Now that I’ve cleared the air, and professed the faith of my conviction, I would like to get back to the subject at hand, which is implementing medical tourism into workers’ compensation. In my last post, I asked the following question:
Is there something different about patients who can afford to pay for medical treatment abroad or who have private health plans that do, from those who get injured on the job and have their treatment paid for by an employer or insurance carrier under workers’ comp?
In that same post, I also asked this question as well:
What difference is there if a person injures their hip or knee by engaging in some sort of physical activity outside of their employment, or if the person gets hurt on the job? Are the surgical procedures for these types of surgeries different for a working person than those for a middle-class or upper-middle-class person?
Well, according to a recent study just released by the Workers’ Compensation Research Institute (WCRI), and reported this week by WorkersCompensation.com, there is something different in what hospitals were paid for shoulder surgeries in workers’ compensation and what hospitals were paid by private or group health insurance for the very same surgeries.
The article, Hospitals Were Paid At Least $2,000 More For Common Surgeries For Injured Workers Than The Typical Patient, stated that in half of the study states, hospital outpatient payments for shoulder surgeries in workers’ compensation were at least $2,000 (or 43 %) higher than group health insurance.
The study, entitled Comparing Workers’ Compensation and Group Health Hospital Outpatient Payments, is the first, WorkersCompensation.com says, that compares hospital payments for the same surgical procedure when paid for by group health versus workers’ compensation.
According to Richard Victor, the executive director of the WCRI, “These are large differences in costs in many states. Policymakers looking to contain medical costs in these states may want to ask if the difference is necessary to induce hospital outpatient departments to treat injured workers”.
The WCRI study also found that workers’ compensation payments exceeded group health payments by the most in states where the price regulations were based on a percentage of the hospital’s charges, or had no price regulation.
The study compared outpatient payments made by workers’ compensation and group health insurers for treatment of common surgical cases in 16 large states, which represents 60% of the workers’ compensation benefits paid in the US, and covers outpatient services delivered in 2008.
So apparently, there is a difference between workers’ compensation and group health insurance after all. The only problem is it does not have to do with the treatment received by patients covered under each type of insurance, but rather on how much workers’ compensation carriers paid hospitals for outpatient surgeries. Silly me, all this time I thought it had to do with the type of patient, now I see it has to do with the kind of insurance he is covered under.
So now, my question to the workers’ compensation industry is this:
How long are you going to put up with overpaying for the same surgical procedure for your workers’ compensation claimants, than what group health insurance pays for its patients for the same procedure under their plans?
And my question to the medical tourism industry is this:
If you claim that medical tourism destination hospitals offer lower cost health care than what is available in the US, then why are you not actively pursuing the workers’ compensation market, instead of just pursuing the private or group health care market? Do breast augmentations/reductions, plastic surgery and other common medical tourism procedures make more profit than that of the US workers’ compensation industry, or is it a lack of vision thing?
Do I have to spell it out every time I write an article? The American health care system (and that includes workers’ compensation) is too expensive. Yes, I know there are regulatory differences between health care and workers’ compensation. Yes, I know that in certain cases, there may be different processes involved with the same type of surgery for different patients. And yes, I realize that there are risk and complications; but really, what difference does it make if the patient was injured on the job and needs shoulder surgery, or if the patient was a weekend warrior playing hoops, football, baseball, or a myriad other sports and activities and needs the same type of surgery? Not much.
The only difference is who pays, and how much, and based on this latest study, it seems the workers’ compensation industry is being hosed, big time. Time to wake up and explore the alternatives to high cost medical care for injured workers. Time to wake up and realize that the rest of the world is catching up to the “good ole’ USA” and providing better quality health care at lower cost.
I am not saying that it will be easy to implement medical tourism, so no one should think reading this that this is what I am advocating. And I am not saying that every destination is up to the task of providing such services. Far from it, but those that can, should be explored. Those that would like to in the future should be encouraged to seek out workers’ compensation carriers, third party administrators and case management firms here in the US for their advice and guidance.
The workers’ compensation industry can take the next step and seriously consider medical tourism, or it can continue to pay at least $2,000 more for the same surgery a group health plan pays. It’s your choice.