Monthly Archives: August 2013

Muy por delante de la multitud

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El título del post de hoy viene de un blogger que todos están familiarizados con estas alturas, Joe Paduda. Joe me dio algunos comentarios el otro día en mi post Lecciones, y al tratar de averiguar cómo llamar a este post, me pareció que éste era un título apropiado, porque he sido siempre muy por delante de la multitud en el tema de la medicina el turismo y la indemnización de los trabajadores, y sobre el tema del post de hoy, que es América Latina.

Uno de mis muy buenos editores, Shanti Nair, en Malasia, me envió un enlace a un comunicado de prensa el SBWire.com titulado “América Latina se convirtió en primer destino de turismo médico”. Otro artículo que encontré en Viajes y Turismo World.com, llamado “turismo médico Boom Testigos de América Latina”, se hace eco de la liberación SBWIRE, pero va un poco más en detalle.

Ambos artículos se analiza un estudio realizado por IPK International, que reveló que aproximadamente el 3 por ciento de la población mundial viaja para el tratamiento médico a los países extranjeros, y ambos se apuntaron a un paciente más allá informe Fronteras, dijo que la industria del turismo médico es un año $ 40 mil millones negocio. (Esto no ha sido confirmado por mí, así que sería mejor que verlo con PBB)

Según el artículo de Viajes y Turismo, el impulso detrás de viajar para recibir atención médica en el extranjero, por lo que se refiere a los EE.UU., está más allá de ahorrar dinero. La comunidad latina se siente atraído por esta, ya que les ofrece la paz de la mente en el tratamiento de los médicos de habla española e instalaciones de calidad. [Énfasis añadido]

Varias cirugías se realizan ahora en México, Costa Rica, Colombia, Argentina y El Salvador. Pacientes sin Fronteras informó que México ahora atrae cada año a más de un millón de pacientes, muchos de los cuales provienen de California, Arizona y Texas, y son principalmente hispanos.

Es la proximidad de América Latina a América del Norte, que hace que el turismo médico tan atractivo, un punto que he estado haciendo desde hace algún tiempo. Otros factores incluyen tasas favorables de cambio, el personal de salud bilingües, culturas amable, climas tropicales, y como he mencionado antes, las barreras culturales más bajos que proporcionarán un período de recuperación relajado, con amigos y familiares en los países que pueden visitar al paciente mientras se recuperaba.

Viajes y Tour Mundial también figuran destinos populares en América Latina, tales como: Costa Rica, Panamá, México, Brasil y Colombia.

Aquellos de ustedes que han estado leyendo mi blog desde hace algún tiempo se nota que he mencionado estos países antes, así que no viene como una sorpresa para usted que estos son los más populares destinos de turismo médico.

Volviendo al título de esta pieza, tuve una conversación de correo electrónico que se ejecuta con Joe ayer por la mañana antes de que tuviera que dejar para un funeral, y el resultado de nuestra conversación fue que la industria de la compensación de los trabajadores no cambia a menos que se ve obligado a cambiar. Mi respuesta a eso fue que la industria tendrá que cambiar si quiere o no, y si le gusta o no, no por mí o mi forma de escribir, sino porque como se puede ver en el mensaje que acompaña a éste, el población de los EE.UU., y la mano de obra es cada vez más hispanos, y hacer caso omiso de su deseo de buscar atención médica en el extranjero en su país de origen, no sólo es caro, ya que los costos son más bajos en estas instalaciones, pero también es contraproducente, en que los mejores resultados y los empleados más felices serán el resultado de aplicar el turismo médico en la compensación de los trabajadores.

Y en cuanto a estar muy por delante de la multitud en este tema, tengo que decir que me siento orgulloso de ser hasta ahora en frente de la multitud, si la futura fuerza laboral de los EE.UU. va a ser más hispanos, pero también me quedo con las ganas que la industria de la remuneración de los trabajadores es lo que va detrás de lo que el resto del mundo está haciendo. La atención médica no se detiene en el borde del agua, y tampoco deberías compensación para trabajadores.

Sí, es un tema complejo, que es otra cosa Joe mencionó a mí, pero eso es porque hemos hecho así. David DePaolo, que escribí el otro día, así lo dijo hace un tiempo, y creo que tiene razón. Hemos dedicado más esfuerzo en tratar con abogados, proveedores, pagadores, proveedores de servicios, etc, y hemos olvidado lo que la compensación de los trabajadores se trata. Se trata de la demandante / paciente, y no debemos pensar en lo que es mejor para ellos, y lo que quiere hacer?

