Healthcare in Puerto Vallarta for Expats: Complete Guide to Medical Services in 2025

Are you considering making Puerto Vallarta your new home? Understanding the healthcare system in Puerto Vallarta is essential for expatriates planning to relocate to this beautiful coastal paradise. This comprehensive guide explores everything you need to know about medical services for expats in Puerto Vallarta in 2025, from top hospitals to insurance options and quality of care.

Understanding the Mexican Healthcare System for Expatriates

Mexico’s healthcare system operates on a dual structure that offers both public and private options for residents, including expatriates with proper documentation. Before diving into specific facilities and services in Puerto Vallarta, it’s crucial to understand how this system works.

The Public vs. Private Healthcare Divide in Puerto Vallarta

The Mexican healthcare system consists of two primary sectors: public and private. For expats in Puerto Vallarta, understanding this distinction is fundamental to making informed healthcare decisions.

Most expatriates in Puerto Vallarta opt for private healthcare due to its high quality, shorter wait times, and availability of English-speaking medical professionals. However, many legal residents also enroll in IMSS as a backup option or for routine care.

IMSS: Mexico’s Public Healthcare Option for Legal Residents

The Instituto Mexicano del Seguro Social (IMSS) serves as Mexico’s primary public healthcare and social security system. For expats living in Puerto Vallarta with temporary or permanent residency status, IMSS offers comprehensive yet affordable healthcare coverage.

Key aspects of IMSS for expatriates:

• Eligibility: Only legal residents (temporary or permanent) can apply
• Enrollment: Voluntary enrollment is possible for non-employed expats
• Annual Cost: Varies by age, ranging from approximately $218 to $590 USD annually
• Coverage: Includes general and specialist consultations, hospitalizations, and medications
• Limitations: Pre-existing conditions may have waiting periods or exclusions
• Language: Services primarily provided in Spanish

While IMSS provides excellent value, expatriates should be aware that wait times can be long, especially for specialists, and not all facilities may have English-speaking staff.

How Puerto Vallarta’s Healthcare System Compares to Other Expat Destinations

Puerto Vallarta stands out among expat destinations in Mexico for its robust healthcare infrastructure. Compared to other popular locations like San Miguel de Allende, Merida, or even some areas of the Riviera Maya, Puerto Vallarta offers a particularly strong combination of quality facilities and medical tourism infrastructure.

The city has developed a reputation for excellent healthcare for foreigners, partly due to its longstanding popularity as a retirement and tourism destination. This has resulted in medical facilities that cater specifically to international patients, with bilingual staff and familiarity with international insurance providers.

Top-Rated Hospitals and Medical Facilities for Expats in Puerto Vallarta

Puerto Vallarta boasts several world-class medical facilities that cater to the expatriate community, offering high-quality care and often English-speaking medical staff.

Hospital Joya: Specialized Care and English-Speaking Medical Staff

Hospital Joya has established itself as one of the premier medical facilities for expatriates in Puerto Vallarta. This modern hospital combines medical excellence with patient-centered care.

Key features of Hospital Joya:

• State-of-the-art emergency department
• Comprehensive diagnostic imaging services
• Specialized surgical units
• Bilingual medical staff
• International patient services department

Many expatriates choose Hospital Joya for its high standards and attention to foreign patients’ specific needs. The hospital has built a strong reputation within the international community.

CMQ Hospitals: Premier Medical Services in Centro and Riviera Nayarit

Hospital CMQ operates two major facilities in the region: CMQ Centro in downtown Puerto Vallarta and CMQ Riviera Nayarit in nearby Nuevo Vallarta. Both locations are popular among the expat community in Puerto Vallarta.

Both CMQ hospitals offer:

• 24/7 emergency services
• Intensive care units
• Advanced diagnostic technology
• Surgical facilities
• Specialized medical departments

CMQ has a long history of serving the international community and maintains relationships with many international insurance providers.

San Maré Health Care Group and Other Leading Private Facilities

San Maré Health Care Group represents another excellent option for expats seeking medical care in Puerto Vallarta. This medical group focuses on providing personalized healthcare with international standards.

