Why Americans seeking affordable doctor visits and medicines abroad may misjudge healthcare quality

With the cost of health insurance rising, Americans are increasingly shopping around for healthcare deals over the border. Nadzeya Haroshka/iStock via Getty Images Plus

As healthcare costs continue to rise, more Americans are looking beyond their regular doctor's office for care.

Some travel to Mexico for prescriptions, routine visits or diagnostic tests. Others turn to telehealth companies that promise convenient access to treatments such as weight loss medications. Increasingly, insured Americans are navigating more than one healthcare market at once. For example, they may buy some prescriptions from their in-network primary care provider and have a separate provider for their cash-based GLP-1 medication.

As researchers who study consumer decision-making, healthcare markets and consumer vulnerability, we wanted to understand how people evaluate healthcare quality when they move between different systems.

Our research suggests that many consumers face a hidden challenge: The signals they rely on to judge quality in one healthcare setting often mean something very different in another. Sometimes these misjudgments lead to adverse health outcomes.

Seeking healthcare access

For decades, employer-sponsored insurance carried an implicit promise. If you get a good job, you'll have access to affordable healthcare. However, that promise has become harder to keep.

Healthcare spending in the United States reached nearly $5 trillion in 2023 and continues to climb. Workers with employer-sponsored insurance continue to face rising deductibles, premiums and out-of-pocket expenses. At the same time, hospital consolidation has contributed to higher prices and fewer competitive options in many communities.

Even beyond cost, many consumers struggle to access care amid the complexity of the U.S. healthcare system.

Meanwhile, Americans insured through Affordable Care Act marketplaces and Medicaid face mounting healthcare costs amid the loss of ACA subsidies and massive Medicaid cuts.

As costs rise, patients are increasingly acting like shoppers, comparing prices and looking for better deals on prescriptions and other healthcare.

Making healthcare decisions involves reading multiple signals about quality and value. Morsa Images/DigitalVision via Getty Images

For some Americans, that means crossing into Mexico, where clinic visits and prescriptions can cost a fraction of U.S. prices. Patients also report fewer administrative hurdles. Instead of waiting weeks for referrals, prior authorizations or insurance approvals, they can often obtain care immediately. To a lesser extent, some also seek care in other countries, including Canada.

Others are seeking care online. Direct-to-consumer telehealth companies have expanded rapidly, particularly for treatments such as GLP-1 weight loss medications. Many patients can now consult with a provider and receive a prescription without directly visiting with a doctor.

These alternatives are often convenient, affordable, helpful and legitimate. But they also require patients to evaluate healthcare quality in unfamiliar ways.

The problem with familiar signals

People rarely have all the information they need when making healthcare decisions. Even with health insurance, the out-of-pocket cost and duration of treatment are difficult to decipher before receiving care. Patients traveling out of the country for care face even more question marks. For example, a provider's credentials and quality of treatment may be hard to figure out.

As a result, consumers rely on fewer signals that could help them estimate quality, such as online reviews, provider credentials, consultation length, facility appearance, recommendations from friends and price.

These shortcuts work reasonably well when consumers understand the system they are operating within. Problems arise when people assume those same signals mean the same thing everywhere.

We studied how people make these decisions by interviewing 71 Americans who sought some of their healthcare in Mexico. We also asked our study participants to keep video diaries of their cross-border healthcare experiences and traveled with some participants ourselves.

Everyone in our study had employer-sponsored health insurance. Many described this benefit as a factor that led them to choose their current job. Yet with deductible and copay costs being so high, they still could not afford routine care, so they sought cheaper care elsewhere.

We found that many familiar indicators changed meaning across healthcare systems.

For example, a crowded waiting room in the United States may suggest inefficiency or poor scheduling. In some Mexican clinics, that same crowd may indicate that a physician is trusted and in high demand.

Long consultations can signal attentive care in one setting and inefficiency in another. A clear price can feel reassuring. But it does not tell you whether the provider is properly trained, who is accountable if care goes wrong or whether follow-up visits are required.

Research on healthcare decision-making has consistently shown that consumers struggle to evaluate medical quality directly and often rely on cues, past choices and physician referrals. When patients move between healthcare markets, these old decision-making processes can become less reliable.

The waiting room can hold cues about the quality of care a facility provides – but those cues may be different in Mexico than they are in the U.S. FatCamera/E+ via Getty Images

Why confidence can become a problem

Healthcare needs are often urgent, and even with health insurance coverage, finding an available in-network provider can sometimes take weeks. As a result, crossing into Mexico or choosing a new telehealth provider for a quick solution offers some relief even if it is not ideal.

One of the most surprising findings from our study was that most consumers did not recognize they were evaluating healthcare in this new market differently.

Some participants recognized that familiar signals and quick decisions no longer worked. They slowed down, asked questions, sought recommendations and researched providers more carefully. While this required additional effort, it often helped them to better evaluate their decisions in this new market.

But others felt completely confident about their evaluation of quality. They assumed that the cues they trusted in one healthcare setting would transfer seamlessly to another. Because they felt certain, they were less likely to question their assumptions or seek additional information. Ironically, those who felt most in control were sometimes the most vulnerable to making mistakes.

For example, some patients described assessing a provider's quality by researching their credentials in the U.S. In Mexico, however, they found themselves evaluating the cleanliness of the clinic and comparing its appearance to U.S.-based clinics to determine the quality of the provider.

When these choices went wrong, some consumers reported serious consequences. One was left temporarily unable to walk. Others developed antibiotic resistance. In some cases, patients in our study had to pay out of pocket for additional treatment to fix a problem caused by the treatment they sought in Mexico.

What consumers can do

None of this means people should avoid alternative healthcare options. In fact, many patients benefit from lower costs, faster access and friendlier service. But consumers should recognize that healthcare quality is not always communicated in the same way across systems.

Before seeking care outside your usual provider network, consider asking questions, such as the following:

What quality signals did I consider when choosing my current provider, and can I use those same cues in this new healthcare setting?What credentials or accreditation matter in the U.S., and do they also matter in other countries?How will I be responsible for my medical records and prescriptions if my providers don't know about each other?What happens if complications arise after treatment in Mexico (or another country)?

As healthcare becomes increasingly fragmented, patients are no longer simply choosing between doctors. They are choosing between different healthcare systems – and the signals they trust may not travel as well as they think.

Kelli Frias has received funding from Blue Cross Blue Shield of Texas, the National Science Foundation, Providence Health, and the VentureWell Foundation.

Deidre Popovich has received grant funding from BlueCross BlueShield of Texas and Providence Health.