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Major U.S. health insurance provider Aetna is just one in a number of services that have introduced a health care plan that allows members to access health care across Mexico — namely in the California or Mexican cities of Mexicali, Tecate, and Tijuana.

In the case of Aetna, this is done through an agreement with Mexico’s Sistemas Medicos Nacionales (SIMNSA), a health management organization that operates similar deals for several other insurers. Unlike other countries, insurance in the U.S. is regulated by the state, so insurers generally offer individual state plans for individuals, even when they are major international insurers. The driving force behind these cross-border plans is that many workers in Southern states are Mexican, or of Mexican descent, and may feel more comfortable discussing their health care across the border in Spanish.

Sarah Horton is an assistant professor of anthropology at the University of Colorado, Denver, and is currently writing a book about cross-border health care for the University of California Press.

Horton explains that of the 35,000 people who go to Mexico for medical treatment each year, a large proportion are Hispanic who would otherwise come to the country for business or pleasure. SIMNSA points out that healthcare needs differ when a border is crossed as insurance may be bought by employees and their families at home in Mexico, while at the same time protecting them from emergencies on the job in the U.S. The failure to understand that people may live in Mexico but work in the USA accounts for why earlier studies overestimated medical tourism by failing to differentiate between where people work and live.