Cuidado, los trabajadores un borrador, el cambio viene, y será mejor que a bordo.

Translated by Google Translate

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Me gustaría llegar a conocerte mejor, así que por favor rellene el formulario abajo y quiero saber quién eres, de dónde eres, y lo que me gusta de mi blog.

Muchas gracias,

Richard

Far In Front of the Crowd

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The title of today’s post comes from a blogger you are all familiar with by now, Joe Paduda. Joe provided me some feedback the other day on my Lessons post, and while trying to figure out what to call this post, I felt that this was an appropriate title, because I have been consistently far in front of the crowd on the issue of medical tourism and workers’ compensation, and on the subject of today’s post, which is Latin America.

One of my very good publishers, Santhi Nair, in Malaysia, sent me a link to a press release on SBWire.com entitled, “Latin America Becoming Prime Destination for Medical Tourism”. Another article that I found on Travel and Tour World.com, called “Latin America’s Medical Tourism Witnessing Boom”,echoes the SBWire release, but goes a bit more into detail.

Both articles discuss a survey conducted by IPK International that revealed that roughly 3 percent of the world’s population travels for medical treatment to foreign countries, and they both pointed to a Patient Beyond Borders report that stated that the medical tourism industry is a $40 billion a year business. (This has not been confirmed by me, so it would be best to check it out with PBB)

According to the Travel and Tour article, the impetus behind traveling for medical care abroad, as far as the US is concerned, is beyond saving money. The Latino community is attracted to this because it affords them peace of mind in dealing with Spanish-speaking doctors and quality facilities. [Emphasis added]

Various surgeries are now performed in Mexico, Costa Rica, Colombia, Argentina, and El Salvador. Patients Beyond Borders reported that Mexico now attracts more than a million patients a year, many of whom come from California, Arizona and Texas, and are mainly Hispanic.

It is Latin America’s proximity to North America that makes medical tourism so attractive, a point I have been making for some time. Other factors include favorable exchange rates, bilingual healthcare personnel, friendly cultures, tropical climates, and as I have mentioned before, lower cultural barriers that will provide a relaxed recovery period, with friends and family in those countries able to visit the patient while recuperating.

Travel and Tour World also listed popular destinations in Latin America such as: Costa Rica, Panama, Mexico, Brazil and Colombia.

Those of you who have been reading my blog for some time will note that I have mentioned these countries before, so it does not come as a surprise to you that these are the most popular medical tourism destinations.

Getting back to the title of this piece, I had a running email conversation with Joe yesterday morning before I had to leave for a memorial service, and the upshot of our conversation was that the workers’ compensation industry does not change unless it is forced to change. My reply to that was that the industry will have to change whether it wants to or not, and whether it likes it or not, not because of me or my writing, but because as you will see in the companion post to this one, the US population, and the workforce is becoming increasingly more Hispanic, and to ignore their desire to seek medical care abroad in their home countries, is not only expensive, given that costs are lower in these facilities, but it is also counter-productive, in that better outcomes and happier employees will result from implementing medical tourism into workers’ compensation.

And as for being far in front of the crowd on this issue, I have to say I am proud to be so far in front of the crowd, if the future workforce of the US is going to be more Hispanic, but I am also disappointed that the workers’ compensation industry is so far behind what the rest of the world is doing. Medical care is not stopping at the water’s edge, and neither should workers’ compensation.

Yes, it is a complex issue, which is something else Joe mentioned to me, but that’s because we have made it so. David DePaolo, who I wrote about the other day, said so a while back, and I think he is right. We have spent more effort on dealing with lawyers, providers, payers, service providers, etc., and have forgotten what workers’ compensation is all about. It’s about the claimant/patient, and shouldn’t we think about what is best for them, and what they would want to do?

Watch out, workers’ comp, change is coming, and you’d better get on board with it.

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Thank you so much,

Richard

Lessons

Today’s post is by way of David DePaolo, on his DePaolo’s Work Comp World blog. It has been a while since I reported on anything from Dave’s blog, because most of the time he writes about California work comp, and has no bearing on the implementation of medical tourism into workers’ compensation.

But Dave’s article yesterday, ACA’s Impact on Comp – Lessons Learned, caught my eye, not because of the ACA, but because of what Dave had to say about workers’ compensation and general health care, and what lessons can be learned from it that can apply to workers’ compensation.

The article discusses the 68th Annual Workers’ Compensation Educational Conference that was held last week in Orlando, Florida, and at which Dave was in attendance. He noted that the ACA was the topic at many of the sessions at the conference, and that the consensus of the presentations was that the impact of the ACA was uncertain.

