A Personal Appeal

As you may have noticed, I have been re-posting several times articles about my interest In finding opportunities or remote/virtual positions.

To date, I have had no success. As I may have mentioned in my previous post, “Now It’s Personal“, I was diagnosed with End-Stage Renal Disease, and have been undergoing peritoneal dialysis at home.

The treatment is going well, but yesterday I began what will be a long, possibly three year process to get a transplant. As I am doing now, and will be doing in the future, I have been staying home to receive my dialysis supplies every two weeks, and going to the clinic for blood work and follow-up. In addition, I will have tests, and need to go down to Miami, so my schedule will not allow me to work full-time, or even part-time for twenty hours a week at some office.

To that end, I am interested in any work any of you can pass onto me that will utilize my skills and experience. No matter where you are in the world, as long as we can communicate online, I can do something constructive and valuable.

If you need my CV, I will gladly provide it upon request.

I would not do this here if the other postings had been successful, and time is running short.

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Words and Phrases: Global Healthcare or Whatever You Want to Call It

This past Saturday, while waiting for power to be restored in my area due to a pesky lizard’s venture where lizards don’t belong, I was able to use my cell phone to read some posts on LinkedIn.

I came across a discussion by three of the top medical travel personnel answering the question, “Is the term “Medical Tourism” obsolete?”

This discussion thread was begun by Stella Tsartsara, and followed by Ilan Geva and Elizabeth Ziemba, including yours truly, who put his two cents into the conversation.

Since Stella has given me her approval to use her comments, and I suspect that Ilan and Elizabeth would not mind, I am going to quote them verbatim here for the reader to digest. There will be some names that I will leave out, because one, I have not contacted them, and two, they were mentioned in passing by the individual who I am quoting.

Stella I. Tsartsara:

“I see Elizabeth Ziemba talking about carrying capacity of HC systems. XXXXXXXXXXXXXXXXXX told me half of the international projects I do have nothing to do with Medical Tourism, XXXXXXXXXXXXXX told me we are dealing with “International Healthcare” anymore, we are passed the term “Medical Tourism ” probably instigated by people traveling to another destination for (cheaper) surgery not covered by their insurance where the “patient” had time to do some sightseeing. But once the demand came to more serious interventions like heart surgery then the only organization needed was a reliable MTF and good research from the patient to guarantee results. Here the “tourism” is at the 4-5th place after doctor, hospital reputation, waiting list time, safety, post- surgery follow up, price and cost reimbursement from insurance.

Now with the Cross Border Healthcare and the Trade in Services Agreement (TiSA) Wikileaks revelation on the globalization of healthcare officially by the states, things take a completely new turn and the fact that we are talking about Medical Tourism is raising some eyebrows. Or at least it should be split from Healthcare delivery.”

https://data.awp.is/international/2015/02/04/22.html

Stella I. Tsartsara:

“I have no possibility for edit, I rephrase here that XXXXXXXXXXXXXXXXXX told me some time ago that her projects deal with international healthcare mostly which is a healthy sign of evolution in the industry although XXXXXXXXXXX says this word does not exist either, to which of course I agree.

Terms are the beginning of taking the trend seriously by the demand. It’s about shaping policy in the end.”

Ilan Geva:

“Stella, I think that the term Medical Tourism was pushed upon us by an association. The fact is no one, except our circle of Professionals, is using it or cares about it. In the effort to differentiate and stand out, many started to use Medical Travel, Global Healthcare…whatever. Patients don’t really care what you call it, they have a need or a want that requires a solution. Many of them are not looking for the “Tourism “aspect of a medical issue. Have you noticed that even the MTA is not using their name as much as they used to? They are now pushing the GHA brand.

Is that an indicator that medical tourism is dead? Who knows, and frankly, who cares? Globally, there are enough tremors in the healthcare sector, enough to guarantee continued movement of patients from one region to another. Maybe we should start calling it “Medical Voyages”?”

Elizabeth Ziemba:

“Thanks for starting a very interesting conversation, Stella. The term “medical tourism” isn’t dead yet because it is still the top search term in the sector and is heavily used by the media. But the sector itself has outgrown the term. I will be giving a presentation at the IMTJ/World Health Care Congress about this very topic. The sector is changing but it is hard to get away from “medical tourism” when SEO rules. I must admit that the name of my company, Medical Tourism Training, was selected because of its SEO and familiarity to people. Even now, people react to it favorably even though I hate it. Time to look past the label to the substance.”

