University of Colorado, Denver College of Liberal Arts & Sciences, Department of Anthropology, Denver, CO 80217-3364, USA.
Soc Sci Med. 2011 Jun;72(11):1846-52. doi: 10.1016/j.socscimed.2011.03.035. Epub 2011 Apr 13.
Despite the growing prevalence of transnational medical travel among immigrant groups in industrialized nations, relatively little scholarship has explored the diverse reasons immigrants return home for care. To date, most research suggests that cost, lack of insurance and convenience propel US Latinos to seek health care along the Mexican border. Yet medical returns are common even among Latinos who do have health insurance and even among those not residing close to the border. This suggests that the distinct culture of medicine as practiced in the border clinics Latinos visit may be as important a factor in influencing medical returns as convenience and cost. Drawing upon qualitative interviews, this article presents an emic account of Latinos' perceptions of the features of medical practice in Mexico that make medical returns attractive. Between November 15, 2009 and January 15, 2010, we conducted qualitative interviews with 15 Mexican immigrants and nine Mexican Americans who sought care at Border Hospital, a private clinic in Tijuana. Sixteen were uninsured and eight had insurance. Yet of the 16 uninsured, six had purposefully dropped their insurance to make this clinic their permanent "medical home." Moreover, those who substituted receiving care at Border Hospital for their US health insurance plan did so not only because of cost, but also because of what they perceived as the distinctive style of medical practice at Border Hospital. Interviewees mentioned the rapidity of services, personal attention, effective medications, and emphasis on clinical discretion as features distinguishing "Mexican medical practice," opposing these features to the frequent referrals and tests, impersonal doctor-patient relationships, uniform treatment protocols and reliance on surgeries they experienced in the US health care system. While interviewees portrayed these features as characterizing a uniform "Mexican medical culture," we suggest that they are best described as unique to the private clinics and hospitals returning migrants visit. In short, we suggest that the perceived contrast in cultures of medicine derives from the difference in organization of health care services on each side of the border.
尽管在工业化国家的移民群体中，跨国医疗旅行的现象越来越普遍，但相对而言，很少有学术研究探讨移民回国就医的各种原因。迄今为止，大多数研究表明，成本、缺乏保险和便利性促使美国拉丁裔人前往墨西哥边境寻求医疗保健。然而，即使是有医疗保险的拉丁裔人，甚至是不住在边境附近的拉丁裔人，也经常会选择回国就医。这表明，拉丁裔人前往的边境诊所所实行的独特医学文化，可能与便利性和成本一样，是影响他们回国就医的重要因素。本文通过定性访谈，从本土视角呈现了拉丁裔人对墨西哥医疗实践特征的看法，这些特征使他们愿意回国就医。2009 年 11 月 15 日至 2010 年 1 月 15 日期间，我们对在提华纳的私人诊所 Border Hospital 就医的 15 名墨西哥移民和 9 名墨西哥裔美国人进行了定性访谈。其中 16 人没有保险，8 人有保险。然而，在这 16 名没有保险的人中，有 6 人故意放弃了保险，将这家诊所作为他们永久的“医疗之家”。此外，那些选择在 Border Hospital 就医而不是使用美国医疗保险计划的人，不仅是因为费用，还因为他们认为 Border Hospital 的医疗实践风格与众不同。受访者提到了服务的快速性、个人关注、有效药物以及对临床裁量权的重视，这些都是将“墨西哥医疗实践”与他们在美国医疗保健系统中经历的频繁转介和检查、非人性化的医患关系、统一的治疗方案和对手术的依赖区分开来的特征。虽然受访者将这些特征描述为一种统一的“墨西哥医疗文化”，但我们认为，这些特征最好被描述为移民所返回的私人诊所和医院所特有的。简而言之，我们认为医学文化的感知差异源于边境两侧医疗服务组织的差异。