Other notable private facilities that cater to expatriates include:

• Hospital Versalles: Modern facility with specialty departments
• Medasist Hospital: Known for personalized care and English-speaking staff
• Spine Clinic Vallarta: Specializes in orthopedic and spinal care
• Advance Medical Center: Popular for outpatient procedures

Specialized Clinics and Medical Centers Worth Knowing

Beyond hospitals, Puerto Vallarta offers numerous specialized clinics that excel in specific areas of healthcare. These facilities often provide more personalized attention and competitive pricing for their specialized services.

Notable specialized clinics include:

• Dental Solutions Puerto Vallarta: High-quality dental care at a fraction of US/Canadian prices
• Oalmo PV: Specialized in ophthalmology and eye care
• Urólogos en Vallarta: Comprehensive urological services
• Cellstime Clinique: Anti-aging and regenerative medicine
• Puerto Vallarta Plastic Surgery: Cosmetic and reconstructive procedures

Many expatriates find that these specialized clinics offer exceptional value, with treatments costing significantly less than in the US or Canada while maintaining comparable or superior quality.

Healthcare Costs in Puerto Vallarta: What Expats Can Expect to Pay in 2025

One of the most attractive aspects of healthcare in Puerto Vallarta for expats is the affordability compared to the United States and Canada. However, costs vary widely depending on the type of care and facility.

Cost Comparison: Public vs. Private Healthcare Services

The cost difference between public and private healthcare is significant, but both options remain affordable for most expatriates.

These figures highlight why many expats in Puerto Vallarta find healthcare more accessible than in their home countries, with substantial savings even at private facilities.

Common Medical Procedures and Their Average Costs

Specialized medical procedures and surgeries also demonstrate significant cost savings compared to the US and Canada. Here are some examples of common procedures sought by expatriates:

• Hip Replacement: $8,000-$12,000 (vs. $40,000-$65,000 in the US)
• Cataract Surgery: $1,500-$3,000 per eye (vs. $3,500-$7,000 in the US)
• Dental Crown: $300-$500 (vs. $1,000-$3,000 in the US)
• Dental Implant: $1,000-$1,800 (vs. $3,000-$5,000 in the US)
• Cosmetic Surgery (facelift): $4,000-$6,000 (vs. $15,000-$25,000 in the US)

This cost difference explains why medical tourism to Puerto Vallarta has grown substantially, with many people traveling specifically for these procedures.

Prescription Medication Expenses and Availability

Prescription medications in Mexico are generally more affordable than in the US and Canada. Many medications are available over the counter that would require prescriptions in other countries. However, some specialized medications may be harder to find.

Key points about medication in Puerto Vallarta:

• Common medications cost 30-70% less than US prices
• Many medications don’t require prescriptions
• Most pharmacies have English-speaking staff
• Consider bringing a supply of specialized medications
• Be aware of regulations when bringing medications across borders

Popular pharmacy chains in Puerto Vallarta include Farmacia Guadalajara, Farmacia San Pablo, and Farmacia Ahorro, all of which offer competitive pricing and reliable quality.

Paying Out-of-Pocket vs. Using Insurance: A Financial Breakdown

Many expats in Puerto Vallarta choose to pay out-of-pocket for routine care and maintain insurance only for major medical events. This approach often makes financial sense given the affordable cost of day-to-day healthcare.

For major surgeries or hospital stays, insurance becomes significantly more valuable. While a routine doctor’s visit might cost just $30-50 out-of-pocket, a week-long hospital stay could reach several thousand dollars.

Medical Insurance Options for Expats Living in Puerto Vallarta

Navigating insurance options is a critical aspect of planning your healthcare as an expat in Puerto Vallarta. Several types of insurance are available, each with its own advantages.

International Health Insurance Plans That Work Well in Mexico

International health insurance plans provide comprehensive coverage that works across borders, making them popular choices for expatriates.

Some highly-rated international insurance providers for Puerto Vallarta expatriates include:

• Cigna Global: Offers flexible plans with worldwide coverage
• GeoBlue Xplorer: Particularly good for US citizens
• Allianz Worldwide Care: Comprehensive international coverage
• IMG Global Medical: Various plan levels for different needs
• Bupa Global: Extensive provider network in Mexico

These plans typically offer:

• Coverage in multiple countries
• Direct billing arrangements with many private hospitals
• Access to a network of quality providers
• Options for evacuation and repatriation
• The ability to receive treatment in your home country

The primary drawback is cost, with annual premiums ranging from $1,700 to $5,900 depending on age, coverage level, and deductibles.

