BACKGROUND: Pervasive poverty and high uninsurance rates in the US-Mexico border region coupled with rising US health care costs and the availability of alternatives to formal US health services—both in the US and Mexico—have resulted in widespread use of alternatives to formal US health care. OBJECTIVES: We investigate variation in the purchase of substitutes for formal US health services among border residents reporting health-related cost constraints. Preferences for various means of substitution (informal US services, formal Mexican services and informal Mexican services) are identified. RESEARCH DESIGN: Cross-sectional study of purposive interview data from the Texas Borderlife Project regarding the purchase of a continuum of informal services/goods, including health care services and prescription medications. SUBJECTS: Study respondents included 320 Latino/Hispanic residents of the Texas border region. MEASURES: Eight health substitutes (medical care, prescription medication, and dental care) were ordered from formal services/goods in Mexico to informal services/goods in Mexico and the US. The independent variable was reporting having gone without seeing a physician in the past 12 months because of cost. RESULTS: Border residents reporting cost constraints were significantly more likely to purchase substitutes for formal US health services. Further, our findings suggest that when substitutes to formal US health care are used, Texas border residents prefer to access formal Mexican health care first, followed by informal US health services. CONCLUSIONS: Increasing access to US health services may require greater effort and resources in border communities given the availability of substitutes for formal health care services in this region.
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