Close to 12% of all Mexican citizens or 12.7 million currently reside in the United States enjoying or enduring diverse migratory statuses. The majority are long-stay migrants, with 68% having over 10 years of residence . The migrants' flow is continuous, with up to 700,000 crossing the border northward and 250,000 returning every year . While 21% have dual citizenship, up to 60% lack migratory papers. In general, the population of Hispanic origin in the U.S. enjoys better health than the average, with the most important exception being diabetes, which is higher among Mexican migrants . Furthermore, evidence indicates that migrants' health status tends to worsen as they assimilate to local life style . The case has also been made that migrants are exposed to a wider range of hazards in the US due to occupational factors .
Undocumented Mexicans migrants report less use of health care services in the United States as well as poorer quality of care compared with their US-born counterparts . However, migrants of Mexican origin in the United States are more likely to be hospitalized than non-migrants in Mexico, regardless of health insurance. Indeed, while the general hospital discharge rate in the four states of high migration intensity of Guanajuato, Jalisco, Michoacan and Zacatecas was 3.6% in 2005 , in the US the rate among Hispanics with low English proficiency -the vast majority migrants of Mexican origin- was of 6.8% for 2008 .
Several studies document the utilization of medical and dental services by the US population of Mexican origin in Mexico, demonstrating the demand for quality, lower cost interventions and medicines . According to Wallace et al , 6.2% of long-stay (≥15 years) and 5.2% of short-stay Mexican migrants resident in California demanded medical care in Mexico in 2001. The strongest predictor of medical service use in Mexico was by far lack of health insurance (Odds ratio 4.61). Poverty was not associated to the use of medical care. Studies of willingness to pay for cross-border health insurance show that 57% of migrants would demand a hypothetical product costing between USD 75 and USD 125 per month. Community Health Centers in the US have shown interest in delivering insured primary health care products for migrants, in combination with insured hospital care in Mexico .
In Mexico, the Ministry of Health (MoH) has increased health financing for the self-employed and the uninsured laboring in the informal sector of the economy through the "Seguro Popular" policy. Seguro Popular aims to reduce out-of-pocket expenditures by providing a free-at-point-of service, defined package of health benefits to individuals who voluntarily affiliate through a means-tested prepayment. While the government is on track to reach universal coverage through Seguro Popular for 2011, it has acknowledged that "a small number" may not affiliate due to lack of interest ; migrants are often included in this group. Indeed, Mexican migrants in the US are not considered within the potential population to be insured by Seguro Popular. Non-the-less, limited efforts have been made to pre-affiliate Mexican nationals visiting consulates in the US as a part of health promotion efforts. Other long-standing efforts to affiliate migrants to mainstream social security health insurance in Mexico have met with very poor results .
The strong ties of migrants to their original households in communities of origin could favor bi-national insurance schemes: 85% of migrants send remittances to 1.3 million Mexican homes, while 16% of married men leave their wives behind. Studies suggest that between 10% and 30% of remittances are spent on health care in Mexico . Demand for care in Mexico, close ties to communities of origin and the volume of health funding spent by migrants represent opportunities to adapt Seguro Popular or other insurance schemes to the needs of migrants in the US.
This paper aims to provide evidence on the need for bi-national health insurance to cover hospital care by migrants in Mexico. Research measured the order of magnitude of public and private hospitalizations in Mexico of migrants who returned specifically from the US for this purpose. Two specific settings in Mexico were analyzed: the US-Mexico border region and migrants' communities of origin in municipalities of high and very high migration intensity (interior region). Based on data for the latter, the share of discharges in communities of origin in Mexico out of the total expected by migrants in the US was estimated.