what to cook...

Before I found the DAVITA site, I asked the nutritionist to give me all the rules, with quantities of nutrients allowed, and it took me a month to come up with recipes and menus researching the food composition in the internet.. I really do not see how the majority of people who have kidney problems can go on a permanent diet here...


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## DiverSailor123 (Sep 17, 2016)

Like it or not, you pretty much get what you pay for .... OK .... More exactly you get what the employer/business owner that you hire is paying his or her employees.. Doctors to lawn mowers, its all the same.. If you think your getting cutting edge medical care for next to nothing your fooling yourself... ( or you honestly don't know any better) 
Medical is very expensive in the USA..... and that cost is not driven by litigation cost. Huge settlements are RARE! Insurance is a Business and the more your provider charges the more Insurance can charge you etc etc etc .. Highest Paid DR's in the World? America comes in at #3 Highest Paid Nurses we are at #2 ..Mexican Doctors come in at #20.. World Class Equipment is EXPENSIVE! Yet unless you came from East Deerwax or Dead Pig-hollow there was anything you could imagine very close by.. Share a Dialysis Machine?? Just this year my daughter authorized the purchase of a $1,000,000.00 Cardio-surgical robot .. ( I am sure there is a proper name and that's not it.. ) Why are there so many Dr's in the USA from all over the world yet few Doctors here from Mexico? So you think your Dr. Came to America to study medicine and could read , write, comprehend and retain at a University Level, was head of his class and when school was over? Unlike most of the other Foreign students he hurried home to work for at best 1/3 and more likely 1/4 of what he could have made in The USA? That's Dedication!


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## AlanMexicali (Jun 1, 2011)

citlali said:


> In CHiapas the IMSS and Seguro Popular are interchangeable and use the same facilities and the overcrowding and is very bad. Many of the patients are indigenous and come with the whole family , only one person is allowed and the rest of the people sleep on the street.
> 
> One day an indigenous friend asked me if he could sleep at my house as his sister in law was going to the hospital for a cesarian. I said I had 2 beds , he told me "no we are more than 2." The next morning, I went to the hospital and 10 people had slept on the sidewalk..
> I felt pretty bad as they could have slept on the floor in the house and at least be protected from the wetness and the cold. At 10 that morning the mother , baby and the whole family went home in a colectivo a couple of hours away...
> ...


I had researched the tax system in Mexico years ago and found some very interesting things out that explain what you are seeing. The more IVA, SAT income and state taxes a certain región or área collects the more the federal government money is earmarked for that región or área including cities and rural population areas. If the tax revenue is large so is the federal expeditures in that area. If the tax revenue is small the percentage goes down accordingly. There are execptions like potable wáter and electricity updates but for everyday expenditures per capita the bottom line is: How much tax revenue was collected from the área?

Large populaton áreas do not necessarily get large tax revenues therefore no large amounts of federal money. Agricultural states do not usually have the tax revenue industrialized states have. The evading of IVA in some áreas created a large déficit and evading income tax also created a large déficit in áreas that traditionally didn´t pay these federal taxes. The new tax law almost overnight changed collecting IVA in most of Mexico - hard not to collect it and not pay it to the federal government anymore, but I presume in some cases it still happens. Corporate and Income taxes are becoming more collectable also.

The corruption in some áreas by not paying taxes really begins with a large population of residents who evaded the taxes and suffered by recieving small amounts back in the tax system they had. 

It seems to be changing and becoming less of a problem and the per capita population is being considered more now than with the former tax system. 

Mexico City´s per capita IVA and SAT tax base is huge as is the State of Mexico and much of the federal tax money traditionally was spent in Mexico City and closeby áreas as can be seen by touring Mexico City.


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## citlali (Mar 4, 2013)

Since I would guess all or almost all indigenous areas do not pay taxes it would explain the sad state of affairs at SP and IMSS, despite the many programs aimed at helping indigenous..
The richest indigenous municipality I would guess is Chamula and they have the best hospital, some say better than San Cristobal..

By the look of the houses that are built and being built on the outskirts some people and more than a few have lots of money and that municipality, of course it also has all the cartels ..I doubt that much tax is paid but they do have a lot of power with PRI and Verde so I guess they get the goodies..


