Monthly Archives: October 2013

New report on growth of medical tourism

As reported last week on Medicalsea.org, a new report by Research and Markets.com, entitled “Medical Tourism Market – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2013 – 2019“, analyzes the medical tourism industry and singles out several major medical tourism destinations such as India, Thailand, Singapore, Malaysia, Mexico, Brazil, Taiwan, Turkey, South Korea, Costa Rica, Poland, Dubai and the Philippines.

The report is available online for between $4,795 and $10,795 US, depending on user size: single user, 1- 5 users, or enterprise-wide.

Health care is globalizing, and to deny it, or to avoid it, is foolish, expensive and dangerous to your bottom line. Quality measures are better, costs are lower, and training in Western medical schools mean that more and more physicians are being trained on the same equipment and with the same knowledge Western doctors are trained on.

Health care no longer stops at the water’s edge, so open your eyes and go see for yourself.

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Richard

What A Long Strange Year It’s Been – My Year as a Medical Tourism Blogger

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Introduction

Today marks one year that I began my blog on medical tourism and its implementation into workers’ compensation.  From the beginning, I did not have any idea if my blog would be successful, or if it would be a complete failure. One year in, with over 8,000 views, and less than 100 followers, the jury is still out, so it remains to be seen where the blog goes in the next year.

Yet, just this month, on October 7th, I had 233 views (highest ever) and 205 visitors. But one thing is certain; I have had a very interesting time writing it, and have made some wonderful connections both in the medical tourism industry and out of the industry, from all over the world. But I have also had some rather disappointing experiences as well. This post then is a look back and maybe a look forward to another year of blogging, hopefully more rewarding, both career-wise and financially than this year coming to a close has been.

Why I started the Blog

I started the blog for three reasons: One, I had just attended the MTA Congress in Hollywood, Florida three days earlier, after they had published my White Paper on their website. The White Paper was too long for their online magazine, so they asked me if I would not mind it if they published as a White Paper. When I said yes, they eventually invited me to come to the Congress free of charge, for which I was very grateful, since I was unable to spend that much money to participate. After the Congress was over, I had learned from a few industry sources and two legal experts, that the MTA copyrighted my paper without my written permission, so I had one of the lawyers find me a template so that we could use to send them a letter asking them to either remove the copyright, and remove the Editor-In-Chief’s name from it, or remove it altogether and let me know in writing. They did remove the paper, but I had to find out for myself when I went to their website.

The second reason I started the blog was because of my MHA degree (Masters in Health Administration) which I received a year earlier, and for which I wrote the term paper that was the basis of the much longer White Paper. My Health Law class required a paper on a legal topic in Health Care, and since I had neither a legal background, nor a health care background, I went out to social media to find a topic. The first topic suggested to me did not yield much information and was not a good research subject, so again I went out to social media, and a lawyer in CA gave me the idea to write about the legal barriers to implementing international medical tourism into workers’ compensation. She helped with getting legal cases and some of the editing of the original paper, as well as some of the work expanding it into the larger White Paper. I was unsuccessful in getting any legal journals to publish it, so that is when I turned to the MTA.

The third and most important reason why I began my blog was to explore new avenues of employment in either medical tourism or in workers’ comp, or even health care. I did this because I felt my workers’ compensation and insurance experience, which consists of work in Auto No-Fault, Risk Management and Insurance Data Processing with regard to claims, brokerage and statistical reporting of workers’ compensation claims and policy data, would be valuable to organizations in those industries. Unfortunately, due to the economic downturn and jobless recovery, many companies have curtailed their hiring, and many are just filling jobs that require a finite set of skills and background that I do not possess. I have made connections both before my degree and after with executives in many companies, and in many parts of the US, but have gotten little or no response to my inquiries.