Mexican Private Insurance Providers for Expatriates

Local Mexican insurance companies often provide more affordable options that still offer good coverage within Mexico.

Popular Mexican insurance providers include:

• GNP Seguros: One of Mexico’s largest insurance companies
• AXA Mexico: International company with strong local presence
• Mapfre: Spanish company with extensive Mexican coverage
• Metlife Mexico: Familiar name with tailored expat policies
• Royal & Sun Alliance (RSA): Known for good expatriate plans

Mexican insurance plans typically cost 30-50% less than international plans, but coverage is generally limited to within Mexico. Some expatriates find these plans offer the best balance of cost and coverage if they plan to receive most of their care in Mexico.

Special Considerations for American and Canadian Residents

For North American expatriates, there are some specific considerations when planning healthcare coverage.

For Americans:

• Medicare generally does not cover healthcare abroad
• Some Medicare supplement plans offer limited international coverage
• Veterans may qualify for Foreign Medical Program benefits
• Consider plans that allow you to maintain coverage during US visits

For Canadians:

• Provincial health plans offer limited or no coverage abroad
• Some provincial plans may cover emergency care at reduced rates
• Extended periods outside Canada may affect eligibility for provincial coverage
• Travel insurance can bridge gaps for visits back to Canada

Lakeside Medical Group: A Unique Option for North American Expats

Lakeside Medical Group (LMG) offers a specialized approach to healthcare for North American expatriates in Puerto Vallarta. LMG allows expatriates to use their existing US or Canadian health insurance plans within their network of providers in Mexico.

Key benefits of Lakeside Medical Group:

• Free registration for expatriates
• Direct billing to US and Canadian insurance plans
• No out-of-pocket expenses, deductibles, or copays in many cases
• Access to a network of hospitals and specialists
• English-speaking healthcare professionals

This option can be particularly valuable for those who maintain insurance coverage in their home country and want to leverage those benefits while living in Puerto Vallarta.

Navigating Healthcare as a Foreign Resident in Puerto Vallarta

Beyond understanding the system and costs, expatriates in Puerto Vallarta need practical knowledge about accessing and navigating healthcare services.

Finding English-Speaking Doctors and Specialists

For many expatriates, language barriers can be a significant concern when seeking medical care. Fortunately, Puerto Vallarta has numerous English-speaking healthcare providers.

Ways to find English-speaking doctors:

• Ask for recommendations in expatriate Facebook groups and forums
• Contact your insurance provider for a list of approved bilingual doctors
• Consult the US Consular Agency in Puerto Vallarta for their medical resources
• Reach out to established expatriate organizations in the area
• Check with hospitals about their English-speaking staff

Many doctors in Puerto Vallarta have received training in the US or Canada and are familiar with Western medical practices and expectations, making the transition easier for expatriates.

Medical Tourism and Planned Procedures in Puerto Vallarta

Puerto Vallarta has become a popular medical tourism destination, particularly for dental care, cosmetic surgery, orthopedics, and wellness treatments. Many facilities cater specifically to international patients seeking planned procedures.

If planning a medical procedure in Puerto Vallarta, it’s advisable to:

• Research the facility and doctor thoroughly
• Verify credentials and certifications
• Request before-and-after photos or testimonials
• Arrange accommodations for recovery time
• Bring someone to assist during recovery if possible

Managing Chronic Conditions While Living Abroad

For expatriates with chronic health conditions, moving to Puerto Vallarta requires careful planning to ensure continuity of care.

Practical tips for managing chronic conditions:

• Get a thorough medical check-up before relocating
• Bring complete medical records, translated if possible
• Research specialists for your condition in Puerto Vallarta
• Identify sources for any specialized medications
• Consider telehealth options with your current doctors
• Develop a relationship with local healthcare providers early

Many expatriates with conditions like diabetes, hypertension, or arthritis report good experiences managing their health in Puerto Vallarta, often at a lower cost than in their home countries.

Emergency Medical Services and What to Expect

Understanding how emergency services work is critical for all expatriates. In Puerto Vallarta, the emergency response system operates differently than in the US or Canada.

Key information about emergency services:

• Emergency Number: 911 (though response may be in Spanish)
• Red Cross Ambulances (Cruz Roja): Basic life support, free but limited equipment
• Private Ambulances: Better equipped but require payment
• Hospital Emergency Rooms: Vary in capability and may require upfront payment

For serious emergencies, private hospitals like Hospital Joya and CMQ offer the most comprehensive emergency care. Many expatriates keep the direct numbers of these hospitals programmed in their phones for faster response in emergencies.