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## Gatos (Aug 16, 2016)

DiverSailor123 said:


> Like it or not, you pretty much get what you pay for .... OK .... More exactly you get what the employer/business owner that you hire is paying his or her employees.. Doctors to lawn mowers, its all the same.. If you think your getting cutting edge medical care for next to nothing your fooling yourself... ( or you honestly don't know any better)
> Medical is very expensive in the USA..... and that cost is not driven by litigation cost. Huge settlements are RARE! Insurance is a Business and the more your provider charges the more Insurance can charge you etc etc etc .. Highest Paid DR's in the World? America comes in at #3 Highest Paid Nurses we are at #2 ..Mexican Doctors come in at #20.. World Class Equipment is EXPENSIVE! Yet unless you came from East Deerwax or Dead Pig-hollow there was anything you could imagine very close by.. Share a Dialysis Machine?? Just this year my daughter authorized the purchase of a $1,000,000.00 Cardio-surgical robot .. ( I am sure there is a proper name and that's not it.. ) Why are there so many Dr's in the USA from all over the world yet few Doctors here from Mexico? So you think your Dr. Came to America to study medicine and could read , write, comprehend and retain at a University Level, was head of his class and when school was over? Unlike most of the other Foreign students he hurried home to work for at best 1/3 and more likely 1/4 of what he could have made in The USA? That's Dedication!


There are two sides to the litigation coin. One is the actual legal proceedings - the other is the ordering up every possible test imaginable to cover one's butt. Also - here in Mexico my wife can simply walk into a very reputable lab - without an appointment - and without a referring doctor to write up a script - ask for a mammogram (using top of the line GE equipment) - which she will receive immediately - a doctor will then review the results right there and then and we will pay about $40 USD for the experience.


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## DiverSailor123 (Sep 17, 2016)

Citlali expresses, Very Much in Line with what I had ALWAYS Heard concerning IMSS. Surely Medical improves over time but jumping from 3rd world to being at the very top of the world is more than ridiculous .. It was Bobbyb IIRC ? That said something along the lines of penny wise pound foolish concerning Expats relying on IMSS.. An Expat friend who had Cancer traveled from Cozumel to Merida even by passing Cancun. We found we had Doctors in our USA System ,who practice in Merida. Now being fully retired and combining Medicare and private insurance its a bit different..


citlali said:


> In CHiapas the IMSS and Seguro Popular are interchangeable and use the same facilities and the overcrowding and is very bad. Many of the patients are indigenous and come with the whole family , only one person is allowed and the rest of the people sleep on the street.
> 
> One day an indigenous friend asked me if he could sleep at my house as his sister in law was going to the hospital for a cesarian. I said I had 2 beds , he told me "no we are more than 2." The next morning, I went to the hospital and 10 people had slept on the sidewalk..
> I felt pretty bad as they could have slept on the floor in the house and at least be protected from the wetness and the cold. At 10 that morning the mother , baby and the whole family went home in a colectivo a couple of hours away...
> ...


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## DiverSailor123 (Sep 17, 2016)

Gatos: I am not here to argue, I am here to try and figure out ahead of time what we need to provide for. Your confusing me.. In a series of posts you go on and on about how involved a simple medical procedure was ( numerous visits waiting in line for hours) and yet you say there is all but a....... *Mammograms! No Waiting Come Right In * sign : ) for Mammograms that they make all but Nothing off of? JSYK and maybe its not the same for everyone but we seldom pay anything for medical .. Dentist? Yes Private Insurance only ...Hearing aids Yes but only $3000 every 4 years thru Private insurance only .. My Total Knee Replacement. My cost was under $1000.00 .. Contrasting your deviated septum with my total Knee replacement.. Visit #1. I was told by the Dr./Surgeon the shots are not working in the right knee blablablabla what do I want to do? blablabla I chose Knee Replacement Surgery...Pick a date... I do ... Visit#2. go down day before do some last minute blood work and paper work... They said , we will cut your co-pay 40% for payment up front.... YOU GOT IT!! etc etc Visit #3. return early the next morning 8 am have surgery within 2 hours of arrival and was home 2 days later. I knew what I was facing I sent a list of potential Surgeons to my daughter.. That's what she does for a living.. She Hires Surgeons and she found the one she would hire if she was hiring Orthopedics'.. I will not be able to get the service in Mexico ... I already asked her.. 


Gatos said:


> There are two sides to the litigation coin. One is the actual legal proceedings - the other is the ordering up every possible test imaginable to cover one's butt. Also - here in Mexico my wife can simply walk into a very reputable lab - without an appointment - and without a referring doctor to write up a script - ask for a mammogram (using top of the line GE equipment) - which she will receive immediately - a doctor will then review the results right there and then and we will pay about $40 USD for the experience.


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## Gatos (Aug 16, 2016)

I don't know how to respond to you because to my simple mind you seem to be all over the map.