My career has been somewhat broad and varied, depending on the nature of jobs available at the time, but they have given me an insight into the world of insurance in general, and the world of workers’ compensation in particular, so after attending the Congress, and meeting different people from other countries, and hearing one company’s experience as a self-insured employer utilizing medical tourism for their employees on their health care plan, I thought that it might be possible to do the same for those employers who are self-insured for workers’ compensation, as well as those who purchase workers’ compensation insurance in the insurance market.

A Brief Review of Past Posts

My first post, on October 29, 2012 was a recap of what I learned at the Congress and what I thought about medical tourism as a viable alternative to high cost medical care in the US. The post, entitled, What I Learned at the 5th World Medical Tourism & Global Healthcare Congress, and Why It Matters to the Workers’ Compensation Industry, also discusses the three cases I cited in my paper which involved some form of medical tourism; either domestic medical tourism, or cross-border medical tourism,( i.e., Mexico), from CA and FL.

The third post I wrote was a shortened version of my White Paper, called Medical Tourism and Workers’ Compensation: What are the barriers? Here, I attempted to get the workers’ comp industry interested in the idea by giving them the highlights of my original paper. Almost immediately after I began blogging, my posts were picked up by other blogs and newsletters in the health care and medical tourism industries, and I am thankful for their faith in me as a blogger that they continue to do so.

As a further inducement to get some interest in the idea of implementing medical tourism into workers’ comp, I created a fictional case study about a self-insured employer who is self-insured for both health care and workers’ comp, but whose Risk Manager was unaware of how much money he could save if he followed what the Employee Benefits Manager was doing on the health care side with medical tourism. In the case study, A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, three workers sustained injuries while working at a job site and needed surgery that would have cost the company thousands of dollars. The Risk Manager told the Employee Benefits Manager about this, and learned that the company was sending its workers to countries in Central America for less expensive health care with better quality outcomes, and the Benefits Manager suggested he do the same with the injured workers.

The one topic that I have written the most about in the past year was about the impact of immigration reform on workers’ compensation, and subsequently, on medical tourism. The following posts were written because I came to believe that Latin America and the Caribbean was the most logical region of the world to pursue medical tourism, since it is so much closer to the mainland US and the workforce here is increasingly Latino and Caribbean.  These are the four 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, Immigration and Workers’ Compensation: Round Two, Testimonial on Medical Tourism in Mexico.

The last post was supposed to be followed by even more testimonials, and may still be, but it will have to wait until after this one is posted. Finally, I decided that I should acquaint the workers’ comp industry with some of the medical tourism facilities that had booths at the MTA Congress, so I wrote the following post from literature I gathered during the last two days when the Exhibition Hall was open. No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin America and the Caribbean, simply listed the hospitals and clinics by country and listed the hospital’s websites, where available. It would be up to the reader, I felt to check them out.

What I have learned About Medical Tourism – The Good, the Bad, and the Ugly

My experience writing the blog has educated me about the medical tourism industry, even though I do not actually work in it at present. Perhaps being an outside observer gives me an honest and forthright perspective that many inside the industry don’t have, but in my email conversations with some of them, they are already aware of the nature of the beast, as it were, so here are my thoughts about the industry —the Good, the Bad, and the Ugly (with apologies to Sergio Leone, but not to “Mr. Talks-to -empty-chairs”).

The Good

In the past year, I have met some very nice and dedicated people who want to provide patients with quality health care, at affordable prices, plus a little extra on the side. Whether it was at the MTA Congress last October where I met people from Mexico, Guatemala (Belgian, actually), Australia, Singapore, China, Canada, Finland and the US, or online through my blog or my LinkedIn profile, I know that the medical tourism industry has very good promoters and patient advocates.

Many of the online connections I have made are in India, which is the primary destination for medical tourism. But there have been other connections made all across the globe from Europe, the Middle East, East Asia, Africa, and some from Latin America and the Caribbean. This proves to me that medical tourism is a growing and dynamic industry that will continue to grow, provided that it attracts the same kind of people I have connected with over the past year. Yet, as we shall see below, there is a grey cloud and a dark cloud over the industry, which threatens its long-term sustainability and growth…the bad and the ugly sides of medical tourism.

