Category Archives: Costa Rica

How Employers (and Medical Travel Facilitators) Can Deal With Zika

Teresa Bartlett, wrote last Friday in Insurance Thought Leadership.com about the precautions employers can take to avoid the Zika virus, and how to think about it.

She raises the following questions, and gives insightful answers:

  •  Where Is Zika Spreading?
  • What Are the Symptoms?
  • How Is Zika Treated?
  • What Special Precautions Should Be Taken by Pregnant Women?
  • What Should Employers Do?

The entire article can be read here.

Now that summer is almost upon us in the US, employers and those in other industries, like health care and medical travel, as well as the travel industry itself, should be fully aware of these facts.

Only time will tell before we have native cases of Zika here. You must be prepared.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp.

I am also looking for a partner who shares my vision of global health care for injured workers.

I am also willing to work with any health care provider, medical tourism facilitator or facility to help you take advantage of a market segment treating workers injured on the job. Workers’ compensation is going through dramatic changes, and may one day be folded into general health care. Injured workers needing surgery for compensable injuries will need to seek alternatives that provide quality medical care at lower cost to their employers. Caribbean and Latin America region preferred.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: richard_krasner@hotmail.com.

Will accept invitations to speak or attend conferences.

Connect with me on LinkedIn, check out my website, FutureComp Consulting, and follow my blog at: richardkrasner.wordpress.com.

Transforming Workers’ Comp Blog is now viewed all over the world in over 250 countries and political entities. I have published nearly 300 articles, many of them re-published in newsletters and other blogs.

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Zika More Dangerous than First Thought

According to two reports on NBCNews.com, the Zika virus is more dangerous than health officials first thought.

The first report from last week can be found here. The second report says that Zika goes to the brain, and causes nerve damage similar to that caused by multiple sclerosis. Zika destroys developing nerve cells.

What does this mean to you, the medical travel facilitators working in Central and South America?

It means that maybe, money spent to attract patients to your countries, might first be better spent cleaning up your slums and cities that have standing water and debris that can be a breeding ground for the mosquitoes that carry the disease.

It also means that you must work closely with your government agencies to assure that medical travel facilities are clean and prepared to deal with the disease, should there be patients who come down with the disease while getting medical care there.

More on Zika and Medical Travel

Ian Youngman posted the following article on IMTJ.com last Friday.

http://www.imtj.com/articles/does-zika-pose-threat-medical-tourism/

This is in addition to the posts I wrote last month, “Will Zika Impact Medical Travel to Latin America?“, “Insurers’ Have Zika on Radar“, “OSHA To Weigh In On Interim Guidelines for Zika this Spring“, and “Zika to Cost Latin America and Caribbean $3.5B“.

 

‘Turkishmaninacanstan’ Strikes Back

Readers of this blog know that from time to time, I have had to criticize those in the workers’ comp industry for their short-sightedness, narrow-mindedness, excessive American Exceptionalism, “Know-nothingism”,  xenophobia and subtle racism.

But when a well-respected online journal re-posts an article by the chief anti-medical travel opponent in the workers’ comp world, it is high time that the medical travel industry speak up and defend itself.

As a tireless advocate for medical travel in workers’ comp, I am leading the charge that you, my friends around the world must do for yourselves.

You will notice the title of this post. This is what the individual in question calls those countries that provide medical travel services. Also, please note that by using this canard as my title, I am in no way insulting Turkey, or any other nation that markets their medical care to the world.

There is fair criticism of Turkey and many other countries in the medical travel industry, but those criticisms are meant to improve the services and to correct the mistakes of the past, and not to pass judgement on them.

But when someone uses a term such as ‘Turkishmaninacanstan’, it conjures up the worse images of third world poverty and backwardness in all aspects of life of the nations so broadly brushed with that epithet.

The individual who coined that despicable name is a self-styled, right-wing American conservative who lives on the gulf coast of the state of Florida, a region where many individuals like him retire to after their careers have declined to play golf.

While this individual may not be one of those just yet, the fact that he dismisses new ideas, that he insults the millions of men and women around the world who are trying to offer real low cost medical care at equal or better quality, that he insults the very nations who could use those resources they are spending to bring medical travelers to their countries as a way to improve their balance of trade and economic power in the global economy, when they could be used to raise the living standards of their poorest citizens, is something that can no longer go unanswered.

So, I ask all of you, doctors, nurses, travel agents, medical tourism promoters and facilitators who are legitimately trying to provide better medical care at lower cost to all of the world’s citizens, to speak up and tell this individual and those like him, that your countries are not ‘Turkishmaninacanstans’, and that you are developing world-class medical facilities that outshine those in his own country, and mine.

Basically, he is calling you con artists and frauds, and that is something that only you can stop.

 

 

 

 

Zika to Cost Latin America and Caribbean $3.5B

Three weeks ago, I wrote a piece about how the Zika virus may affect medical travel to Latin America and the Caribbean.