But what struck me was the fact that Dave reported one senior executive being optimistic about the health quality outcomes based standards and reward system for general health care that could spill over into workers’ compensation.

The general health care system, Dave said, has lead the workers’ compensation system in several respects, and generally by years, in such things as treatment guidelines and protocol, billing standards, electronic records and reimbursement systems, etc.

That brought to Dave’s mind, an earlier conference some years ago, also in Orlando, where the Chief Medical Officer for Liberty Mutual Insurance Company asked the audience, if given the choice between general health care and workers’ compensation, how many would choose workers’ compensation. No one raised their hands.

If the senior executive Dave mentioned is correct about spill over, might there also be other spillovers from general health care that can improve the quality and cost of the workers’ compensation system.

Perhaps as more people are covered under ACA, and the doctor and nurse shortage leads some to go abroad for general health care, the same impulse will be felt within the workers’ compensation industry.

One thing is certain from Dave’s article, there are lessons to be learned from general health care that the workers’ compensation industry needs to learn, and perhaps medical tourism is one of them.

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Thank you so much,

Richard

Getting to know you

To all my readers around the world:

Having now written over sixty blog articles and seeing where the visitors are coming from, I’d like to get to know you better, so please complete the form and let me know who you are, where you are, and what you like about my blog.

Thank you so much,

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Testimonial on Medical Tourism in Mexico

Here is a comment from a plan administrator in California that is so positive about medical tourism, that I had to share it with the blog readers and with those who read my posts from LinkedIn.

I administer a plan serving farmworkers, mostly in California, predominantly Mexican and Mexican American, predominantly Spanish speaking. We have long used providers of medical and dental services and some pharmacy services on the border in Mexico at negotiated rates well below US rates. One thing I noticed a couple of years ago – at a large travel convention in Los Angeles next to the meetings I attended there were two booths – one from Mexicali Tourism Board or Bureau and another from Tijuana. Both had several hotels – on both sides of the border promoting that they would provide transportation to and from various medical facilities – in other words, the medical providers and the lodging businesses were allied in promoting medical tourism to their respective areas. Later at a meeting in Palm Desert I ended up sitting next to a woman representing hotels in the Palm Springs area and suggested she may want to talk with the providers in her area about a similar marketing promotion. I agree that obtaining more transparent pricing from providers is critical – but it really is not that difficult to negotiate – at least with the Mexico based providers we have dealt with. My dominant population often prefers to travel to Mexico just for medical services – partly for the financial savings but also for “peace of mind” reasons – the providers speak the language, may have served them or family and/or friends in the past and there is a much greater sense of ease in such circumstances. I think US employers will find it worth the time to consider medical tourism options.

Immigration and Workers’ Compensation: Round Two

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Now that the summer is almost over, and we have had a brief, educational interlude, thanks to my recent quiz and the article about the 1798 mandated health care law for merchant sailors, let’s turn back to more serious and more immediate subjects that are relevant to our times.

One such subject is immigration, and thanks to both Joe Paduda and Peter Rousmaniere, today’s post will build upon that subject, as I have previously written about it in my earlier posts, The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation, Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, as well as my post, Survey says most immigrant workers unaware of Workers’ Compensation: What this means to Workers’ Compensation and Medical Tourism.

Joe’s post today, Immigrants in the workforce – and implications thereof, mentions that one of every seven workers in the US is foreign-born, and that about half are Hispanic and a quarter Asian.  About a third of the foreign born workers are undocumented.

Peter’s post, Foreign Born Workers Take Center Stage, in WorkCompWire.com, reiterates some of the statistics I mentioned in my posts on the subject, that foreign workers are skewed toward above average injury risk jobs, and sustain a large share of the nation’s annual three million work injuries.

He goes on to add that in 2012, there were 25 million foreign-born persons in the U.S. labor force, comprising 16% of the total workforce. Hispanics accounted for 48% of the foreign-born labor force in 2012, and Asians accounted for 24%. (Recently Asians have been entering the U.S. at higher levels than Hispanics.) Undocumented workers account overall for about 5% of the nation’s total workforce and roughly one third of foreign-born workers.

There are three key takeaways for those in the workers’ compensation arena to be aware of:

      • A foreign born worker poses higher injury risk due to language barriers, cultural miscues and poor health literacy.
      • The growing presence of immigrant workers is not temporary and reversible. It is part of global economic forces. Some 150 million workers globally are estimated to be working outside their country of origin.
      • Private sector employment growth has been and will continue be in fields with relatively high immigrant participation, ranging from software engineers to personal health aides.

