Monthly Archives: January 2013

Will the Future of Workers Comp Follow Healthcare?

Saw this today from Medical Travel by Dr. John Maa, assistant adjunct professor of Surgery, Division of General Surgery, and director, Surgical Hospitalist Program, at the University of California, San Francisco (UCSF).

Pay attention to what he says about US employers and employees.

The re-election of President Barack Obama ensures the preservation of his signature healthcare and insurance reform legislationSome suggest that the focus on medical travel expansion will therefore shift away from the care of uninsured Americans towards insurance companies seeking to offer low-cost alternatives to employers and employees.

The special opportunity to utilize financial forces to drive healthcare costs down in the US remains untapped. What’s more, there is much that the nation can learn from the healthcare delivery systems in other countries.  Consider the following from The Nation: Thailand spends just over four percent of its gross domestic product (GDP) on healthcare, and achieved universal access to healthcare in 2002, along with remarkable reductions in infant mortality and HIV infection rates.

In the World Health Organization ranking of healthcare systems of 2000, the US was 37th, while Thailand was 47th. As US healthcare expenditures approach 20 percent, with the Congressional Budget Office projecting that 30 million Americans will still remain uninsured despite the ACA, one might reasonably conclude that the Thailand system represents a better return on investment for their healthcare dollars. Perhaps the greatest benefit would result from sending elected US officials, health policy experts and policymakers abroad to observe real-world solutions that are succeeding in other nations, and integrating these valuable lessons into the US healthcare system.

Shouldn’t this be a focus of the US workers’ compensation system also?

No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean

Readers of my previous twelve posts have no doubt seen that I have been writing about how workers’ compensation can benefit from implementing medical tourism. So for my next post, I decided to reverse direction, and write about how medical tourism can benefit workers’ compensation. I decided the best way to do that was to write about the hospitals, clinics and hospital networks that exist in Latin American and the Caribbean. My last post on the impending immigration reform, and our guest contributor, Steve Schmutz‘s post on immigration, highlights the reality that Latin America and the Caribbean is a vital and nearby region of the world to the mainland US that cannot be ignored. And for the future of workers’ compensation, this is very important as more and more workers will have been born in those countries or will have ties to them through their family.

So by perusing the literature I collected when I attended the 5th World Medical Tourism and Global Healthcare Congress last October, I have put together a list of some of the hospitals, clinics and hospital networks in several Latin American and Caribbean countries. This list is by no means exhaustive, and while I originally decided to give some text for each hospital or clinic, I decided in the end just to list them by country with links to their website where available.

It should be noted that much of the literature I picked up was mostly slick marketing tools, and some of the websites are not very well made, so getting a lot of information from them was not always easy. Those websites that are in Spanish or Portuguese can be translated or have links to English versions.

Finally, I have not visited any of these hospitals, clinics or networks, so I am unable to verify the validity of their services, but am going on the assumption that since many of them are accredited by the Joint Commission International (JCI), or certified by the Center for Medicare and Medicaid Services (CMS), as are those in Puerto Rico, that they are equal to or better than US hospitals.

After reading the following list and checking out some of the hospitals, clinics and networks that are available in Latin America and the Caribbean, you will learn that the days of back alley, dubious medical care in the rest of the Western hemisphere are a thing of the past. Here is the list in alphabetical order:


Buenos Aires

Hospital Alemán


Bahamas Medical Center


Hospital Alemão Oswaldo Cruz

Cayman Islands

Cayman Spine Institute


Hospital del Trabajador (Working Man – Specializing in Trauma, Burns and Rehabilitation)

Red Salud UC

Santiago Salud Chile



Clinical Colsanitas SA

Fundación Santa Fe de Bogotá

Hospital Universitario de San Ignacio


Clinica Medihelp Services


Salud Sin Fronteras

Clinical Las Vegas

Hospital Pablo Tobón Uribe

Grupo Empresarial Las Américas

Clinica Medellin

San Vicente Fundación

Costa Rica

San Jose

Hospital Clinica Biblica

Hospital La Católica

Dominican Republic

Hospital General de la Plaza de la Salud


Centro Medico

Hospital Herrera Llerandi

Hospital el Pilar (Sanatario de Nuestra Señora del Pilar)


Amerimed (Network)


