Research Summary

Over 1.2 million Americans crossed into Mexico for healthcare in 2024, seeking everything from routine dental care to complex surgical procedures. Yet despite this massive wave of cross-border medical travel, a critical problem remains largely invisible: patients are becoming healthcare ghosts, losing pieces of their medical history with every border crossing.

Kelli Frias, whose groundbreaking research at American University's Kogod School of Business examines cross-border healthcare dynamics, challenges a fundamental assumption about these international care journeys. The issue isn't just about cost savings or access—it's about something far more essential to quality care: medical record continuity.

"We've kind of set up these artificial boundaries," Dr. Frias explains, "and [act like] what's happening there is very different or is in some way inferior. The reality is people are using this regularly, seeing a lot of success, and we should be thinking about more productive ways to create or formalize some of this care."

The Healthcare Ghost Phenomenon

When Americans cross the border for medical care, they enter a regulatory grey zone where their health information suddenly exists outside the protections of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA regulations don't apply to medical information obtained outside the United States, creating a fragmented system where patients must manually piece together their own healthcare narratives.

Recent research from the Kaiser Family Foundation reveals that 8 million people live in the 44 US counties along the Mexico border, many routinely accessing healthcare on both sides. These aren't one-time medical tourists—they're building long-term relationships with providers in two different healthcare systems, often maintaining specialists in both countries simultaneously.

The challenge goes beyond simple inconvenience. A 2020 study published in the Journal of the American Pharmacists Association found that more than 75 percent of medical tourists who sought non-dental care abroad and cited cost concerns actually had health insurance. Their coverage simply didn't meet their needs, forcing them to seek alternatives that exist outside their official medical record.

The Business Associate Agreement Problem

Current regulations require US healthcare providers to establish Business Associate Agreements (BAAs) when engaging foreign vendors that handle Protected Health Information (PHI). In 2025, new cybersecurity requirements and stricter enforcement have made cross-border data sharing even more complex.

Some states have gone further, implementing their own restrictions. Wisconsin prohibits contractors from performing work outside the US that involves patient data access, while Texas requires all Managed Care Organization services to occur within U.S. territory. These well-intentioned protections create an unintended consequence: patients who need care in both countries find themselves navigating two completely separate systems with no bridge between them.

Dr. Frias's research highlights a particularly troubling reality: "Me as a consumer, I want to have my medical record. I want to have my total medical record with me my entire life."

Quality Care Exists on Both Sides

The assumption that Mexican healthcare is inherently inferior doesn't match the evidence. Mexican hospitals increasingly use Joint Commission accreditation standards—the same standards that certify US hospitals. Many border facilities offer state-of-the-art equipment, English-speaking staff, and shorter wait times for specialist appointments.

Analysis of 2020 health ministry data show Americans save 40-60 percent on average across common procedures in Mexico. But cost isn't the only driver. A survey of 427 Americans crossing the California-Mexico border for medical services found that most respondents felt Mexican healthcare services were of the same or better quality compared to the United States.

The problem isn't quality—it's continuity. When patients maintain relationships with providers on both sides of the border, their medical records exist in silos. A neurologist in El Paso can't access treatment notes from a neurologist in Ciudad Juárez. Lab results, imaging studies, and medication lists remain fragmented across two systems.

The Path Forward: Practical Solutions

Bi-National Medical Record Systems

Creating interoperable health information exchanges between US and Mexican border regions would allow authorized providers to access complete patient histories regardless of where care occurred. The technology exists—Health Level 7 International's Fast Healthcare Interoperability Resources (FHIR) standard has successfully enabled cross-border record sharing in other regions, including between the Philippines and Taiwan.

Consumer-Controlled Health Records

Personal health record systems that patients control could bridge the gap. Rather than waiting for institutional cooperation, patients could maintain their own comprehensive records accessible to any provider they authorize. Several companies already offer HIPAA-compliant personal health record platforms; expanding these to include international care documentation would empower patients who navigate multiple systems.

Business Associate Agreements for Border Regions

The US Department of Justice has indicated 2025 will bring comprehensive regulations governing sensitive health data in bulk transactions, particularly for cross-border transfers. Rather than treating all international data sharing as equally risky, creating streamlined BAA processes specifically for established border healthcare facilities could maintain security while enabling continuity.

Insurance Coverage for Coordinated Care

Blue Shield of California has already partnered with CIMA Hospital in Hermosillo, allowing members to receive covered care in Mexico at approximately 60 percent lower costs than comparable US procedures. Expanding these partnerships while ensuring bidirectional medical record sharing could serve as a model for other insurers.

The Innovation Opportunity

Cross-border healthcare patients have become unintentional innovators, developing sophisticated strategies for navigating dual healthcare systems. They comparison shop across markets, maintain relationships with multiple specialists, and become highly informed consumers of medical services—exactly the kind of engaged healthcare consumers that policy experts have long encouraged.

Dr. Frias's research reveals these patients don't just accept fragmented care—they actively work to coordinate it. They carry paper records across borders, translate medical terminology between systems, and educate providers about treatments received elsewhere. This resourcefulness shouldn't be necessary, but it demonstrates the value patients place on comprehensive medical documentation.

What Healthcare Leaders Should Do Now

For Healthcare Administrators:

Review your facility's policies on international medical records. Create protocols for incorporating foreign medical documentation into patient charts. Train staff on how to verify and integrate cross-border care information.

For Health Insurance Companies:

Explore partnerships with accredited Mexican facilities along border regions. Develop pilot programs that maintain record continuity for members who seek care abroad. Consider how coverage could include coordinated bi-national care management.

For Technology Vendors:

Prioritize FHIR implementation that includes cross-border capabilities. Develop patient-facing tools that aggregate care documentation from multiple countries. Ensure your systems can handle multilingual records and diverse documentation standards.

For Policymakers:

Distinguish between legitimate cross-border care coordination and data security risks. Create regulatory pathways that enable safe, compliant information sharing between established healthcare facilities in border regions. Support pilot programs testing bi-national medical record systems.

The Bottom Line

Dr. Frias is right: we've created artificial boundaries that serve no one's interests. The estimated 1.3 million Americans who sought care in Mexico last year deserve better than becoming healthcare ghosts, losing pieces of their medical narrative with every border crossing.

Quality care exists on both sides of the border. The challenge isn't clinical competence—it's administrative fragmentation. As healthcare becomes increasingly global, our record-keeping systems must evolve beyond national boundaries. The alternative is forcing millions of Americans to cobble together their own healthcare stories from scattered fragments, hoping they remember every detail when it matters most.

The technology exists. The clinical relationships exist. What's missing is the political and institutional will to build the bridges that would allow medical information to travel as freely as the patients it documents.