Peter also details which industries are more likely to have high percentages of foreign-born workers and what that entails for future workers’ compensation injuries, something I also mentioned in an earlier piece. A key passage in his article states the following:

When you estimate the number of future work injuries, taking into account the injury rates of the individual jobs and their expected growth of openings, you find that immigrant workers will likely sustain 20% — one of every five – of work injuries.

The implications of this are clear as Joe points, out in his blog post today, and that I have already touched upon in the Survey piece, namely that:

Given these facts, it might be worth the workers’ compensation industry’s while to explore and seriously consider medical tourism as an alternative, but as much of the industry is focused on the issues of opioid abuse and the physician dispensing of drugs, which are certainly important issues, they nevertheless cannot blind the industry to other issues such as the impact of immigration on workers’ compensation, and to the alternatives that are out there to deal with them.

As I have been saying for some time, the implementation of medical tourism into the American workers’ compensation system is not just some fanciful dream or exercise in seeing myself in print. It is a rational, thoughtful and reasoned alternative to the high cost of medical care, not only within the general health care system of the US, but within the niche market that is the US Workers’ Compensation system.

As Joe and Peter so skillfully point out, and as I have done so in the past, the future American workforce will be made up of men and women who either were born in, or whose families came from countries in the Latin American and Caribbean region.

Sending injured workers to these and other countries in the region for medical treatment is a logical idea because of language and cultural barriers, access to quality medical care in the best facilities in their native countries or similar countries, and the ability of friends and relatives living there to visit the injured worker while recuperating from surgery, and therefore making recovery faster and more likely to have better outcomes.

If Peter’s 20% figure is correct, then it is safe to assume that a percentage of those injuries will require surgery at some point in the treatment process.

And if they will require surgery, what guarantees do we have that negotiations and fee schedules will bring down the cost of these future surgeries here at home, when a cheaper, better quality alternative is just a short flight away from the US mainland?

I have tried to get data on costs of certain surgeries common to workers’ compensation from a facility in the Caribbean and from hospitals in Latin America, and while I have also written about how difficult it is in getting such information, it nevertheless is imperative that the workers’ compensation industry gets behind this idea, and pushes for transparency from these facilities so that comparisons can be made between costs here and costs there, as well as quality.

But let me be clear, this is not going to be easy, and I have said it before, and it needs to be said again and again, it will be difficult to implement medical tourism into workers’ compensation, but can you really afford not to?

Recently, I had a conversation with the President and CEO of a surgery benefit management company, who also had the same idea, and in our conversation, he told me that he believed that the savings would have to be greater than $5,000, including surgery and airfare, for medical tourism to be a financially viable alternative to the high cost of surgery. His business model relied on getting the lowest cost domestically for his clients, which is still higher than what might be possible in Latin America or the Caribbean, but without reliable data, it is impossible to prove that claim.

What needs to happen is this, both the medical tourism industry and the workers’ compensation industry need to find each other and begin the process of determining how best they can help each other, and how best they can serve each other’s needs. One way for this to happen is for large, workers’ compensation services companies that already provide various services to the workers’ compensation industry such as medical care, translation services, and transportation services, through an in-house or contracted travel agency, so that their insurance carrier or employer clients can confidently and effectively secure better quality and lower cost care for their foreign and native born workforce in the event of serious work-related injuries.

The workers’ compensation industry needs to get focused on this issue, and the medical tourism industry needs to come clean with just how much it costs to perform surgery X, Y, or Z, and in which countries. Not being transparent and basing costs on multiple factors is like buying a car and being told that the price depends on the color, the time of day it is bought, the time of year, whether or not the salesman woke up on the right side of the bed that morning, and so on.

We cannot shut out the rest of the world, despite what the Tea Party wants, because like their Know-Nothing and Whig Party forefathers, they too will disappear from history if they continue to ignore the immigration issue. Let’s hope the medical tourism and workers’ compensation industries don’t either.

Answers to Last Week’s Quiz

Unfortunately, only one person was brave enough to attempt the quiz, and that person got half of them right.

This says one of two things, either they were very hard quotes to figure out who said them, or we are woefully ignorant about the subject of health care and the history of ideas about health and health care.

Such ignorance plays into the hands of those who would deny health care for all, since they can claim that it is not a “right”, when in reality, we have seen with the passage of the Act for the Relief of Sick and Disabled Seamen in 1798, and through the quotes, that health care was seen as a right; however, it was only seen in the abstract and not as a concrete reality that government had to provide.

Here are the answers:

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