From Tijuana to Nuevo Progreso, Mexican towns near the U.S. made a big bet that the high cost of health care in the United States would bring patients and money south of the border for surgeries, dental care and prescription medicines.
Yet amid the novel coronavirus pandemic, that bet has looked like less of a sure thing as travel ground to a halt, businesses shuttered and jobs disappeared.
In Los Algodones, a small town bordered by California to the north and Arizona to the east, dentistry dominates the local economy. The town has just 5,000 residents, but it’s home to hundreds of dental clinics, drugstores and other medical facilities meant not for locals but for foreigners.
During the busy winter season, thousands of Americans and Canadians flock to Los Algodones for dental work that’s 40% to 50% less expensive than in their home countries. That’s why the town has earned the sobriquet “Molar City.”
Visitors from the north support the town’s entire economy: hotels, restaurants, shops, liquor stores, street vendors and jaladores who get tips for directing patients to clinics. A downturn in the town’s leading sector means lost jobs and lost money for virtually every resident and commuter.
The border never officially closed to Americans seeking medical care in Mexico, and Canadians also are permitted to travel abroad for health care as long as they quarantine for 14 days after returning home.
But businesses in Los Algodones say confusion about travel restrictions and reentry has deterred more patients than fear of contracting COVID-19. And the hours the border crossing at Andrade, California, is open have been cut; the crossing was open from 6 a.m. to 10 p.m. prior to the pandemic, but now closes at 2 p.m.
“Everyone suffered the same way,” said Alejandro Gutiérrez, chief operating officer of Sani Dental Group, the biggest player in town. “People in Los Algodones, regardless of whether they work in dental clinics or not, we rely on medical and dental tourism. People with their taco shop, they rely on patients being in the street: ‘Let’s get some tacos!’ The whole community has suffered a lot. I think a lot of people lost their jobs.”
Sani is currently treating about 60% fewer patients than it normally would be, Gutiérrez said.
Frank Navarro and Aida Osuna, husband and wife, own the Supreme Dental Clinic in Los Algodones. They closed the facility from mid-March until early May. Their mid-sized clinic treats more than 5,000 foreigners in a typical year, and the business had been growing prior to the pandemic. They were in the midst of an expansion.
Navarro and Osuna are still moving forward with expansion and have devoted considerable resources to implementing new safety protocols. They have had fewer patients this year, but those who do come are seeking more complex, costlier treatments, Navarro said. They have not had to lay off any employees and believe their company can recover in time for the winter high season.
“As long as there’s people, there are going to be teeth,” said Navarro, who was born in the United States.
Still, it’s been a challenging time. On a typical day, about 8,000 people cross from Andrade to Los Algodones, Navarro said, citing local officials. In March, that was down to less than 200. The numbers are slowly rebounding, but it has certainly affected medical clinics and other businesses.
“There’s dental clinics closing and they’re not going to reopen,” Navarro said. “If you were to walk around today, right now, it’s a ghost town. After 2 o’clock, everything closes. Even the pharmacies close, the liquor stores close.”
The pandemic has affected medical tourism destinations worldwide in places like Thailand, Indonesia, Hungary and Argentina, said Josef Woodman, author of the guidebook “Patients Beyond Borders” and founder of a Chapel Hill, North Carolina-based organization by the same name.
“It’s devastating” to local economies, Woodman said. “It’s not just the dentists and the clinics. It’s the transportation people, it’s the restaurant people. Their livelihood is 100% all about medical and dental tourism or pharma tourism.”
Medical Departures and Dental Departures, two Bangkok-based companies that facilitate medical travel, saw huge drops in bookings early in the pandemic, but they’ve begun to pick back up, said founder Paul McTaggart. Medical tourism bookings through these companies were 89% lower in April 2020 than in April 2019. Although improving, the August figures were still 23% lower than last August’s figures, McTaggart said.
“The COVID-19 pandemic has decimated medical tourism destinations around the globe,” McTaggart said. “When medical tourists are not able to travel to their global medical [or] dental clinics and hospitals due to quarantine or travel restrictions [or] outright bans, the ecosystem collapses.”
As long as there’s people, there are going to be teeth.
Frank Navarro, co-owner, Supreme Dental Clinic
But the faltering world economy, flaws in the American health care system and the lack of dental coverage under Canada’s national health care program are bad enough that even a pandemic can’t kill medical tourism, McTaggart said.
“The economic wave of COVID-19 has rippled through the U.S. economy, adversely affecting not just low-income families but also middle-class Americans,” McTaggart said. “Medical tourism is being more widely sought out by American patients as an alternative to going without or delaying their medical [or] dental care.”
Businesses in Los Algodones worked quickly to establish safety procedures to limit the spread of the virus, said Tomas Osuna, Aida Osuna’s father and the owner of the Plaza Guadalajara, a large shopping center that includes Supreme Dental Clinic and numerous other businesses.
“Dental clinics and pharmacies, they’re going above and beyond to make that sure everybody feels safe, beyond any protocols that are actually required,” Tomas Osuna said. (Navarro acted as translator for the interview with his father-in-law).
Like Supreme Dental Clinic, Sani Dental Group made significant changes to its procedures and the layouts of its facilities in response to the coronavirus, Gutiérrez said.
Waiting rooms have fewer seats and a covered outdoor waiting area is now available. Much more of the patient intake process is done online before arriving at the clinic. The clinic schedules fewer appointments a day to minimize the number of people present at the same time, instituted a stricter room-sanitizing protocol, and installed a new air filtration system.
“We understood how to work with this pandemic, so the risk is very controlled,” Gutiérrez said.
Sani Dental Group even went ahead with opening a new clinic in Playa del Carmen in the resort area south of Cancún in March, a sign the company is confident it will get through the coronavirus crisis.
“We saw this like a sandstorm: Let’s just wait a little bit, and the idea is to come out the other side complete,” Gutiérrez said. “The great thing about Los Algodones is we’re going to bounce back, and the community will bounce back.”
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