The Bad

Any industry and any business in that industry must be able to not only justify its existence, but to prove its value and worth to the customer, and medical tourism is no exception. So, it has been disheartening to me that I have been unable to get exact cost figures for certain surgeries that are common to workers’ compensation from some medical tourism facilities in Latin America and the Caribbean, as I described in my post, If You Have to Ask…Fuggedaboutit!.

In that post, I said that transparency on costs was vital if the medical tourism industry wanted to pursue business in the American workers’ compensation industry, because employers, insurance companies, and third party administrators will want to know up front if this is really a less expensive alternative to high-cost surgery in the US. I even cited surgical costs from some countries in the region, and some costs from Asian countries that I originally cited in my White Paper. These last figures, I have been told by some people are not accurate and therefore, are only a guesstimate of the actual costs.

In addition, I have been told that figures on the number of Americans going abroad for care are inflated, often because they count expatriates who are living and working in those countries as patients, besides those who actually did travel abroad for treatment, so again here is another area where transparency is needed.

Finally, as I point out in my post, Ensuring Patient Safety: Making Sure Medical Tourism Puts Its Money Where Its Mouth Is, patient safety and quality are also important areas where transparency must be observed if the medical tourism industry is to be more than just a rich man’s game. You have to prove to all stakeholders in the care and treatment of patients, and even the patients themselves, that you have equal or better quality outcomes than what is available in the US, and that patient safety, like costs and numbers of treated patients, are presented upfront and clearly to all interested parties. Failing to do so will only drag down the growth of medical tourism, and may even give it a black eye from which it may never recover.

The Ugly

As in any endeavor, individuals are bound to find detractors who critique and even attack you for your beliefs and for your efforts. I am no exception to that, and have received my share of critiques and attacks during the past year. I answered these critics in the following two posts, The Faith of My Conviction: Integrating Medical Tourism into Workers’ Compensation is Possible and is not a Pipe Dream, and Clearing the Air: My Defense of Implementing Medical Tourism into Workers’ Compensation.

I am not going to rehash this issue here again, but only bring it up as one part of what I see as the ugly side of medical tourism. There is too much personal animosity among certain individuals and organizations, especially in an industry that is still in its infancy. And while I have accepted an apology from one of my critics, there are still some ugly and vile behaviors that have been perpetrated against well-meaning and decent people who just want to grow this industry from the bottom up, instead of from the top down. There is no reason why people have to be nasty to each other, there is enough business on this planet of seven billion to go around.

Any organization that purports to represent the interests of an industry at large, and whose executives claim to be reputable spokespersons for that industry, must not engage in childish and unprofessional behavior that casts doubt on the individuals involved, the organization they belong to and the industry as a whole.

Holding fancy conferences around the world and charging big numbers only to see a handful of attendees actually paying and the rest being invited or begged to attend, does not suggest a healthy and vibrant industry, nor does it show that the leading organization promoting that industry is a trustworthy and honest one.

What I have not gotten from both industries

Medical Tourism industry

Perhaps it is because many in the industry have a background in general health care, or perhaps it is because they have experience in the travel, wellness and resort industries, that many of the people who have connected with me are not familiar or aware of what potential the US workers’ compensation market can be. I have received many offers of partnerships with these individuals, but I have to point out to them that I am not a doctor, I am not a medical tourism facilitator, nor do I have any other business that would partner with them in such an endeavor, and therefore, cannot refer patients to them.

Naturally, I thank them for considering me, but given that many of them are in Asia, and I am focusing on Latin America and the Caribbean, there is no reason for me to explore it. I would, however, like to hear from some organization or company doing business in that region who is seriously considering entering a new market such as workers’ compensation, given the increase in the Hispanic and Caribbean workforce in the US. That region has many “rising stars” in the medical tourism world, and can be very lucrative if the right people recognize its potential.