Today, Business Insurance.com (article unavailable online due to error) reported that the World Bank warned that the spread of the Zika virus across Latin America and the Caribbean is expected to cost those regions about $3.5 billion in forgone economic output.

A full article can be found here.

According to the article, the World Bank is offering $150 million in financing to those countries combating the disease.

This money is nearly three times the the amount of money requested by the United Nations’ health arm on Wednesday.

However, officials at the World Health Organization said that they needed $56 million to help prevent the spread of the virus.

The officials also said that the short-term funding request would be used to speed up research, vaccine development and diagnostics of the relatively unknown virus, and would last until June.

Insurers’ Have Zika on Radar

As a follow-up to my last post on the Zika virus and what the medical travel industry should be doing about it, I want to direct you to what Shelby Livingston wrote last week in Business Insurance.

She said that American health care insurers are closely monitoring the virus, educating their members, but have not yet figured out what it will cost payers.

A spokesperson for Aetna said, “We are in contact with the Centers for Disease Control, U.S. federal agencies, state and local health departments, health care providers and others so that we can provide timely, relevant and accurate information from the CDC to our members and customers. Additionally, we have distributed health information from the CDC to our disease management and case management teams to help support our members.

The statement also said, that it is premature to predict health care costs associated with the Zika virus.

Anthem posted a message on Twitter, Livingston reported, cautioning travelers to the Caribbean to heed the CDC’s warnings; UnitedHealth Group has published updates on its website, but did not respond to her requests for comment on how they are responding to the virus, or whether they are projecting costs associated with the virus.

As I noted in my post last week, this virus may have a chilling effect on your business and the health of your patients. It is advisable to monitor what the US insurers say and do going forward.

Will Zika Impact Medical Travel to Latin America?

By now, we have all heard about the Zika outbreak in Brazil that has led to many children being born with microcephaly, a disease that causes the baby to be born with a small head and brain.

But with the World Health Organization’s announcement that it is a global health emergency, and that several cases have been found throughout other Western hemisphere countries and the US, one through sexual contact in Texas, the medical travel industry needs to be concerned that they prepare their patients to deal with the possibility of infection.

In addition, medical travel facilitators should work closely with the medical personnel in the target destination to guarantee that not only is the area free of the mosquitoes that carry the disease, but that the facilities are capable of handling an outbreak of Zika, especially if foreign patients are involved.

Medical travel facilitators should also take precautions to ascertain if patients are, or will become pregnant before going to any of these countries where Zika has been found.

An ounce or more of prevention will be worth a whole lot of cure.

 

Knee Surgery in Latin America under $20,000

As a follow-up to my post, Top 10 Hospitals for Knee Surgery Under $50,000, here is a graphic I submitted recently to a workers’ comp carrier in Florida I am interested in exploring opportunities with.

The hospitals and costs were culled from the Archimedicx website I linked to in the previous post.

Western Hemisphere Hospitals Knee Surgery under $20,000

I am sure there are many more, and there are more that are between $20,000 and $50,000 that were not mentioned in the first article by Archimedicx.

Even if these figures are not completely accurate, why take the chance that they are not at least representative of the cost difference between what is charged by hospitals in the US. And when you add in all the additional fees one finds on a US hospital, these prices are practically a bargain.

But go on and pay through the nose. Or is that the knee? To quote Forrest Gump, “stupid is as stupid does”.

Carta Abierta a la Comunidad Latinoamericana de Turismo Médico

Hoy celebra el primer aniversario de la creación de FutureComp Consulting, y el pasado 29 de octubre fue el aniversario de tres años de la creación de mi blog, Comp transformando los trabajadores.

En los tres años que he estado escribiendo mi blog, he asistido a turismo médico tres conferencias, dos en Florida y uno en México en noviembre de 2014, donde dio una presentación titulada, “Barreras, obstáculos, oportunidades y dificultades de implementación de turismo médico en compensación a los trabajadores.”

En estas conferencias han conocí a muchas personas de América Latina y han dicho de mi idea para la transformación de compensación a los trabajadores en los Estados Unidos mediante el envío de pacientes a los países de la región.

Hasta la fecha, no una persona que conocí en estas conferencias, ni quien ha leído mi blog y es de la región ha puesto en contacto conmigo para ofrecer su apoyo y servicios para hacer de esta idea una realidad.

Y al discutir la cuestión con los americanos, especialmente ésos en la industria de la compensación a los trabajadores, su respuesta ha sido llamarlo una idea estúpida y ridícula y no.

También han sugerido que médicos de su región no es hasta los estándares americanos, a pesar de que he señalado a ellos que no están garantizados los resultados aquí, y que errores pueden ocurrir en los hospitales locales.

Este es un ejemplo de una típica respuesta de alguien en la industria de comp de los trabajadores:

“Honestamente, turismo médico para empleados lesionados no funcionará. Ya estamos desafiados diariamente cuando empleados lesionados dejan el país y tenemos que brindarles atención fuera de los Estados Unidos. Te escucho pero es un tramo. No podemos obtener buenos resultados aquí odio pensar qué sucedería cuando enviamos algún otro lugar. Las leyes son mucho demasiado complicadas para obtener el resultado deseado”.

