Alfredo Corchado / The Dallas Morning News

NUEVO VALLARTA, Mexico — Bruce Fry fixes his gaze on the ocean and talks about his vision for the future of medical tourism on Mexico’s Pacific Coast: patients from Texas and elsewhere in the U.S. finding a low-cost alternative to soaring medical prices for everything from knee replacements to heart surgery, then healing by the beach with their families.

Fry, of Carrollton, Texas-based Fry Construction, which builds medical facilities, and his partner, Collin Childress, are convinced that Americans, particularly baby boomers, will one day pay less for health care without having to fly to faraway India, Thailand, Malaysia or Brazil — popular current destinations for medical care.

They could hop on a plane and in a matter of hours, be in Cozumel, Cancun or here on the shores of the Bahia de Banderas, just up the coast from Puerto Vallarta, with its airport and world-class medical facilities.

Fry and others say the vision isn’t far from reality, but many obstacles remain.

“This could be a game changer for both countries because we’re talking new income stream for Mexico, improving the overall tourism economy,” he said. “But as a gringo from Dallas trying to make this a reality, getting there is too often like a dog chasing his tail.”

It’s been nearly 20 years since the signing of the North American Free Trade Agreement, which opened the border to increased trade in merchandise and services, among them medical care. But a plethora of restrictions remains, preventing Americans from cashing in on quality care that could be as much as 40 percent cheaper, Fry and others say.

A recent report by the U.N. Economic Commission for Latin America and the Caribbean shows that despite its proximity to the U.S., Mexico is woefully behind other countries in attracting American patients. Mexico needs to do more both to improve security and to certify hospitals to treat international patients, experts say. Only 19 Mexican hospitals are certified by the Joint Commission, a world body that accredits hospitals, compared with 35 in Brazil.

“Mexico needs to get more hospitals certified by the Joint Commission, address violence and the perception of it, and needs to significantly increase advertising in the United States,” said Christopher Wilson, an expert on economic issues at the Woodrow Wilson Center’s Mexico Institute.

“In the U.S., states need to see if changes are needed in insurance regulation to allow policies to cover care in Mexico,” Wilson said. “In California, for instance, some insurance companies are selling policies to cover care in Mexico. Finally, getting Medicare to cover treatment out of the U.S. is the holy grail for medical tourism advocates.”

Making changes to Medicare coverage is a thorny issue in Congress, though, and such changes are unlikely anytime soon, despite increased lobbying from many of the estimated 1 million Americans living in Mexico, many of them retirees.

Two years ago, David Wagner, an expert on health care at the University of Texas, sent members of Congress a study showing how their constituents would benefit from access to health care in Mexico. “Not one of them responded,” he said.

“The real deal-killer to retiring in Mexico is that your Medicare doesn’t cover you down there,” Wagner said. “If Medicare would cover, it would save the government money and people would live a lot better.”

For now, Brazil, Ecuador and some Caribbean countries continue to make significant gains in attracting Americans for private care, said Arturo Vargas Bustamante, a health care expert at the University of California, Los Angeles. Vargas said the things preventing Mexico from becoming a bigger player are a lack of U.S. political will and Mexico’s monopolistic business culture, in which mammoth corporations dominate industries ranging from telephones to medical care and are able to avoid competition.

“My perspective is Mexican doctors seem to be too comfortable in what is working now, meaning they make enough money,” Vargas said. “They’re shielded from the competition, and so private providers make a lot of money. The government has been trying to encourage them to be more ambitious, but they need to do more on that end and also do more to position themselves with a better strategy and market.”

A tourism official in the new administration of Enrique Pena Nieto said the president is committed to medical tourism and will continue to promote an office set up in 2012 to expand the industry. About 1.6 million Americans now actively seek health care abroad, Guevara said, and they represent an estimated $4.1 billion spent abroad annually for medical care. Millions more lack insurance and presumably might choose the lower-priced care outside the U.S., and the 35 million Americans with roots in Mexico constitute another potential market — especially along the Texas-Mexico border.

“It’s inevitable that the market will continue to grow because there’s a greater value for return in Mexico — great medical services and great doctors, with springlike weather most of the year,” said Guevara, a former Dallas resident. “It’s huge, and that’s why it’s so important to build on the foundation that we started.”

Wagner said that the U.S.-Mexico border, particularly El Paso, Laredo and the Rio Grande Valley, should be a testing ground for insurance companies and Medicare to cover health care costs.

“We’re looking at a lot of people who cannot afford quality health care, and Mexico would be a great option for them,” he said.