Because of the way the Mexican civil courts are structured, litigation there is rare*. It follows that Mexican doctors are not strangled by exorbitant premiums for malpractice insurance and every bit of CYA that goes with it, such as unnecessary interventions and overzealous, superfluous documentation. Too, there is a definite cultural distinction regarding how doctors are perceived. As in the U.S., doctors are at the high end of the income scale, but that income band is not as wide. The average doctor in Mexico can live very comfortably, but will earn less than a quarter of the income of her U.S. counterpart. The profession in Mexico is respected, but not exalted. When my mom was in a private hospital in Puerto Vallarta for surgery to repair her broken femur, I was caught off guard several times at the intimate, casual nature of the care. The white coat is not de rigueur; her surgeon often did his rounds in street clothes and the first time we met her anesthesiologist, the woman walked into the room looking no different than a woman in the grocery store, with her purse hanging from her arm. And like other small businesses in Mexico, a doctor’s practice is as likely to be run out of their home as any other location. For all of these reasons, Mexican health care systems can be easily pared down and adapted to meet the needs of even the very poor. I think these same factors are at play in other countries to varying extents.