Stella I. Tsartsara:

“Ilan Geva “medical tourism” is not dead and maybe never dead as there are interventions where tourism plays an important part and here individual consultants have a bigger profit margin. But definitely movement of patients for elective treatment is not and cannot be called this way.

In EU we call it “Cross Border Healthcare” because we established the Institutional parameters for its organization and delivery.

This is what is lacking from an international perspective for the term to have a meaning. By the way trained eyes in institutional development like XXXXXXXXXXX will see immediately that the TiSA is exactly the same (with 2 additions on insurance and compulsory post-surgery monitoring & liability) with the EU Directive 24/11/EC on the Cross Border Healthcare in EU.”

Me:

“I have used “Medical Travel” in my posts, but for the purpose of selecting a category to place them in, or to tag them when I write, I use both “Medical Tourism” and “Medical Travel”.”

Stella I. Tsartsara:

“Elizabeth Ziemba & Richard Krasner, MA, MHA I tend to agree more with Ilan Geva on the matter. However as I said there will always be room for the “tourism” side for hundreds of treatments where tourism plays a very significant part like Medical SPA, cosmetic surgery, diagnostics, dental etc, although still I do believe that it’s not a priority. What Ilan said it’s a revelation for the “association”. Who else would give international care such a limited meaning maybe pushed by its operators back then.

But what is coming ahead e.g. Institutional and Regulative development of international healthcare (among public hospitals as well) has absolutely nothing to do with “tourism”. We have to set things straight if we want to be taken seriously by those who will be in our path in the consultation activities for its future development. Those who were (are still) building the TiSA are not going to look or refer to “medical tourism”.”

Stella I. Tsartsara:

“I also have the impression that something is moving in layers that are not yet visible to us, on the management of this new trend. I believe that actors are organizing themselves differently and as there is not yet a market (it’s still a taboo internationally exactly because it involves also public HC, we in EU have solved this but it’s not the case at global level) and the demand is still hybrid, there is no business development and marketing yet of this new consulting set of skills and delivery. But very soon we are going to see a new type of developers in this perspective catering for the state development of international HC. I have proposed years ago through this group the organization of such Groups combining inevitably many specializations and some do exist already run by big Hospital Groups.”

It would seem there is not clear consensus on what term is appropriate for the activity of leaving one’s home country and travelling to a second country for medical care, no matter what the reason for travel may be.

If, as Stella said, it was for heart surgery, doubtless the patient would not be doing much sightseeing post-operation. Yet, on the other hand, if it was for less invasive, and less stressful surgeries and procedures, and if the patient was cleared by the physician and physically able, then the tourism part would apply.

The revelations by Wikileaks of the negotiations on the TisA is no doubt a concern to the entire industry, whether one calls it medical tourism, medical travel, health tourism, health travel, etc. The result is the same. Knowledge of the existence of such an agreement may forestall that agreement being finalized, if not totally scrapped altogether if the right individuals lead a campaign against it in member countries.

Such was the case with Brexit, and such was the case with the 2016 U.S. elections that Wikileaks had a hand in derailing.

The solution, therefore is a stronger effort on the part of all stakeholders to develop strategies, plans, and standards to regulate the industry and to promote it effectively. Relying on an association we know is unreliable is not going to work. Before TiSA is tossed aside like the TPP, or the Paris Climate Treaty by nationalistic dunderheads, the industry must do more.

P.S. The rest of the thread can be seen here: https://www.linkedin.com/groups/4304089/4304089-6368077962927050755

Russian Anchor Babies: Has Putin Already Begun the Invasion?

As loathe as I am to address anything from the MTA, this item caught my attention just now, as I am an hour north of Miami, and with all the talk about Dreamers and immigration from so-called “s**thole” countries, why is it not on the GOP’s radar that Putin is sending us his women to give birth so that they can claim American citizenship for the children born here?

Not that I am opposed to legal immigration and a path towards legalization for those who came here undocumented, either willingly or because their parents brought them here as children.

What impact this will have on the health care system cannot be determined just yet, but with all the problems we have, this will add to it in greater numbers.

Here is the article.

Let’s hope that Special Counsel Robert Mueller finishes his investigation into Russian interference into the 2016 election. Then he can turn his attention to Russian anchor babies.

 

New Study Concludes States with Employer Choice Have Higher Claim Costs

While scanning LinkedIn yesterday afternoon, I noticed someone had posted a link to an article in the Journal of Occupational and Environmental Medicine (JOEM) early last month.

