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IMSS vs Seguro Popular


ibarra

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I asked a person who sells IMSS insurance to give me an opinion about the difference between IMSS and Seguro Poppular.  I am curious about your experience with the information given.  In particular, if you need surgery with SP, does a representative actually check your income to determine the cost of the surgery?  According to SP website, it looks like most surgeries are included with the policy.   Here is the information that I was provided:

1. IMSS provides National wide coverage, seguro popular will provide you coverage only in Jalisco state.
2. IMSS owns more the 3,000 clinics and hospitals national wide, Seguro Popular probably a hundreds in all Mexico.
3. IMSS provides all the kinds of medicines for any condition, even it provides expensive treatment for cancer, diabetics, orthopedic, prosthesis 
Seguro Popular will no cover nothing expensive.
Seguro Popular's hospitals are very modest.
They provides only generic brand medicine, if they do not have you must to buy you medicine.
Seguro Popular provides a very small coverage.
If you obtain a cirgury through Seguro Popular hospital you must to pay for it, the will sent a social worker and SP will charge according income.
In IMSS people pay once a year.
IMSS has beter facilities and is more modern then Seguro Popular.
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Another basic difference is that everyone pays IMSS the same yearly fee, regardless of income. The cost increases with age.

SP is means tested.

Pre-existing conditions are excluded in IMSS for a period of years. SP covers them from the beginning.

SP will usually not cover cardiac procedures after a certain age.

 

 

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1 hour ago, oregontochapala said:

Doing anything in either system at the present time may prove to be a waste of time, including finding out people's experience with either. AMLO has indicated he will soon be changing both and has said that Seguro Popular will ONLY be for Mexican citizens in the near future. Plan to put aside a little each month to pay for medical care. Just my 2 cents worth.

I've spent some quality time with Senor Google just now and can't find any reference to such a proposal going anywhere.  Please give us the quote source. Thanks.

Since SP is my backup plan to paying out of pocket for everything medical, I'm naturally concerned.

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Ibarra - you are being fed a lot of disinformation. Nobody knows what  AMLO's plans are at this point. I think there is discussion about only including permanentes and citizens because the current system is open to medical fraud, coming to Mexico on Temporale, having many medical procedures, and then return to the U.S.A., to avoid medical caused bankruptcy, for example. I do not include Canada and Canadians because they offer reciprocity - you legally immigrate to Canada, they pay for education, healthcare and a wide variety of other social benefits.

Both systems carry a lot of political baggage. - I.M.S.S., trade unions and cronyism. Seguro Popular's baggage is religion, especially Catholicism. The previous president put a vast amount of funding into Seguro Popular in a short period of time. This decision was based on populism and the fact that Sequro Popular was more likely to recieve donors and bequeathments for expansion, etc.. I have been told that it would be very difficult for the two schemes to merge, but they are very seriously exploring ways to share resources. Also, all public and community hospitals accept SP insurance, not IMSS. One system is going through growing pains, the other is dying from lack of interest. For example I have been in the General Hospital Occidente, had a stent removed from kidney stone laser surgery, the new geriatric wing is beautiful including a new, and badly needed medical heliport on the roof. I saw one black Federale copter, and two yellow air ambulance copters arrive and leave, but they were god awful noisy. The little kids sure loved it though, genuine joy and wonder. Another example, I had to pay 3,500 pesos to rent the special endocope, from a private company to have the stent removed in the Urology wing, because the operating rooms were too booked. The technician told me this is common in public hospitals, they are dedicated to provide more patient beds than buying the newest sophisticated technologies.

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On a practical decision level, I'd advise trying to sign up for IMSS if the person has no pre-existing conditions that would bar some coverage.  After the dust has settled on the political front, that can be dropped and the person can switch to SP.

I haven't actually used either coverage, so can't comment on the conditions in the hospitals.

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2 hours ago, lakeside7 said:

I wonder how long you have lived in MX

Individuals do not sell IMSS coverage, you enroll in the system for a premium  depending on your age. 

You may be talking to a facilitator who for a fee will help you  

Been here 21 years, full time.  Sorry I used the wrong word.  Should have used facilitator.

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1 hour ago, oregontochapala said:

Doing anything in either system at the present time may prove to be a waste of time, including finding out people's experience with either. AMLO has indicated he will soon be changing both and has said that Seguro Popular will ONLY be for Mexican citizens in the near future. Plan to put aside a little each month to pay for medical care. Just my 2 cents worth.

In case what you say IS true regarding AMLO's plans, my husband nationalized several years ago so he IS a Mexican citizen.

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2 hours ago, oregontochapala said:

Doing anything in either system at the present time may prove to be a waste of time, including finding out people's experience with either. AMLO has indicated he will soon be changing both and has said that Seguro Popular will ONLY be for Mexican citizens in the near future. Plan to put aside a little each month to pay for medical care. Just my 2 cents worth.

