Monthly Archives: July 2018

Update to Cayman Islands Hospital Delivers Lower Cost Care

Last week, The Economist published a short article on how the medical travel industry  thrives.

I had intended to write about the article, but there was not much there to go on, except for the part that mentioned Health City Cayman Islands. (See post, Cayman Islands Hospital Delivers Lower Cost Care).

As reported in The Economist, when the work first began on the 2,000-bed hospital, the $2 billion project was expected to attract more than 17,000 foreign patients annually, mostly from the US.

However, when the first wing opened in 2014, fewer than 1,000 overseas patients arrived in its first year, according to the International Medical Travel Journal.

One reason give for this was that the backers of the project based their projections of customer numbers on a flawed study, according to an investigation by a government public-accounts committee.

Fewer Americans came, the article said, partly because health care insurance companies were not interested in sending people overseas.

This is not unexpected, even if the backers themselves expected more patients to come from the US. American exceptionalism and the belief that the American health care system is the best in the world, is one reason for the reluctance of US insurers to send patients out of the country.

The other reason is that doing so would not bring in more profit from the ever-growing health care systems that hospitals are building as they purchase more and more practices, and add on more services like insurance that used to be separate from the provider community.

Until health care providers travel overseas to treat patients, as The Economist reports, the lack of patients at Health City Cayman Islands and elsewhere will continue. During the Olympics a few years ago, Dubai Health City advertised regularly during commercial breaks, Perhaps that is what Health City Cayman Islands should do.

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Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

This is an upcoming webinar led by the person who got me started in writing about medical travel, Kristen Montez, Esq. I think that anyone in this space should listen to what she and the other attorneys have to say on the matter.

I am paying her back for all her wonderful efforts on my behalf. Please pay me back by attending.

Thank you.

Your humble blogger.

List of upcoming SDCBA and legal community events including section, committee and division meetings, CLE and other events.

Source: Medical Tourism Agencies and Facilitators: Legal Pitfalls and Risk Mitigation: A Case Study Analysis – SDCBA Calendar

Cayman Islands Hospital Delivers Lower Cost Care

This morning’s post by fellow blogger, Joe Paduda, contained a small paragraph that linked to an article in the Harvard Business Review (HBR) about a hospital in the Cayman Islands that is delivering excellent care at a fraction of the cost.

Joe’s blog generally focuses on health care and workers’ comp issues, and has never crossed over into my territory. Not that I mind that.

In fact, this post is a shoutout to Joe for understanding what many in health care and workers’ comp have failed to realize — the US health care system, which includes workers’ comp medical care, has failed and failed miserably to keep costs down and to provide excellent care at lower cost.

That the medical-industrial complex and their political lackeys refuse to see this is a crime against the rights of Americans to get the best care possible at the lowest cost.

As I have pointed out in previous posts, the average medical cost for lost-time claims in workers’ comp has been rising for more than twenty years, even if from year to year there has been a modest decrease, the trend line has always been on the upward slope, as seen in this chart from this year’s NCCI State of the Line Report.

The authors of the HBR article asked this question: What if you could provide excellent care at ultra-low prices at a location close to the US?

Narayana Health (NH) did exactly that in 2014 when they opened a hospital in the Cayman Islands — Health City Cayman Islands (HCCI). It was close to the US, but outside its regulatory ambit.

The founder of Narayana Health, Dr. Devi Shetty, wanted to disrupt the US health care system with this venture, and established a partnership with the largest American not-for-profit hospital network, Ascension.

According to Dr. Shetty, “For the world to change, American has to change…So it is important that American policy makers and American think-tanks can look at a model that costs a fraction of what they pay and see that it has similarly good outcomes.”

Narayana Health imported innovative practices they honed in India to offer first-rate care for 25-40% of US prices. Prices in India, the authors state, were 2-5% of US prices, but are still 60-75% cheaper than US prices, and at those prices can be extremely profitable as patient volume picked up.

In 2017, HCCI had seen about 30,000 outpatients and over 3,500 inpatients. They performed almost 2,000 procedures, including 759 cath-lab procedures.

HCCI’s outcomes were excellent with a mortality rate of zero — true value-based care. [Emphasis mine]

HCCI is accredited by the JCI, Joint Commission International.

Patient testimonials were glowing, especially from a vascular surgeon from Massachusetts vacationing in the Caymans who underwent open-heart surgery at HCCI following a heart attack. “I see plenty of patients post cardiac surgery. My care and recovery (at HCCI) is as good or better than what I have seen. The model here is what the US health-care system is striving to get to.

A ringing endorsement from a practicing US physician about a medical travel facility and the level of care they provide.

HCCI achieved these ultra-low prices by adopting many of the frugal practices from India:

  • Hospital was built at a cost of $700,00 per bed, versus $2 million per bed in the US. Building has large windows to take advantage of natural light, cutting down on air-conditioning costs. Has open-bay intensive care unit to optimize physical space and required fewer nurses on duty.
  • NH leverage relations with its suppliers in India to get similar discounts at HCCI. All FDA approved medicines were purchased at one-tenth the cost for the same medicines in the US. They bought equipment for one-third or half as much it would cost in the US.
  • They outsourced back-office operations to low-cost but high skilled employees in India.
  • High-performing physicians were transferred from India to HCCI. They were full-time employees on fixed salary with no perverse incentives to perform unnecessary tests or procedures. Physicians at HCCI received about 70% of US salary levels.
  • HCCI saved on costs through intelligent make-versus-buy decisions. Ex., making their own medical oxygen rather than importing it from the US. HCCI saved 40% on energy by building its own 1.2 megawatt solar farm.

