WHAT TO DO ABOUT THE PROBLEM OF MEXICO BARIATRIC SURGERY?
I practice in Reno, Nevada, which is not particularly close in distance to Mexico, and yet with increasing frequency, I find myself caring for people who have suffered devastating complications after undergoing bariatric surgery in Mexico. The phenomenon poses many challenging questions for all of us and it is difficult to know exactly how to solve the problems posed by this practice.
It’s no secret that healthcare in the United States is expensive. It’s also no secret that weight loss surgery is among the most beneficial health interventions available in the world today as measured by any outcomes measure. And yet, while insurance plans pay for things like Viagra and futile advanced radiation and chemotherapy treatments, often they do not pay for weight loss surgery. An increasing number of people seek the effective solution for improved health and longevity that weight loss surgery represents and they shop for the best locations, surgeons and prices. And on price, it is difficult to compete with Mexico.
Mexican surgeons and centers are unabashed in promoting their services and their cut-rate prices. It is impossible to do an internet search for weight loss surgery information without being bombarded with numerous advertisements and promotions of discount weight loss surgical procedures performed in Mexico. So it’s quite understandable why a person would travel to Mexico to undergo a badly needed procedure and also save thousands of dollars. Even the media in the United States have encouraged this phenomenon. I previously commented on a National Public Radio story by the usually more thoughtful Jason Bovian who described the development of surgical centers and technology and availability in Mexico, and he didn’t make the slightest mention of the tremendous problems associated with this phenomenon for US citizens.
I am currently taking care of a critically ill man who may not survive his weight loss surgery that was performed in Mexico weeks ago. After returning to his community and mine, the problems with the surgery became evident. He became toxic with severe sepsis and has clung to life with the aid of life support, multiple corrective operations and all of the modern, sophisticated ICU care that can be provided. It is unlikely his American, employer based insurance plan will pay for any of the bills, making this multi-million dollar hospital stay and indigent case and huge loss for our community hospital.
While the finances are a serious matter to community hospitals that are struggling to stay in the black, the problem is even more devastating for my patient and his family. While there are no good studies on the subject, it is without a doubt that the firm impression of nearly every bariatric surgeon in the United States that the rate of serious complications is markedly higher among people who travel to Mexico.
A more insidious problem is the poor weight loss results achieved by individuals who travel to Mexico for their surgery. If we’ve learned anything over the last decade, we have learned that weight loss surgery provides fantastic results when it is more properly a “weight loss surgery program”. The surgery in itself is not a magic wand, but it creates the conditions for change and for success. After that, it takes education, support, follow-up, accountability, expert advice, laboratory testing and in short, a “program” to ensure success. No such program exists for people who travel outside the country to undergo their procedure hence weight loss results suffer greatly.
Among the many concerns I have for members of my community is that they are not adequately informed about these risks when they travel to Mexico for weight loss surgery. The expose themselves to financial ruin and personal bankruptcy as has occurred among patients I have personally cared for. They expose themselves to poorer weight loss results due to lack of an effective follow-up program with their surgeon and they expose themselves to surgical risks and complications that certainly appear to be much higher than what they would experience undergoing surgery at a US based center of excellence with all of its emphasis on continuous quality improvement and rigorous reporting of results.
A complex problem, doubtless, but one that deserves more consideration by all of us. Greater responsibility by employers and insurance carriers to cover weight loss surgery as a proven health benefit, greater responsibility among Mexican bariatric surgeons to provide informed consent and a mechanism for follow-up. Greater responsibility on the part of the media to discuss these potentially devastating problems arising from traveling to Mexico for surgery. Greater responsibility among providers, hospitals and surgery centers in the United States to cut costs and reduce profits in order to make the procedure more affordable and reduce the incentive for unwitting patients to travel to Mexico. And greater responsibility among manufactures of bariatric surgical devices, namely the REALIZE Band manufacturers to stop providing the critical piece of equipment, the adjustable gastric band, to the centers south of the border at cut-rate prices, further adding to the incentives for Americans to travel south of the border (Allergan, the maker of the Lap-Band, does not offer the most recent version of the Lap-Band in Mexico, but does offer older generations, which American consumers are not as interested in). All of these are controversial areas deserving of more attention. What do you think?