Let's start with Mammograms - I brought that up in response to your comment that you get what you pay for. My wife pays for her mammograms (and her lab work - perhaps $20 USD btw) out of pocket. It is dirt cheap and you could not get better service in the US. That has nothing to do with IMSS or any other social medicine program. Walk in off the street.

Regarding my simple recent procedure at IMSS - my only rant was in regards to the administrative aspects (at IMSS) of that experience. In terms of dollars - I think we pay something like $700-800 USD for the two of us (family plan) a year. My wife has not cost IMSS a penny - not even an aspirin. IMSS is VERY drug happy. I have a couple drawers full of medicine they have given me which I have stopped taking - I think one was making my hair fall out. The medicines they have given me would probably have cost me $400 USD (with INAPAM) at a pharmacy. I routinely donate my excess medicines to the local pharmacy for those who can't afford them since IMSS will not take them back. My procedure last week at IMSS would have run me about $5000 USD out of pocket - outside IMSS - and it would have been the same doctor - perhaps my wife would not have needed to sleep on the floor.

And as I mentioned - the deviated septum ran $700 USD out of pocket. The facilities were ultra-modern and were similar to a four star resort.

We have an excellent dentist - who also teaches dentistry at the local dental college. Recently for a cleaning, cavity and a full mouth xray I paid $20 USD (out of pocket) - and she is the best.

Sorry if my previous posts were not clear. Have I been clearer here ?


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## lagoloo (Apr 12, 2011)

Gatos said:


> I don't know how to respond to you because to my simple mind you seem to be all over the map.
> 
> Let's start with Mammograms - I brought that up in response to your comment that you get what you pay for. My wife pays for her mammograms (and her lab work - perhaps $20 USD btw) out of pocket. It is dirt cheap and you could not get better service in the US. That has nothing to do with IMSS or any other social medicine program. Walk in off the street.
> 
> ...


You're clear, at least in my reading. And no, you do not necessarily "get what you pay for". If that were true, the U.S.A. would have the #1 rating in quality of medical care. It isn't. France in #1 and the U.S.A. is #27. Go figure.

The term "socialized medicine" is usually accompanied by a slight sneer, as though it couldn't, by definition, possibly be as good as other types of medicine. That defies logic. The dreamers are those who believe that the outrageous cost of medical care in the U.S. equals the best care. From personal experience, I learned that the number one motivation for getting an M.D. in the U.S. was the $$$ to be made. The altruism was right up there with that of hedge fund managers. You can check out the statistics for hospital deaths due to carelessness. It's appalling.

The "socialized medicine" available in countries like Mexico beats what many of the citizens would be getting otherwise...........*no care*. Indeed, if there were no such care available, the poorer citizens would surely be getting what they didn't pay for.

The U.S.A. is about to dump the only universally available health care program it's ever had. It will be interesting to hear about the fallout, especially for those with pre-existing conditions.


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## DiverSailor123 (Sep 17, 2016)

Thanks that was helpful.. Mammograms were not IMSS .. I assumed it was for tracking purposes.. This is a much harder choice to make at 65 than at 45... This will Be Our Last Move.. if it is a move..:yo:
Medical is FAR MORE important today than it was for us 20 years ago.. The cost of moving will or could be many times more ..The day of a couple hundred dollars being all the paper work you needed to bring items into Mexico are over.. 


Gatos said:


> I don't know how to respond to you because to my simple mind you seem to be all over the map.
> 
> Let's start with Mammograms - I brought that up in response to your comment that you get what you pay for. My wife pays for her mammograms (and her lab work - perhaps $20 USD btw) out of pocket. It is dirt cheap and you could not get better service in the US. That has nothing to do with IMSS or any other social medicine program. Walk in off the street.
> 
> ...


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## Gatos (Aug 16, 2016)

There is one thing I don't quite get. I knew someone who at one point was very ill (in the US). They had a pre-existing condition - and could not find a medical policy in the US - or if they could it was extremely expensive and didn't cover the 'condition'. This was before the days of ObamaCare. 

The US had a plan for those people even in those days. I 'think' it may have been tied into the exact same plan all the senators and congressman are given. The plan cost in the area of $500 USD/month - and it provided excellent coverage. At that time I was healthy and paying something like $1200 USD/month for my COBRA insurance.

If the US could provide such a plan back then - why couldn't they provide such a plan today ?


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## lagoloo (Apr 12, 2011)

I don't know what the plan you refer to could have been. During most of my years in the states, I couldn't find any affordable health insurance for a self employed person with chronic bronchitis. 