I can't find any articles where AMLO directly states that these health insurance programs are or will be ONLY for Mexican citizens in the future.  He does however, as far as I can see, only refer to Mexican's in his statements.  If you would please provide your sources it would be appreciated.

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seriously ibarra, if you have been around for that length of time then you are as wise as the rest of us posting on this board. The subject has been covered at ad norsum    and changes as does the experiences of individuals go for treatment. In a nut shell its a crap shot and like playing the tables.... cover as much as you can afford..then pray , pray hard that you do not need to test the system... 

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We all have to wait to see what will develop , in some areas IMSS and Seguro popular are operating out of the same facilities and believe me you would not want to go there..AMLO says he will concentrate on poor rural areas first  so I do not think he has expats on his mind so far..

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2 hours ago, tomgates said:

When you get Mexico's version of US Medicaid, you get what you pay (or not) for.

I don't think that is true at all. In the U.S.A. the highest salary job is aneasthotologist, about $300,00 U.S. per year. General doctors make about $200,000 U.S. - but they also have to shoulder the costs of opening a private clinic, etc. Many general doctors in the U.S. will not accept medicaid patients, it is not enough return on their investment. No medical people in Mexico make anything close to these sorts of numbers. Yes, there are private doctors and specialists, but they really have to hustle to make higher incomes. Many of them hustle, but not in a good way. In Mexico I notice much more camaraderie and a culture of "doing the right thing". Profit and high pay is much less of a cultural thing than in the U.S.A. In Canada, universal healthcare laws generally forbid private, for profit endeavours. The general doctors still have to pay the costs of an office, etc., but they usually purchase a retiring doctor's clinic and medical billing number, usually around $60,000 Cdn.

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As someone whose wife has used SG and we just signed up again for 3 more years we are happy with the system. My wife had an emergency hernia in her lower intestine and was in old Seville for 8 days and a pretty major successful operation with great doctors 6-8 of them. all spoke english well. we were charged a pretty small amount in comparison to private hospitals but we were charged and were very happy. The hospital is very old and old-fashioned, you need to have someone there 24 seven but the doctors are great.

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36 minutes ago, glws7777 said:

As someone whose wife has used SG and we just signed up again for 3 more years we are happy with the system. My wife had an emergency hernia in her lower intestine and was in old Seville for 8 days and a pretty major successful operation with great doctors 6-8 of them. all spoke english well. we were charged a pretty small amount in comparison to private hospitals but we were charged and were very happy. The hospital is very old and old-fashioned, you need to have someone there 24 seven but the doctors are great.

FYI, I started this thread.  How did they determine what to charge you?  You can send a pm if you want to. 

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3 hours ago, glws7777 said:

As someone whose wife has used SG and we just signed up again for 3 more years we are happy with the system. My wife had an emergency hernia in her lower intestine and was in old Seville for 8 days and a pretty major successful operation with great doctors 6-8 of them. all spoke english well. we were charged a pretty small amount in comparison to private hospitals but we were charged and were very happy. The hospital is very old and old-fashioned, you need to have someone there 24 seven but the doctors are great.

I am not a qualified medical services person..but I doubt that your "great 6-8 doctors" were actually Doctors. This is a medical training school and my guess is many of 6/8 were there for the experience.

Sadly there seems to be no access in the  Private or Public hospitals system, to find out surgery success/mortality  rates,   Maybe they do not bother to keep them!!!! 

I trust your wife is still well

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3 hours ago, ibarra said:

FYI, I started this thread.  How did they determine what to charge you?  You can send a pm if you want to.  

It would depend on what you are having done. There is no real means test, especially if you are over 60. They cover many procedures 100% but some parts maybe outside the coverage, such as rental of specialized equipment (such as laproscopic frame for gall bladder removal, laser stone crusher) For example, they cover the cost of treating hernias, but you have to pay for the special mesh. Likewise, for a knee replacement, you have to pay extra if you want titanium screws. Pacemaker, if you want a model other than their generic one - you have to pay extra. The only thing you can not pay extra for is a private room - they do not exist except in private hospitals where you pay $500 U.S. per day for 24 hour care.

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8 minutes ago, lakeside7 said:

..but I doubt that your "great 6-8 doctors" were actually Doctors. This is a medical training school and my guess is many of 6/8 were there for the experience.

 

You are a doctor, MD, before you go train aka residency.

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I am not a doctor also but I have experience that many people have not. I also see myself as a pretty good judge of Character and what I have seen is impressive as far as doctors are concerned in the Old Seville hospital. I have spent time in 2-3 other upscale hospitals and found them to NOT have the best patient client approach and private room or not the service is minimum. At PR there are trainees and they are involved with specialist doctors who are pretty good. I gave you some real hands-on feedback some people will like and others don't like to accept this type of service.

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