In addition, the newsletters and blogs that have re-posted my posts have for the most part, not generated much feedback or comments, and I wonder if anyone besides the publishers and their staffs are reading them. My own blog publishing site, WordPress.com, has garnered me nearly 10,000 views since I began blogging, but again, the response has been rather weak.

Workers’ Compensation industry

As I stated above, the most important reason why I began the blog was to simply find a job in the workers’ compensation industry after spending two years in school getting my MHA degree and looking for work after the recession and jobless recovery following the events of 9/11, the housing bubble that burst in 2007, and the financial collapse of 2008. The problem that I and many others are facing is that the industry is shrinking and companies are being bought by either their competitors, or by private equity firms, such as what just was announced recently when a company called Apax Partners bought One Call Care Management (OCCM), a workers’ compensation services company in a multi-billion dollar deal.

In May, I had lunch with one of OCCM’s Regional Sales Directors who shares my idea about medical tourism and workers’ compensation, and who thought we might be able to put something together that would address his clients’ concerns about the high cost of surgery. His company provides transportation, translation, home care equipment and medical devices to the work comp industry, and even has an in-house travel agency, which would make them the ideal medical tourism facilitator for workers’ compensation patients.

After several phone calls that ended without any further action on our parts, I decided to contact the top management of his company, even sending my White Paper and resume to the Chairman of the company and the President and CEO. That was back in September, and one month later, I have not heard from either of them.

I learned recently that because of this deal, it is unlikely that the President of the company will do anything with my idea. That seems to be the case with many other companies, and why I have gotten no traction with my idea from anyone else in the workers’ comp industry. When I post my blog posts on social media, it is like they are falling on deaf ears, or in this case, blind eyes. They seem to more concerned with being bought up, dealing with the opioid issue, or the physician dispensing issue (which is related to the opioid issue), or they just don’t see this as a viable alternative because they are too conservative and too cautious, and too willing to do the same things over and over again and expect different results. That, as I said before in a more recent post, is The Definition of Crazy.

Predictions

Making predictions nowadays is a little like knowing what Ted Cruz is going to do next for an encore; they’re unpredictable and designed to make the person doing so look good, so to spare you and me from any embarrassment, let me just add that health care is changing, and the direction that it takes will depend a lot on what has already happened, and what is currently happening, especially in light of the problems with the ACA rollout earlier this month.

But my recent post, Ten Years On: One Person’s View of Where the Medical Tourism Industry will be a decade from now, spells out some of the things that may influence the direction medical tourism takes in the future. Hospital costs, outpatient costs, consolidation of hospitals, cost to employees, immigration reform and technology will all play a role in determining the direction medical tourism takes in the next ten years and beyond.

Conclusion

As I begin a new year of blogging, I am grateful for the opportunity to provide my readers with new knowledge and insights to different topics, ideas and issues that affect not only workers’ compensation, but all of health care, medical tourism included. I hope that my writing has made many of you stop and think and look at things in a different light. I also hope that you have been entertained by my writing, as far as a serious subject can be entertaining when it pertains to human life.

But most important, I hope that this next year will provide with me everything I had hoped the last year would have; a new position, recognition of my idea as a viable alternative to high cost health care for workers’ compensation, and greater opportunities to personally interact and meet so many of the people engaged in the medical tourism industry around the world.

Here’s to a better blogging year!

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I’d like to get to know you better, so please complete the form below and let me know who you are, where you are from (country and city, please), and what you like about my blog.

Thank you so much,

Richard

“Have I Got A Deal For You?” — The Medical-Device Tax Shuffle and Medical Tourism

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An Opinion piece in today’s New York Times by Topher Spiro, VP for health policy at the Center for American Progress, brought to mind two earlier posts I wrote about medical devices, more specifically hip replacements.

The first post, How much is that Hip Replacement in the Window?, described one woman’s attempt to get prices for hip replacement for her fictitious grandmother. The second post, If it is Tuesday, It Must Be Belgium, or an Inexpensive Hip Surgery, described how an American man went to Belgium to get a hip replacement and discovered that the cost of his hip differed drastically in Belgium from the price it cost in the US. The hip he received was manufactured by the same company that had quoted him a higher price here.

