Cross-Border Purchase of Medications and Health Care in a Sample of Residents of El Paso, Texas, and Ciudad Juarez, Mexico

doi:10.1016/S0027-9684(15)30831-2

Journal of the National Medical Association

Volume 101, Issue 2, February 2009, Pages 167-173

https://doi.org/10.1016/S0027-9684(15)30831-2 Get rights and content

Background

We examined data from a US-Mexico bi-national survey conducted among adult residents of El Paso, Texas, and Ciudad Juarez, Mexico, to assess frequency of purchase of medications and use of health care services across the border.

Method

We analyzed questionnaire data from face-to-face interviews of 1000 randomly selected adults on both sides of the border to assess prevalence and prevalence ratios using log binomial logistic regression analysis.

Results

One-third of adult residents of El Paso and 5% of those in Ciudad Juarez reported crossing the border to purchase medications (P < .001). Lack of health insurance in the United States was associated with crossing the border to purchase medications. Nine percent and 7% of US residents traveled to Mexico seeking dental and medical care, respectively. Mexican nationals traveling to the United States to purchase medications or health care services were more likely to be uninsured and more-educated men.

Conclusions

US residents of areas along the border in close proximity to Mexico often travel south to purchase medications. Other health care services are also utilized, although at lower rates. These patterns may be attributed to a number of barriers to health care in the United States.

References (11)

J.P. Calvillo et al.
Pilot study of a survey of US residents purchasing medications in Mexico: demographics, reasons, and types of medications purchased
Clin Ther
(2003)
H.A. Schwertner et al.
Comparison of actual and stated concentrations of pharmaceuticals manufactured in Mexico
Clin Ther
(2005)
University of Texas at El Paso Institute for Policy and Economic Development
Report prepared for the US / Mexico Border Counties Coalition
(2006)
L.G. Escobedo et al.
Utilization and Purchase of Medical Care Services in Mexico by US Residents
Pan American J Pub Health
(2006)
D. Spiegelman et al.
SAS calculations for risk or prevalence ratios and differences
Am J Epidemiol
(2005)

There are more references available in the full text version of this article.

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This scenario has given rise to investigations that seek to understand the cross-border mobility dynamics that occur in the PoEs among Mexico and the United States. However, of the fourteen cross-border metropolitan regions that exist in this international border, most of the studies have been developed in the two largest ones, which are Tijuana, B.C.-San Diego, CA, and Ciudad Juárez, CH-El Paso, TX (Alegría, 2015; Castañeda Pérez, 2020; Fullerton & Walke, 2014; Fullerton, 2007; Herzog & Sohn, 2014; Mendoza-Cota, 2012; Rivera et al., 2009; Viswanathan et al., 2005). These two cross-border metropolitan regions have cities of considerable size and populations of over a million inhabitants on both sides of the border (see Fig. 1).
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Analysis of medical tourism at the Andrade port of entry
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Five of these 11 drugs correlated to the top 20 responses found in this study, showing that antibiotics and pain relievers tend to be the most common medications purchased for medical tourism purposes. Rivera et al.16 conducted data analysis on a 2-stage cluster sampling survey conducted from September 2002 to June 2003 using the census tract for El Paso county and census equivalents in Ciudad Juarez, Mexico.16 The researchers found that 59.6% (n = 298) of the survey responders in Texas traveling south to Mexico for medical services and medication were insured.
Medical tourism, a term used to describe the practice of traveling to obtain medical services or products, is known to occur along the U.S.–Mexico border and has for some time. Despite the ever-increasing number of local border crossings, there is little research or monitoring done on the prevalence of medical tourism or to show the products and services sought.
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Most survey respondents felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost, and plan to participate in medical tourism moving forward. Many opportunities for future research exist on this topic, including follow-up surveys and laboratory analyses to compare medication samples.
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Furthermore, Hispanic ethnicity, previous residency of Mexico (in particular Ciudad Juárez), language barriers, and younger age were also positively associated with cross-border health care and pharmacy shopping. Rivera, Ortiz, & Cardenas (2009) also studied cross-border purchases of medications and health care using data from a U.S.–Mexico binational survey of 1000 randomly selected adults on both sides of the border. The main objective of the study was to assess frequency of pharmaceutical shopping and use of health care services across the border.
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This indicates that immigrant status has both compositional (individual) and contextual (neighborhood) effects that are protective of Hispanic children׳s respiratory health. Another plausible explanation for the protective effects of immigrant status, contextually-relevant to the study area, is that foreign-born (predominantly Mexican-origin) Hispanics living in El Paso׳s immigrant enclaves are more likely to cross the international border to Ciudad Juárez in order to access relatively low-cost medical treatments (Rivera et al., 2009). However, that is not a valid primary explanation since less than 5% of Hispanic children whose parents responded to the survey had their usual source of care in Mexico.
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: Funding/Support? The authors would like to acknowledge the financial support of the Paso del Norte Health Foundation to conduct this survey. The authors have no financial or any other conflict of interest to disclose. Jose C. Rodriguez, CPhT, CCRP, and Armando Gonzalez-Stuart, PhD, provided assistance in conducting this study. University of Texas-Houston School of Public Health supported the conduct of the data analysis and reporting of the findings.

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Original CommunicationCross-Border Purchase of Medications and Health Care in a Sample of Residents of El Paso, Texas, and Ciudad Juarez, Mexico

Background

Method

Results

Conclusions

Clin Ther

Clin Ther

University of Texas at El Paso Institute for Policy and Economic Development

Report prepared for the US / Mexico Border Counties Coalition

Utilization and Purchase of Medical Care Services in Mexico by US Residents

Pan American J Pub Health

SAS calculations for risk or prevalence ratios and differences

Am J Epidemiol

Original Communication
Cross-Border Purchase of Medications and Health Care in a Sample of Residents of El Paso, Texas, and Ciudad Juarez, Mexico