ORIGINAL PAPER Mexican Immigrants in the US Living Far from the Border may Return to Mexico for Health Services Regan Bergmark Æ Donald Barr Æ Ronald Garcia Published online: 5 December 2008 Ó Springer Science+Business Media, LLC 2008 Abstract Background This study explores to what extent and why Mexican immigrants in the U.S. living far from the border return to Mexico for medical services. Methods Structured Spanish-language qualitative interviews were completed with a crosssectional sample of 10 Central Mexican immigrants living in Northern California and with 10 physicians and 25 former immigrants living in Central Mexico. Results Sixteen of the 35 current and former immigrants (46%) said they or a close friend or relative had returned to Mexico from the U.S. for health-related rea- sons. Participants returned to Mexico for care due to unsuccessful treatment in the U.S., the difficulty of accessing care in the U.S. and preference for Mexican care. Discussion Obtaining care in Mexico appears to be com- mon. These findings have implications for the maintenance of continuity of care, for Mexico’s healthcare system, and for the impact of changing border policies on immigrant health. Keywords Border crossing Á Healthcare Á Immigrants Á Medical tourism Á Mexico Á California Á Mental health Á Minority health Á Dental care Introduction Latino immigrants confront many barriers to accessing medical care in the U.S., including lack of information, difficulty making appointments, cost, lack of insurance, transportation, lack of cultural competency, language, and long waiting times [1, 2]. More than 40% of Hispanics are uninsured, compared to 13% for non-Hispanic Whites [3]. Latinos immigrants are more than twice as likely as U.S.- born Latinos to lack health insurance [4]. Latino immi- grants in the U.S. are disproportionately poor and disproportionately lack health insurance of any kind [5]. Mexicans immigrants, especially those who are undocu- mented, are less likely to use medical services or to have a usual source of care than U.S.-born people of Mexican descent [6, 7]. Latino immigrants also report less utilization of mental health and dental services compared to non- immigrants or non-Latino Whites [8–10]. Families with undocumented members may be reluctant to use social services due to Immigration and Naturalization Service (INS) public charge laws. For example, patients may fear that applying for public programs such as Medi-Cal will negatively impact their attempts to attain citizenship or naturalize legally. This apprehension increased in response to welfare reform in the late 1990s mandating that Med- icaid share information with the INS [11, 12]. Discrimination and even sexual harassment from medical staff have been described [11, 13]. All of these factors contribute to Latino immigrants having poorer health and poorer access to healthcare services than non-Latino Whites [14]. Given these barriers to access, Mexican immigrants in particular may resort to or prefer other sources of medical care, including returning to Mexico for care. Quantitative studies within 100 km the U.S.-Mexico border have R. Bergmark (&) Program in Human Biology, Stanford University, 33 Pond Avenue, Suite 722, Brookline, Stanford, CA 02445, USA e-mail: regan_bergmark@hms.harvard.edu D. Barr Department of Sociology and Program in Human Biology, Stanford University, Stanford, CA, USA e-mail: barr@stanford.edu R. Garcia Department of Family and Community Medicine, Stanford University School of Medicine, Stanford, CA, USA e-mail: rgarcia@stanford.edu 123 J Immigrant Minority Health (2010) 12:610–614 DOI 10.1007/s10903-008-9213-8