Spiro’s article, The Myth of the Medical-Device Tax, explodes the myth about the Medical-Device tax and its repeal, which was one of the ransom demands made by the Tea Party Republicans, as part of their attempt to defund, delay or repeal outright, the ACA, also known as “Obamacare”, during the recent hostage taking affair that ended today.

According to Spiro, the medical-device industry waged an intense lobbying campaign to repeal the tax on medical-devices, claiming that it would stifle innovation and increase health care costs. Spiro rightly labels this argument as “doubly disingenuous”, because he states that not only can the industry afford the tax without compromising innovation, but their enormous profits are the result of anticompetitive practices that drive up medical costs. He calls the tax a distraction from urgently needed reform to lower costs.

Here’s where the shuffle comes in, according to Spiro:

  • The medical-device industry faces virtually no price competition.
  • Confidentiality agreements that manufacturers require hospitals to sign mean the prices of the devices are cloaked in secrecy.
  • Lack of transparency (where have we heard this before, I wonder?) impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
  • Manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) – more like bribes [emphasis added] with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest.
  • Often the physicians don’t know the costs of the devices and the individual physicians choose devices on their own, weakening the hospitals ability to get volume discounts.

These anticompetitive practices, Spiro writes, help generate a wide variation in the prices of medical devices, which contribute to higher prices in general. Spiro points out that the GAO (General Accountability Office of the US Congress), found that prices for implantable cardiac devices in the US vary by several thousand dollars, and the lowest-price devices are expensive when compared to those in other developed countries, as my second post on the subject describes in Belgium.

Spiro cites the consulting firm, McKinsey & Company, who reported that the US spends about 50% more on the top five medical devices, compared with Europe and Japan. This amounts to $26 billion in excessive spending each year, according to McKinsey.

What does Spiro recommend to lower costs? Here are the three key points he makes:

  • End the anticompetitive practices that prevent hospitals from getting the best deals.
  • Medicare should force manufacturers to compete for business based on a product’s price and quality, instead of simply paying hospitals based in part on what they have spent on them.
  • Medicare should also pay hospitals a single lump sum for all associated costs of a procedure, like hip replacements. This is called “bundling”.

With the recent “temper tantrum” of the GOP now abated for the next two or three months, it seems that the ACA is safe from the likes of Ted Cruz and his band of 18th century Classical Libertarians (i.e., conservative, laissez-faire capitalism). But as anyone who understands the mindset of such individuals knows, they will never give up in their attempt to recrudesce the Calvinist, Puritan spirit of original capitalism that Max Weber so eloquently described in his now-famous essay, “The Protestant Ethic and the Spirit of Capitalism”.

Yet, when one examines the high cost of the US health care system, due in part to  the free-market, and in the case of hip replacements, that traditional, capitalist practices as fair competition and transparency of prices, can be distorted by the manufacturers of such devices, then perhaps it is time to change direction and allow greater competition and greater transparency by opening up the US health care system to medical tourism, and for our purposes on this blog, the workers’ compensation system as well.

We have seen in the earlier posts that I have written on the subject, and others, that medical tourism can offer better health care at lower cost and at equal or better quality than what is available in the US today. I have said this before, and it bears repeating again and again…both the medical tourism industry and the workers’ compensation industry, must get to know each other, so that price transparency can  prove once and for all that medical tourism destinations are really cheaper than anything the workers’ compensation industry claims they can get here, and the workers’ compensation industry can see proof from the medical tourism industry that their quality is better.

It’s a win-win for both. To not do so is, well, you know, crazy.