And here is the key takeaway:

The HCCI model is potentially very disruptive to US health care. Even with zero copays and deductibles and free travel for the patient and a chaperone for 1-2 weeks, insurers would save a lot of money. [Emphasis mine]

US insurers have watched HCCI with interest, but so far has not offered it as an option to their patients. A team of US doctors came away with this warning: “The Cayman Health City might be one of the disruptors that finally pushes the overly expensive US system to innovate.”

The authors conclude by stating that US health care providers can afford to ignore experiments like HCCI at their own peril.

The attitude towards medical travel among Americans can be summed up by the following from Robert Pearl, CEO of Permanante Medical Group and a clinical professor of surgery at Stanford: “Ask most Americans about obtaining their health care outside the United States, and they respond with disdain and negativity. In their mind, the quality and medical expertise available elsewhere is second-rate, Of course, that’s exactly what Yellow Cab thought about Uber. Kodak thought about digital photography, General Motors thought about Toyota, and Borders thought about Amazon.”

Until this attitude changes, and Americans drop their jingoistic American Exceptionalism, they will continue to pay higher costs for less excellent care in US hospitals. More facilities like HCCI in places like Mexico, Costa Rica, the Caymans, and elsewhere in the region need to step up like HCCI and Narayana Health have. Then the medical-industrial complex will have to change.

Immigrants in construction — key facts « Working Immigrants

Peter Rousmaniere posted the following fact sheet about immigrants working in construction. While this has no bearing on health care at present, it does have some bearing on workers’ comp, especially in light of the current regime’s draconian policy towards immigrants from Central America.

As this “crisis” progresses, it may be harder for construction companies to find workers to employ on construction sites.

This, in turn would mean that they may be less construction work, and for the insurance industry, less risk and less profit to be made from insuring these projects.

In workers’ comp, that would translate into less frequency of losses, but it would also cut off revenue from carriers covering such risks.

And he promised to create jobs? Hardly.

Source: Immigrants in construction — key facts « Working Immigrants

Baby Formula Battle Redux


In the mid-1970’s, a boycott was launched to protest the promotion of baby formula in the Third World by the Nestlé Company of Switzerland. I remember it well, because I researched it while in college.

At the crux of the boycott was that due to poor water quality, and the high cost of the infant formula which was in powder form and had to be mixed with the water, babies were not getting sufficient nutrition from the formula because of contaminated water and because their mothers only used less than the recommended amount of formula to make it last longer.

The worldwide boycott was promoted by a documentary that explained how Nestlé promoted the formula in countries mainly in Africa, and how the contaminated water supply, plus the watered down formula led to various diseases in infants.

The boycott has, according to Wikipedia, been cancelled and renewed because of business practices of Nestlé and other manufacturers.

The New York Times reported yesterday, that earlier this spring, in Geneva, a resolution regarding breast-feeding was expected to pass quickly and easily, was opposed by the American delegation to the World Health Assembly, a UN-affiliated organization.

According to the Times, American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

The American effort failed, so in keeping with the current regime’s bullying tactics against friends and allies and trading partners, the Times reported that they turned to threats, according to diplomats and government officials who took part in the discussions.

One of the countries they threatened was Ecuador. Ecuador had planned to introduce the measure. The fascist regime told the Ecuadoreans that if they refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

Research has proven that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes, the Times went on to say. A 2016 Lancet study found that universal breast-feeding would prevent 800,000 deaths a year around the world, and yield $300 billion in savings from reduced health care costs, and improved economic outcomes for those reared on breast milk.

But owing to its slavish devotion to corporate America and the pursuit of profit at any cost, the fascist regime in Washington has embraced the interests of the infant formula manufacturers.

Thus, the battle to protect the health and safety of infants and children in the developing world has been renewed. However, this time with the threat of economic blackmail, countries that dare to introduce this resolution or enact its recommendations to promote breast-feeding over that of breast milk substitutes, may not be able to defend themselves, and represents a threat not only to the health and welfare of children in developing nations, but to the health and stability of their home countries as well.

Advocates for health scrambled to find another sponsor for the resolution, but a dozen countries, mostly in Africa and Latin America, backed off citing fears of US retaliation.

The Russians stepped in to introduce the measure, but the Americans did not threaten them. Of course not, the Orangutan takes his orders from Moscow.

The Russian delegate said, “We’re not trying to be a hero here, but we feel that it is wrong when a big country tries to push around some very small countries, especially on an issue that is really important for the rest of the world.”

Oh, so I guess we can forget the over forty years the Soviet Union pushed around the smaller nations in Eastern Europe, as well as their allies in the third world? What would you call the invasions of Hungary and Czechoslovakia? Simple misunderstandings?

But getting back to the issue, it is sickening that the US, being more concerned with the financial health of some multinational formula manufacturers, would prevent mothers from getting information about how beneficial breast-feeding is for their babies, which would go along way to moving them out of poverty, and improve the overall health of people in those countries. Then maybe they wouldn’t need to rush towards our southern border to escape violence, drugs, hunger, poverty and despair. Profits before people, that’s the real American motto and values.