Cabo San Lucas


Puerta Vallarta

San José del Cabo

Angeles Health International (Network) – 23 hospitals across Mexico


Hospital Galenia


CIMA – Centro Internacional de Medicina


Hospital Almater



Hospital Metropolitano Vivian Pellas


Panama City

Hospital Punta Pacifica

Hospital San Fernando

Clínica Ortopédica Dayan

Centro Ortopédico Nacional

Puerto Rico

Metro Pavia Health System (MPHS) (website under construction)


Hospital Pavia Santuce

Hospital Pavia Hato Rey

Hospital Metropolitano de San Juan

Hospital San Francisco

Metropolitan Hospital of Miami

Hima Health


Hospital HIMA – San Pablo Bayamon

Hospital HIMA – San Pablo Caguas

Immigration Can Be Both Compassionate and Just

Richard’s Note: Steve Schmutz and I decided to collaborate after he glowingly commented about my recent post on what immigration reform will mean for medical tourism and workers’ compensation. Steve is very involved with Workers’ Compensation issues and is the CEO of Claimwire, a workers’ compensation industry service provider.

Author’s Note:  I first wrote this article for Claimwire. It received a good amount of attention and social media commentary. Richard’s blog readers will know that he is deeply involved in immigration issues and how they affect workers’ compensation. His interest lead him to request that I post this article on his site. I have made a few changes since the original, which you can read here.

I spent nearly two years living in Central America in the early 1980s. I lived in Honduras and Belize, but I worked with and became friends with people of nearly every country in the region.

The people I came to know were good, hard working, and honest people. They were people who wanted to improve their lives. Unfortunately for them, the economically depressed and politically corrupt areas in which they lived limited their dreams and ambitions.

That was 30 years ago. Not much has changed. In fact, by many standards, things are even worse today than they were in the 1980s.

We who are fortunate enough to live in the greatest country the world has ever known, must grapple with an issue that has no perfect solution – an issue that strikes at the deepest levels of humanity and justice at the very same moment.

I speak, of course, of immigration.

On the one hand, I find myself filled with compassion for those who wish come to the United States in search of a better life. Fathers and mothers wanting to provide for their children the same opportunities and hopes that I want to provide for mine. Hard workers who want to receive an honest wage for honest work. Families who want to live in a safe community.

Don’t we all want those things? Wouldn’t we try to come to America if we were in their shoes?

I would.

On the other hand, one thing that make this country great is its laws and adherence to those laws. America is a land of justice, a land where no one person is above, or beneath the scales of justice.

Our freedoms, our economy, our safety – our lives as we know them today – are founded on the proper adjudication and application of our laws.

In 1863 my great, great grandfather and his family immigrated to the United States from Switzerland. They left a beautiful farm, friends and family, and even their eldest son who chose to remain on the farm. To my great, great grandfather, America was the land of opportunity and freedom.

Ninety-eight years later I was born.

I was born in Northridge, California as an American Citizen. Not because of anything I did, but because of what my ancestors did. Is that any different than what’s happening today?

Actually, yes.

My ancestors came to America legally. They followed the laws, filled out the paperwork, paid the fees, etc. I know times are different now. Things were a lot simpler 150 years ago.

And that’s just the point.

The deep divide that exists today between those on the side of compassion, and those on the side of justice can be solved.


When the law is reasonable to follow, and fairly enforced, both compassion and justice can be served.

We need to re-structure our immigration laws, and remove the useless and time-consuming roadblocks that keep honest people from obtaining lawful entrance into our country. The process to enter, and the process to stay must be realistic and practical. Much like it was in 1863.

Note that I didn’t say there should be no process at all. I’m not advocating “no borders.” I’m suggesting a reasonable level of requirements for people from other countries to enter, work and live in our country.

In 1776, the signers of the Declaration of Independence penned these powerful words:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

All people, regardless of their country of origin, should have equal opportunity to come to America to pursue their rights to life, liberty and happiness. But, only by complying with the law.

I don’t know if we will ever have the perfect solution, but we must have well-crafted, reasonable laws, and they must be properly and fairly enforced.

Then and only then will both compassion and justice be served.

May I add my voice to Richard Krasner’s – we must embrace reform not fight it. We must adopt laws and policies that help those who wish to come, which in turn will help us all.

Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation

Five years ago, members of a risk management discussion group I belong to on Yahoo Groups, raised the question of whether or not, illegal immigrants, i.e., undocumented immigrants were entitled to workers’ compensation benefits. The answer most of the respondents gave was yes, but with some restrictions, depending upon the state. One respondent in particular, even provided the group with documents from the Independent Insurance Agents & Brokers of America, Inc. (IIABA) that gave the pros and cons in the debate on whether undocumented immigrants were entitled to benefits or not.