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Richard

US Companies Look to ‘Medical Tourism’ To Cut Costs

http://abcnews.go.com/Health/americans-surgeries-overseas-us-companies-medical-tourism-health/story?id=20423011

ABC’s Nightline program featuring video of two Americans getting health care in Costa Rica. Ignore the Fruit of the Loom ad and the story about the government shutdown. Both patients are getting their care paid for by their employer, one patient is retired, and the other is currently employed. Both received $2,500 from their company as a portion of the savings the company realized by sending them abroad. If they do this for general health care, why not for workers’ comp?

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Thank you so much,

Richard

 

Debunking Myths

Keith Pollard on the International Medical Tourism Journal (IMTJ) blog today exploded five myths surrounding medical tourism that I thought you’d like to know about. While I agree with much of what Keith has to say, I am still convinced that there is a place for medical tourism in the workers’ comp process here in the US, given the demographic changes taking place with Latino, Caribbean, and even Asian immigrants.

The five myths are:

  1. The exponential growth of medical tourism
  2. Global healthcare (this is where Keith and I may disagree, but I don’t feel he is wrong at the present time. I am looking far ahead into the future, so who knows?
  3. The medical tourism cluster
  4. JCI accreditation is the key to success
  5. Build it and they will come

As I’ve said in the past, I know that implementing medical tourism into workers’ compensation will not be easy, nor is it risk-free; nothing ever is, but to dismiss it outright without trying it and seeing if it will work is like trying to defund, delay or repeal the ACA, either before the exchanges went online last week, or after last Tuesday when the system crashed because too many people were accessing it.

Keith does make one point that I agree with slightly. He says that given a choice to be treated anywhere in the world, “They would stay at home…. because what they want is to be treated in an environment they know, by people they trust, in a culture and language that they understand.” I agree with him on the last part, which is why I have strongly pushed Latin America and the Caribbean as the best region for American workers’ compensation implementation.

So it remains to be seen what the future of medical tourism will be, but it can be a bright one if all interested parties recognize the strengths, weakness, threats and opportunities that medical tourism offers.

To read the rest of Keith’s article, go to: http://www.imtj.com/blog/2013/five-medical-tourism-myths-40186/?utm_source=IMTJ_News&utm_medium=Email&utm_campaign=IMTJ_News_131007&utm_content=TextLink&inf_contact_key=a21a6625ed8726ee291dc6890f3853d5e998d50ddd1cf4c4e3b7bc270e8ddb04

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Richard

The Definition of Crazy

As reported earlier this week by Nancy Grover in Risk and Insurance, workers’ compensation payers are losing billions in unnecessary costs. Her article focused in on the presentation given at the annual Workers’ Compensation Education Conference in Orlando, Florida by Richard Victor, the executive director of the Workers’ Compensation Research Institute (WCRI).

Victor said that nearly $9 billion in the workers’ comp system is spent on unnecessary medical costs, and represents the pro rata share of $765 billion of unnecessary medical costs spent in the general health care system. He also stated that unnecessary care and unnecessarily high or low costs were among the prime culprits for wasted spending in workers’ comp.

Some of the examples of unnecessary care that drives up costs are some opioids, as I have written about before, and will not address here, and surgeries.

The other culprit was prices, and a study of the prices paid for nonhospital services provided in the first half of 2012 showed difference between states. While the article did not address hospital services, it is safe to assume that such services are also part of the problem, as we have discussed in earlier posts.

According to Victor, “The medical prices in Wisconsin, Indiana, and New Jersey were about double the prices in California, Florida, and North Carolina.”

Prices that are too high are to blame for driving up costs unnecessarily; so too are prices that are too low and may reduce the number of providers willing to treat injured workers. Again, since we are only talking about nonhospital services, we can only speculate on those hospital costs that are too low and may reduce the number of domestic providers to treat injured workers.

This where medical tourism can be implemented into workers’ compensation, provided that prices are transparent and quality is equal to or better than what is available in the US. Not considering alternatives to high costs and low costs that reduce the number of treating physicians is not only a bad idea; it is the definition of crazy.

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I’d like to get to know you better, so please complete the form below and let me know who you are, where you are from (country and city, please), and what you like about my blog.

Thank you so much,

Richard