The abstract stated that the financial impact of choice of physician within workers’ compensation had not be well studied, and that the purpose of the article was to assess the difference in cost between employer and employee directed choice of physician.

As many of you will recall, this subject was one of the first topics I covered when I began my blog over five years ago.

The following articles are linked here for your review:

Employee vs Employer Choice of Physician: How best to Incorporate Medical Tourism into Workers’ Compensation

Employee vs. Employer Choice of Physician Revisited: Additional Commentary on How Best to Incorporate Medical Tourism into Workers’ Compensation

Employer Choice States See Lower Claim Costs

Follow-up to Employee/Employer Choice: Three Years Later

The authors, Tao, Leung, Kalia, Lavin, Yuspeh, Bernacki (2017) analyzed 35,640 indemnity lost time claims from a 13-year period at a nationwide company, using multivariate logistic regression to determine association of medical direction with high-cost of claims.

Tao et al. found that states that have employer-directed choice of physician have lower risk of having high cost claims, greater than or equal to, $50,000, but had higher attorney involvement compared to employee direction. Their results showed that the net effect of attorneys offset the benefits of employer choice.

This study may be in line with the WCRI study I cited in the article above, “Employer Choice States See Lower Claim Costs”, but because of higher attorney involvement, the benefits are negated.

They concluded that states that permit employer selection of treating physician have higher cost due to greater participation by attorneys in the claims process.

Health Care Top US Employer and What It Means for Medical Travel

Back to the real world of health care, et. al.

Last week, The Atlantic magazine reported that the US health care industry has supplanted manufacturing and retail to become the largest source of jobs in the US.

The article, by Derek Thompson, reports that for the first time in history, in the last quarter, there are now more jobs in health care than in the two industries that were the leading job engines of the 20th century.

According to Thompson, in 2000, there were 7 million more workers in manufacturing than in health care, and at the beginning of the Great Recession, there were 2.4 million more workers in retail than in health care.

Thompson says that there are three main drivers of the boom in health care jobs.

  • First, Americans as a group are getting older. By 2025, one-quarter of the workforce will be older than 55 (your humble blogger). This will have doubled in just 30 years. It will have a profound economic and political impact, such as declining productivity and electoral showdowns between a young, diverse workforce and an older, whiter retirement bloc. [True in the last election.] The most obvious effect of an aging population will be that it needs more care, and more workers to care for them.
  • Second, health care is publicly subsidized. The US spends hundreds of billions of dollars on Medicare, Medicaid, and benefits for government employees and veterans. [The recent tax bill passed will make substantial cuts to many of these programs, or outright privatize them.] The US also subsidizes private insurance through tax breaks for employers who sponsor health care.
  • Third, two of the most destabilizing forces for labor in the last generation have been globalization and automation. They have hurt manufacturing and retail by offshoring factories, replacing human arms with robotic limbs, and dooming fusty department stores. Health care is resistant to both. While globalization has revolutionized supply chains and created a global market for manufacturing labor, most health care is local. A Connecticut dentist isn’t selling her services to Portugal, and a physician’s receptionist in Lisbon isn’t directing her patient to Stamford. [I take exception here, as many of you will too. It seems Mr. Thompson has not heard of Medical Travel, both inbound and outbound, and therein lies your problem.]

Finally, the growth in health care employment is more located in administrative jobs than in physician jobs. The number of non-physicians has exploded in the last two decades. Most of these jobs are administrative such as receptionists and office clerks. It is not clear that these workers improve outcomes for patients.

Robert Kocher, a senior fellow at the Schaeffer Center for Health Policy and Economics at USC said the following, “Despite all this additional labor, the most meaningful difference in quality over the past 10 years is the recent reduction in 30-day hospital readmissions from an average of 19 percent to 17.8 percent.”

One other point Thompson notes, is that categories like retail and health care are imperfect approximations, and that some categories are too restrictive, and some are too broad. He points out that there are more jobs in leisure and hospitality than in health care. [Which would explain why some in Medical Travel are more like travel agents, than medical professionals.]

So, while there is good news about the position of health care employment in the US, the downside is, at least as far as Medical Travel is concerned, that globalization may not have as much of an impact on health care as I, and others have thought, and that portends bad news for the industry.

S**thole Countries and Medical Travel

The comment yesterday that the current occupant of 1600 Pennsylvania Avenue said, is not only revolting, disgusting, sick and racist. It is also a threat to the national security of the United States, and to the economic health of the nation, and of the medical travel industry.