The purpose of this post is not to rehash the debate points, but to explore what impact impending immigration reform, which has been promised by the Obama administration in the upcoming second term of the president, will have on workers’ compensation and the likelihood that injured newly legal immigrant workers, especially from Mexico and other Latin American countries, will avail themselves of the benefits of medical tourism to their home countries as an option if injured on the job.

According to the IIABA White Paper, which cited a Pew Hispanic Center
report published in 2006, there are probably 11 to 12 million undocumented immigrants in the US, depending upon how many “self-deported” recently due to the current US economic slowdown, of which demographically, this represents 5.4 million men, 3.9 million women, and 1.8 million children. In addition, there are 3.1 million children who are US citizens having been born here (64% of all children of the undocumented) from one or more parent.

President Obama’s Executive Order last year gave many of these children a reprieve from deportation while they are attending college here and until more comprehensive reform can be achieved for all undocumented immigrants. Undocumented immigrants account for almost one-third of all foreign-born residents of the US, and about 80% of these are from Mexico and other Latin American countries.

The report also states that out of the total number of undocumented adults, 9.3 million, 7.2 million (77%) are employed and account for around 5% of the US workforce. They comprise a disproportionate percentage in some industries, such as 24% of farm workers, 17% of cleaning workers, 14% of construction workers, and 12% of food preparers.

These industries typically account for much of the claims filed under the US workers’ compensation system. Within a particular industry, undocumented workers comprise a higher percentage of more hazardous occupations, e.g., 36% of insulation workers and 29% of all roofing employees are estimated to be undocumented.

In my post, The Stars Aligned, I briefly touched upon the issue of immigration reform’s impact on medical tourism for workers’ compensation in regard to Mexican workers in the US. But since President Obama, and Florida Senator Marco Rubio have outlined recently different reform plans, which I will discuss here in this post, it is important to mention first how undocumented workers are treated under the various laws each state has established to govern their workers’ compensation systems.

The other document I mentioned that one of the respondents had forwarded to the discussion group was a chart of the laws governing workers’ compensation and undocumented workers. Undocumented workers are entitled to workers’ compensation benefits in thirty-eight states, however, six states have statutes that allow or restrict benefits for various reasons such as if the employment was obtained under false pretenses (FL); disability benefits were payable of they were unable to work because of the injury (GA); they were entitled to medical, but not disability benefits because of a commission of a crime under the Immigration Reform and Control Act (IRCA) of 1986 signed by Ronald Reagan (MI); vocational rehabilitation benefits were covered since the worker could get employment outside the US (NV); disability payments were recoverable at US wages rather than those of the home country, if the employer was aware or should have been aware of the undocumented status (NH); disability benefits were not payable if the worker was unable to work due to his status, and not the injury (NC).

Three states, California, Georgia and Nebraska have statutes that indicate that undocumented workers are not entitled to benefits in certain situations. California case law established that undocumented workers could be refused vocational rehabilitation benefits. Georgia case law ruled that disability benefits were not payable if the worker was unable to work due to his status and not his injury, and Nebraska case law established that a worker named Ortiz could be refused vocational rehabilitation benefits because he could not legally work in the US and did not plan to return to Mexico to work. Only Wyoming has a statute that expressly includes only “legally employed…aliens.” And case law in 1999 confirmed that undocumented were not entitled to benefits. Eleven states, Alaska, Delaware, Indiana, Maine, Missouri, Rhode Island, South Dakota, Vermont, Washington State, West Virginia and Wisconsin were listed in the chart as unknown as to whether or not undocumented are entitled to benefits.

As we begin the second Obama Administration, immigration reform has risen to the top of the list, only to be preceded by the debt crisis and the fiscal cliff. As I mentioned above, both President Obama and Florida Senator Marco Rubio have outlined their own versions of what immigration reform would look like. Senator Rubio’s plan would rely more on skilled workers such as engineers and seasonal farm workers while tightening border enforcement and immigration laws, something that would please his right-wing allies on talk-radio. Senator Rubio’s plan would not provide blanket amnesty to those already here.

On the other hand, President Obama’s plan, as outlined in a recent New York Times article, would seek to give undocumented workers a path to citizenship. Sen. Rubio’s plan would focus more on merit and skill as prerequisites for entry into the US, much like earlier immigration laws passed in the 1920’s and other decades. The president’s plan would be broader and more immediate, and would probably have less of an impact on the economic stability of those industries that currently rely on undocumented workers.