Expat Healthcare Experiences: Real Stories from Puerto Vallarta

Nothing illustrates the reality of healthcare in Puerto Vallarta better than the experiences of expatriates who have navigated the system firsthand.

Success Stories with the Private Healthcare System

Many expatriates report overwhelmingly positive experiences with private healthcare in Puerto Vallarta, often highlighting the personalized attention they receive.

John, a Canadian expatriate living in Puerto Vallarta since 2020, shares:

“After a minor heart scare, I visited Hospital CMQ and was amazed by the experience. I saw a cardiologist within an hour, underwent comprehensive testing the same day, and received a full report and treatment plan by evening. The entire experience, including tests that would have cost thousands in Canada, came to less than $500. The doctor even gave me his personal cell number for follow-up questions.”

These personalized experiences are commonly reported among expatriates using private healthcare facilities in Puerto Vallarta.

Navigating Challenges and Solutions

While healthcare in Puerto Vallarta offers many advantages, expatriates do face some challenges. Understanding common issues and their solutions can help new arrivals prepare effectively.

Common challenges include:

• Language barriers – Solution: Find doctors who speak your language or use translation services
• Insurance coordination – Solution: Work with facilities experienced with international insurance
• Medication differences – Solution: Learn generic names and Mexican equivalents
• Cultural differences in care – Solution: Ask questions and communicate preferences clearly
• Follow-up protocols – Solution: Be proactive about scheduling follow-ups and keeping records

Tips from Long-Term Expats for New Arrivals

Experienced expatriates offer valuable advice for newcomers navigating the Puerto Vallarta healthcare system:

1. Build relationships with healthcare providers before you need urgent care
2. Keep digital copies of all medical records, prescriptions, and test results
3. Learn basic medical terminology in Spanish for emergencies
4. Carry your insurance information and emergency contacts at all times
5. Join expatriate groups for recommendations and support
6. Research before procedures – quality can vary significantly between providers
7. Consider a medical alert system or service if you live alone

Important Healthcare Documents and Legal Considerations

Understanding the legal aspects of healthcare is crucial for expatriates planning to live in Puerto Vallarta long-term.

Medical Power of Attorney for Expatriates in Mexico

A poder notarial para cuestiones de salud (medical power of attorney) is essential for expatriates. This legal document designates someone to make healthcare decisions on your behalf if you become unable to do so.

Key considerations:

• Must be created with a Mexican notary public
• Should be in both Spanish and your native language
• Specify your healthcare preferences clearly
• Choose someone trustworthy who resides in Mexico
• Keep copies with your designated representative, your doctor, and yourself

This document becomes especially important for expatriates whose family members may not be in Mexico or may not speak Spanish.

Maintaining Medical Records Across Borders

Maintaining comprehensive medical records is particularly important for expatriates who may receive care across different countries and systems.

Effective strategies include:

• Request copies of all medical records, tests, and procedures
• Maintain a digital archive of all health information
• Consider using medical record apps designed for international patients
• Keep a list of all medications with generic names
• Translate important medical history into Spanish
• Keep vaccination records current and accessible

Understanding Informed Consent in Mexican Healthcare

Informed consent is taken seriously in Mexican healthcare. Before any significant procedure, medical providers must explain the risks, benefits, and alternatives, then obtain written consent.

For expatriates, it’s important to:

• Ask questions if something isn’t clear
• Request written materials in your language when possible
• Consider bringing a friend or translator for complex discussions
• Understand that you have the right to decline treatments
• Know that you can seek second opinions before consenting

Healthcare Technology and Telemedicine Options in Puerto Vallarta

Digital health solutions are increasingly available to expatriates in Puerto Vallarta, offering convenient access to care and bridging gaps between healthcare systems.

Digital Health Services Available to Expatriates

Puerto Vallarta’s healthcare ecosystem has embraced digital tools that can be particularly helpful for the expatriate community:

• Electronic medical records at major hospitals
• Laboratory results delivered via email or patient portals
• Online appointment scheduling at many private practices
• Prescription management through pharmacy apps
• Remote monitoring for chronic conditions

These digital services continue to expand, particularly in facilities that cater to international patients.