A host on the Fox News network defended what was said Thursday by saying that this is how forgotten men and women talk. If by “forgotten men and women” he means the men and women who lost their jobs because their wealthy bosses sent their jobs overseas or they were lost due to automation, then they only have to blame themselves for voting against their economic interests, and not the immigrants they blame for losing their jobs.

As to what this means for medical travel, think carefully about who travels from the US to other countries like India, Thailand, Singapore, Costa Rica, Mexico, and others, and not to mention those countries he did mention as “s**tholes”, especially in Africa, the Caribbean, and the Middle East (a region he did not mention yesterday, but has singled out for a Muslim ban).

And consider also what this means for inbound medical travel from those continents and countries that American hospitals might want to attract. Would you, as a citizen of those countries, travel to the US if that was what the leader of the US thought about you and your country? I don’t think so.

The notion that we should take in people from Norway (not that there is anything wrong with Norwegians, in fact, I am watching a series on early Norwegian history, Vikings on the cable channel History) is proof that he is a racist and a white supremacist.

Comments on social media have even gone so far as to indicate that Norwegians would never consider moving to the US because they have a better standard of living and have free education, health care, and rank higher on all social metrics.

So, those of you in the medical travel industry should be aware that some of the resistance to medical travel from America, and from the very people who would benefit greatly from it, are the forgotten men and women the Fox host mentioned. If so, it will be a tough sell to get them over there.

Disgusted!

I want to take a break from writing about medical travel, health care and workers’ comp, and address my comments to my many readers around the world from Africa, Asia, Europe, and Latin America and the Caribbean.

As a second-generation American, whose paternal grandparents arrived here from Russia more than a century ago, and whose maternal grandparents also arrived from Russia (they both held Polish passports when they emigrated) almost a hundred years ago, 1921 and 1923, respectively, I am disgusted, angry, and outraged that the Chief Executive of my country is an outright racist and bigot.

I am only glad that my parents, the children of my aforementioned grandparents did not live to see this asshole either become President, or was unable to understand that he was President due to suffering from Alzheimer’s.

I, like this moron, was born and grew up in New York City, having been born in Brooklyn, and lived in two different neighborhoods that had diverse populations. I also lived on NY’s Long Island, and while my town was less diverse than my previous residences; nevertheless, the proximity of New York City to where I lived, went to school and worked meant that I was never too far away from people of different cultures, ethnicities, racial makeups, and religions. When I had the chance, I always visited the United Nations and felt a great deal of joy knowing that such an organization, as flawed as the world is, existed and that my hometown was its headquarters.

On September 11, 2001, I was more than a thousand miles from NY when the planes struck the two towers, places I had spent time in during my early working life. In point of fact, I was driving to work in Houston, Texas when the first plane struck, and was listening to the local classical radio station on my car’s radio, The news came on at 8 am, local time, and the announcer said a plane had struck the World Trade Center. My first thought was terrorism, but I soon realized that many small planes fly up and down the Hudson, and that perhaps this is what happened.

When I arrived at my office, because we had very little work to do, and because we were all new, I took a brief nap, and when I went out into the hallway of my floor, I was told to go upstairs to the break room and watch the newscast on television. When I arrived in the break room, the first tower collapsed, and this boy from New York City saw my hometown under attack.

I never lashed out at an entire group of people, but knew immediately and from what the reporters were saying, that this was the work of Al Qaeda and Osama bin Laden. But I will tell you what I did see on television. I saw people in the West Bank cheering the attacks, not people in Jersey City, like the current occupant of the Oval Office has claimed he saw.

In fact, one of my high school alumna was interviewed on television, and has been on American television and written of in the New York Times many times. She came to the US from India and is a Muslim woman, married to the Iman who wanted to build a cultural center near the WTC. Our yearbook pictures are diagonally opposite each other in our school’s yearbook, and she was very friendly with a neighbor, whose brother was responsible for the biggest financial disaster of the last decade.

There have been American presidents of this person’s party who I did not vote for, or agree with, but at no time in my life, or that of my parents and grandparents, did they have to feel ashamed, disgusted, and incensed at the blatant racism, sexism, homophobia, crudeness, and Antisemitism of any of them, including FDR, who many have accused as not doing enough to save the six million Jews who perished in the Holocaust, including my maternal grandfather’s older brother, his wife and six children.

So I say to you, my dear and devoted readers around this wonderful world of ours, I am sorry if this idiot offends you, your country, your race, ethnicity, religion or culture. He does not speak for me, nor does he speak with the vast number of Americans who feel like I do. We, the American people, apologize. It is our fault, and our fault alone.