The reason they aren't able to put something together is the lack of will to do so. Hevvin forbid anyone should have to pay out for general health care to cover the sick and well as the healthy. No insurance plan works unless the pool includes those who don't need it along with those who do. Car insurance is mandated by the law for that reason. In this case, the hue and cry about it being obligatory and having fines is what's killing it.


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## Gatos (Aug 16, 2016)

lagoloo said:


> I don't know what the plan you refer to could have been. During most of my years in the states, I couldn't find any affordable health insurance for a self employed person with chronic bronchitis.
> 
> The reason they aren't able to put something together is the lack of will to do so. Hevvin forbid anyone should have to pay out for general health care to cover the sick and well as the healthy. No insurance plan works unless the pool includes those who don't need it along with those who do. Car insurance is mandated by the law for that reason. In this case, the hue and cry about it being obligatory and having fines is what's killing it.


This is what I was referring to :

http://naschip.org/portal/index.php?view=article&id=54:about-pools&format=pdf

Apparently it was state by state - and it was an excellent program.


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## xolo (May 25, 2014)

citlali said:


> Since I would guess all or almost all indigenous areas do not pay taxes it would explain the sad state of affairs at SP and IMSS, despite the many programs aimed at helping indigenous..
> The richest indigenous municipality I would guess is Chamula and they have the best hospital, some say better than San Cristobal..
> 
> By the look of the houses that are built and being built on the outskirts some people and more than a few have lots of money and that municipality, of course it also has all the cartels ..I doubt that much tax is paid but they do have a lot of power with PRI and Verde so I guess they get the goodies..


Hi Citlali, I know this is off topic for this thread but my study language is a fairly obscure otomanguean language not Mayan but anyway in general this is another hint why the 70+ indigenous languages in Mexico should be considered at risk of extinction. Such dismal prospects in so many ways. There used to be an otomanguean language spoken in Chiapas, Chiapaneco, but it is now extinct only just recently last century I believe.


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## citlali (Mar 4, 2013)

I have often wonder if Chiapaneco is still spoken or not. I have never hear it in Chiapa de Corzo or Suchiapa but some locals say that a few people still speak it. I doubt it but that is the rumor. If it is not extinct it will be very soon. The Zoque seem in danger too, they have literature and events trying to keep the language alone but with the proximity of Tuxtla it is tough going.
In the Highlands the variations of Maya seem alive and well for the Tzeltal and the Tzotzil but much less so for the Tojolabals and Chol.. eventually I guess they will all go extinct but right too the two main languages are still widely used.


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## Bobbyb (Mar 9, 2014)

Mexico's health system is not pure socialized medicine. It is multi tiered. At the bottom is IMSS and Seguro Popular, then there is ISSTE and the military. Some states have a system for their employees. And of course the wholly private system. If you have the $$ it is a good system. Middle class can buy insurance and use the private system. The wealthy can just pay if they desire. I know some want to use IMSS but I still would never bother. We have a small clinic in our community. It is staffed by Drs. who are doing their community service before going into the private system. Often you get a real good Dr. They are trained in modern medicine. But the facility sucks. Dirty old equipment rusty everything. Good place for something like a sliver in your finger !


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## Gatos (Aug 16, 2016)

Bobbyb said:


> Mexico's health system is not pure socialized medicine. It is multi tiered. At the bottom is IMSS and Seguro Popular, then there is ISSTE and the military. Some states have a system for their employees. And of course the wholly private system. If you have the $$ it is a good system. Middle class can buy insurance and use the private system. The wealthy can just pay if they desire. I know some want to use IMSS but I still would never bother. We have a small clinic in our community. It is staffed by Drs. who are doing their community service before going into the private system. Often you get a real good Dr. They are trained in modern medicine. But the facility sucks. Dirty old equipment rusty everything. Good place for something like a sliver in your finger !


In terms of professional services (versus administrative) I think our local IMSS hospital is as good or better than the pubic hospital we had in South Florida (Broward General) - and a lot more affordable. A person from Boston, say, might feel differently. You just have to be patient. But - I have walked out of a doctor's office in the US when I have felt the wait time excessive as well.


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## xolo (May 25, 2014)

That's all very interesting.

Well if you find a speaker of Chiapaneco you could get yourself a PhD. 

I really don't know anything about the language.

WALS has this entry for Chiapaneco: No known L1 speakers. Ethnic population: 32. However, I didn't check Ethnologue and Summer Institute of Linguistics which might say something different.


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