Whatever form immigration reform will take, the opportunities to offer medical tourism as an option to injured undocumented workers, once they achieve some legal form of citizenship, will no doubt increase. The likelihood that something will be done this year has already been the topic of many news programs and even has been discussed by congressional leaders as Harry Reid, the Senate Majority leader.

Once the currently undocumented can legally remain in the US and continue to work in the industries they occupy, the more likely is the possibility that they would opt to go to their home country for medical treatment, should they get injured on the job, and if the benefits of doing so, such as not having language barriers, cultural barriers, and will be able to be visited by friends and family living there, they will be more open to receiving treatment at facilities they normally could never get into. And as many of these countries are fast becoming “rising stars” as medical tourism destinations, the more likely they will want to get treated at the best hospitals in their countries, which will have a huge impact on their recovery, their well-being and their standing with friends and family. And the financial burden of not having to look for a job back home and being able to return to the US will convince them to opt for medical tourism as injured workers.

The Doctor will see you now….Online

Happy New Year!

Now that the holidays are over, and a new year has begun, I wanted to take some time off from writing until I could find a topic worth writing about. I think I have done that with an article that was published on December 21, 2012 in the Wall Street Journal by Anna Wilde Mathews. Her article entitled, Doctors Move To Webcams, profiled a recent trend in healthcare that, while involved with primary care, could have significant impact on how medical tourism and medical tourism for workers’ compensation will be conducted in the future.

The article discusses virtual doctor visit services, which allow patients to connect with physicians from their homes. Ms. Mathews points out that WellPoint and other insurers such as Aetna and United Health plan to offer or are already offering such services to its employer and individual plans, or to certain employers as in the case of Aetna and United Health. WellPoint’s plan will allow people to consult with physicians on-demand using laptops, tablets and smartphones. A growing number of employers such as Home Depot, Booz & Co. and Westinghouse Electric are moving to include remote consultations to their benefits.

However, such services, Mathews points out, are generating tension with state regulators and doctor groups. They argue, Mathews says, that remote visits make sense when a patient is communicating with their regular doctor, but that care may suffer when patients are connecting with physicians in other cities or states, or countries (emphasis mine). A survey by Mercer, a unit of Marsh & McLennan mentioned in the article, indicates that 15% of very large employers use some form of telemedicine, and another 39% are considering doing so.

In an earlier post, Medical Tourism and Workers’ Compensation: What are the Barriers?, I discussed some of the legal barriers to implementing medical tourism into workers’ compensation, with long-distance communication and the issue of prior face-to-face contact between patient and physician as some of the minor barriers that need to be overcome. A more complete discussion of the barriers to implementing medical tourism into workers’ compensation can be found in my White Paper, Legal Barriers to Implementing International Medical Providers into Medical Provider Networks for Workers’ Compensation.

Mathews quoted Ginny Proestakes, director of health benefits at General Electric, which is testing a virtual-consult service from United Health Group’s Optum for employees in Ohio, and plans to roll it out more broadly this year. “The ability to communicate with a doctor 24/7 via the Internet, without an appointment, at an attractive price point, is very appealing.” Employers and insurers say such services could possibly ease the shortage of primary-care doctors. Ann Boynton, deputy executive officer for health coverage for California’s Public Employees’ Retirement System, said that if it does not drive down the costs, then it isn’t worth it. They started testing a service for phone and online video from Teledoc last year. Teledoc has clashed with regulators in Texas over its service, but Teledoc said that its doctors have performed more than 100,000 consults with no malpractice claims. Teledoc has clients such as Aetna, Blue Shield of CA, and Highmark.

Currently, Mathews indicates, only 13 states allow doctors to establish a relationship with a patient, without an initial in-person visit, according to the Robert J. Waters Center for Telehealth and e-Health Law. What this means for medical tourism in general, and for medical tourism in workers’ compensation, specifically, is until more states allow such visits for primary care, and more insurers offer it under individual and group plans, the barriers I mentioned in my earlier post and my White Paper are still formidable, although minor and must be overcome. Medical tourism facilitators must take this into consideration when they market, plan and sell medical tourism packages to potential patient clients. The doctors themselves, and the hospitals they work at, must also take this into consideration.

For implementing medical tourism into workers’ compensation in the US, one must be aware of state regulations and whether or not virtual doctor visit services will be included in the treatment plan for injured workers. The day when the nurse will say to a patient in the US, that the doctor will see you now, when the doctor is thousands of miles away is still not here, but that day will come.