Using Telemedicine to Connect with Doctors in Your Home Country

Telemedicine offers expatriates a valuable bridge to their home country’s healthcare system. Many expatriates maintain relationships with their doctors back home through virtual consultations.

Benefits of telemedicine for expatriates:

• Continuity of care with trusted providers
• Access to specialists not available locally
• Easy second opinions on diagnoses or treatment plans
• Care coordination between home country and local providers

Health Apps and Resources Specifically for Puerto Vallarta Residents

Several digital health resources cater specifically to the expat community in Puerto Vallarta:

• Doctor Finder PV: Directory app for English-speaking healthcare providers
• Mexico Pharmacy Online: Medication delivery service with English interface
• Lakeside Connect: App connecting North American expatriates to healthcare services
• DocTalk Puerto Vallarta: Telemedicine platform with local doctors
• Mi Doctor PV: Concierge medical service with house calls and digital records

Many expatriates find these specialized resources invaluable for navigating healthcare in their new home, especially during the initial transition period.

Wellness and Preventive Care Resources for Expats

Beyond traditional medical care, Puerto Vallarta offers a wealth of wellness and preventive health resources that many expatriates incorporate into their healthcare routines.

Holistic Health Centers and Alternative Medicine

Alternative medicine in Puerto Vallarta has gained significant popularity among expatriates seeking holistic approaches to health.

These alternative approaches often complement conventional medical care, and many expatriates report improved overall wellness from integrating these practices into their healthcare routines.

Dental Care Options and Quality Considerations

Dental care in Puerto Vallarta deserves special attention as it’s one of the most commonly sought services by expatriates, thanks to high quality and significant cost savings.

Top dental clinics catering to expatriates include:

• Dental Solutions Puerto Vallarta: Comprehensive services with state-of-the-art technology
• Denticenter: Popular for cosmetic and restorative work
• PV Smile: Specializes in full-mouth rehabilitation and implants
• Odontología Integral: Family dental care with English-speaking staff

Quality of dental care varies widely, so research is essential. Look for:

• Dentists with international certifications and continuing education
• Modern sterilization protocols and equipment
• Digital X-rays and modern diagnostic tools
• Clear communication about treatment plans and costs
• Patient reviews, especially from other expatriates

Mental Health Resources for the Expatriate Community

Relocating to another country can present unique mental health challenges, and access to appropriate support is crucial for expatriates.

Mental health resources in Puerto Vallarta include:

• Bilingual therapists and counselors offering in-person and virtual sessions
• Support groups specifically for expatriates
• Psychiatrists for medication management when needed
• Mindfulness and stress reduction programs tailored to the expat experience
• Online therapy platforms that connect to international providers

Organizations like the International Association for Medical Assistance to Travelers (IAMAT) can help connect expatriates with mental health professionals who understand the unique challenges of living abroad.

Future of Healthcare in Puerto Vallarta: 2025 Developments and Beyond

The healthcare landscape in Puerto Vallarta continues to evolve, with several notable developments shaping the future of medical services for expatriates.

Expansion of Medical Facilities and Specialties

Puerto Vallarta’s healthcare infrastructure is growing to meet increasing demand from both locals and the expatriate community.

Key developments include:

• New Civil Hospital: Currently under construction at the Centro Universitario de la Costa, aimed at increasing medical professional capacity in the region
• Expansion of existing private hospitals: Several facilities are adding specialties and technologies
• Growing medical tourism infrastructure: Purpose-built facilities catering to international patients
• Specialized clinics: Increasing focus on areas like regenerative medicine, anti-aging, and wellness

These expansions are increasing both capacity and the range of specialized services available locally.

Healthcare Initiatives Benefiting the Expatriate Community

Various initiatives are specifically addressing the needs of the international community in Puerto Vallarta:

• Mobile medical units (“Dr. Tucán”) offering free basic medical, dental, and nutritional services in various neighborhoods
• Improved specialized services for diverse communities, including the LGBTQ+ population
• Enhanced emergency response systems with better coordination between public and private resources
• Community health workshops offered in English and Spanish

These community-focused initiatives help create a more integrated and accessible healthcare environment for all residents, including expatriates.

