"We go to Tijuana to double check everything": The contemporaneous use of health services in the U.S. and Mexico by Mexican immigrants in a border region.

Research in 2009 showed that hundreds of thousands of Mexican immigrants in the U.S. return to Mexico for healthcare annually. Existing studies on the cross-border healthcare behaviors of this group are dominated by two related questions: 1) Why do Mexican immigrants go to Mexico for care? and 2) What are individual-level predictors of seeking care in Mexico? While this research has identified people's motivations for crossing the border for care and key characteristics associated with this behavior, it has underemphasized an important feature of cross-border healthcare seeking, namely that some immigrants contemporaneously use healthcare in the U.S. and Mexico. Drawing on qualitative interviews with Mexican immigrants in San Diego, CA, located on the U.S.-Mexico border, I show that for some, seeking care in Mexico is a way to supplement the care they receive in the U.S. In this region, some people combine care in the two countries in attempts to achieve what they believe to be optimal care results. Their cross-border behaviors include seeking care in the U.S. for a health condition and, if dissatisfied, going to Mexico for care; getting care in the U.S for certain health problems and Mexico for others; going to Mexico for specialist care when their U.S. doctors will not refer them to specialists; and going to Mexico for pharmaceuticals their U.S. doctors will not prescribe. For these individuals, proximity to the border changes the meanings and behaviors associated with being a patient, in that it enables them to be more actively engaged in their care. At the same time, findings raise questions about the quality of care that results from mixing care in the two countries. These findings suggest a need to understand cross-border healthcare seeking among some border residents as embedded in a larger repertoire of healthcare practices.