How Recent Healthcare Policies Affect Foreign Residents

Recent policy changes are influencing how expatriates access and experience healthcare in Puerto Vallarta:

• Potential tourist fees under consideration may indirectly contribute to improved public services, including healthcare infrastructure
• Expansion of telemedicine regulations allowing for greater cross-border healthcare services
• Reciprocal healthcare agreements between Mexico and certain countries benefiting some expatriates
• Improved electronic medical record systems facilitating coordination between providers

Staying informed about these policy developments helps expatriates navigate the changing healthcare landscape effectively.

Conclusion: Making Informed Healthcare Decisions as an Expat in Puerto Vallarta

Healthcare in Puerto Vallarta offers expatriates a compelling combination of quality, affordability, and accessibility. The robust private healthcare system, coupled with options like IMSS for legal residents, provides multiple pathways to receiving excellent care.

For those considering relocation to this beautiful coastal city, understanding the healthcare landscape is a crucial step in planning a successful transition. The high standards of private facilities, availability of English-speaking providers, and significant cost savings compared to the US and Canada make Puerto Vallarta an attractive destination for health-conscious expatriates.

By researching options, establishing relationships with healthcare providers, and setting up appropriate insurance coverage, expatriates can enjoy peace of mind knowing that their healthcare needs can be well-met in their new home.

Need personalized guidance on healthcare options in Puerto Vallarta? Our team at Discover PV specializes in helping expatriates navigate all aspects of relocation, including healthcare planning. Contact us via WhatsApp for a consultation tailored to your specific healthcare needs.

Frequently Asked Questions About Healthcare in Puerto Vallarta for Expats

Can I use my US or Canadian health insurance in Puerto Vallarta?

Most US and Canadian health insurance plans, including Medicare, do not provide coverage in Mexico except for limited emergency situations. However, some international plans and specialized services like Lakeside Medical Group allow North American expatriates to use their existing insurance in Puerto Vallarta. It’s essential to check your specific policy details and consider supplemental international coverage if needed.

What are the requirements to enroll in Mexico’s public healthcare system (IMSS)?

To enroll in IMSS, you must have legal residency status in Mexico (temporary or permanent). The enrollment process involves completing application forms, providing identification documents, proof of address in Mexico, and paying the annual fee based on your age. Enrollment is open to non-employed residents, making it accessible to retirees and other expatriates not working for Mexican companies.

How much does private healthcare typically cost in Puerto Vallarta?

Private healthcare in Puerto Vallarta is significantly more affordable than in the US or Canada. A consultation with a general practitioner typically costs $25-50, while specialist visits range from $50-100. Hospital stays average $300-800 per day, and common procedures cost 50-70% less than in the US. These lower costs allow many expatriates to pay out-of-pocket for routine care while maintaining insurance for major medical events.

Are there English-speaking doctors and medical staff in Puerto Vallarta?

Yes, Puerto Vallarta has numerous English-speaking healthcare providers, particularly in private hospitals and clinics that cater to the international community. Major facilities like Hospital Joya, CMQ, and San Maré Health Care Group all have bilingual staff. There are also directories and resources specifically designed to help expatriates find English-speaking doctors across various specialties.

What should I do in case of a medical emergency in Puerto Vallarta?

In a medical emergency, call 911 (though response may be in Spanish). For serious emergencies, private hospitals like Hospital Joya and CMQ offer the most comprehensive emergency care. Many expatriates keep the direct numbers of these hospitals programmed in their phones for faster response. It’s advisable to have a plan in place, including knowing which hospital you prefer and how you would get there in an emergency.

How does the quality of healthcare in Puerto Vallarta compare to the US or Canada?

The quality of private healthcare in Puerto Vallarta is generally excellent, comparable to standards in the US and Canada, particularly in major private hospitals and specialty clinics. Many doctors are internationally trained, facilities use modern equipment, and hospitals maintain high standards of care. Public healthcare through IMSS, while comprehensive, may have longer wait times and fewer amenities than private options.

What types of medical insurance are recommended for expatriates in Puerto Vallarta?

Most expatriates choose between international health insurance plans (like Cigna Global, GeoBlue, or Bupa), which offer worldwide coverage but at higher premiums, or Mexican private insurance (like GNP Seguros or AXA Mexico), which is more affordable but limited to care within Mexico. Many adopt a hybrid approach: paying out-of-pocket for routine care, maintaining catastrophic coverage for major medical events, and possibly enrolling in IMSS as an additional safety net.