En mi blog, escribí el siguiente artículo basado en algunas observaciones sobre los medios sociales que incluí en un diálogo virtual, “Punto/contrapunto: A Virtual diálogo en el fondo de aplicación médica Turismo en compensación”.

En la presentación que dio en Reynosa, dijo que hay una falta de conocimiento acerca de la calidad de la atención médica en el extranjero (llamada “medicina de tercer mundo”) y que americano abrigó las actitudes negativas hacia la atención médica en el extranjero, así como la presunción conocida como “Excepcionalismo norteamericano” por el que médicos americanos sólo saben practicar medicina y sólo hospitales estadounidenses están calificados para ofrecer cuidado.

Sin embargo, no todos los americanos son así; de hecho, un abogado que representa a los trabajadores lesionados tenía cirugía de rodilla en Costa Rica y tenía una gran experiencia, quiere que sus clientes tengan también.

En mi presentación, presentado seis principales barreras y obstáculos para la implementación, pero escrito esta carta ahora, quiero decir a la comunidad de turismo de América Latina, que hay una séptimo barrera y obstáculo y es su incapacidad del mercado y defender su médico servicios a la industria del seguro americano y más concretamente, a comunidad de comp de los trabajadores.

Ha sido una de las razones por qué he estado escribiendo acerca de esto por tanto tiempo. En muchos de mis artículos, te imploro que hagas algo al respecto. Incluso dije esto en México cuando le dije que tenía que ir después del mercado; el mercado no vendrá a usted.

Por lo que no crees que yo soy un gringo loco, Norte Americano, aquí están algunos de los artículos que he escrito que hace exactamente eso:

“La estrellas alineado: México como un destino de turismo médico para los trabajadores de Estados Unidos nacidos en México, en compensación a los trabajadores”

“Un menor costo, atención médica de alta calidad está cercano”

“Limpiar el aire: mi defensa de la aplicación de turismo médico en compensación a los trabajadores”

“Far in front of the crowd”

“Muy por delante de la multitud”

“E PLURIBUS UNUM: América Latina y Caribe inmigración, compensación y turismo médico”

Por qué el turismo médico para Comp trabajadores es una idea cuyo tiempo ha llegado»

“Questions, Questions, How Medical Tourism Can Become a Real Alternative in Health Care and What It Means for Workers’ Compensation

“More questions, Questions: A Call for Answers from the Medical Tourism Industry”

«Más preguntas, preguntas: Una llamada para obtener respuestas de la industria del turismo médico»

Finalmente, la semana que viene iba a ser cuando yo me iba a dar una segunda presentación en México, esta vez en Puerto Vallarta, pero por motivos personales, tuve que sacar.

Esta es la presentación que iba a dar que describe los desafíos que enfrenta la compensación a los trabajadores, y lo que debe hacer la industria del turismo médico.

Así que mi reto es Latina y América Central. ¿Vas a comercializar sus servicios a esta industria, y defenderá su atención médica, como igual o mejor que la atención que recibe en los Estados Unidos?

¿Precio y transparencia? ¿Compartirán datos con líderes escépticos de su mejor atención médica, o vas a permitir que le llamen “barkers del carnaval”?

Estoy dispuesto a trabajar con usted. Sabes como contactarme.

 

SPOTLIGHT Interview – October 31, 2013

This is the original interview published on October 31, 2013 by Medical Travel Today.com.

Medical Travel Today (MTT): Tell us your position in the medical tourism industry, as well as your thoughts on integrating medical tourism into workers’ compensation cases in the U.S.

Richard Krasner (RK): Currently, I am a blogger, blogging about the implementation of medical tourism into workers’ compensation.

I first began looking into integrating medical tourism into workers’ compensation when I needed a topic for a paper in my Health Law class as part of my M.H.A. degree program in March of 2011. A lawyer who was working for a medical tourism facilitator company at that time, and who had written an article in a law journal about medical tourism, gave me the idea after my first topic did not pan out. She thought that the legal barriers to implementing international medical providers into workers’ compensation through medical provider networks was a good idea, and since I had a small interest in the subject of medical tourism, I submitted that as my topic to the instructor.

He gave me his approval and, as I started to do my research, I found many articles on medical tourism and nothing on medical tourism and workers’ compensation, so I knew my task was a difficult one. But as the point of the paper was to write about a legal issue and persuade people one way or the other, I felt that I could mention the lack of literature on the subject and perhaps open up dialogue in that area. I then found a roundtable discussion from the January/February 2008 issue of the journal Telemedicine and e-health.

In the discussion, I found something that I had been looking for, but had not expected in a medical journal: a validation from four of the participants for my idea to implement medical tourism into workers’ compensation. I made their discussion the centerpiece of my paper, and thus my argument in favor of implementation. They said essentially that they thought that medical tourism could work for non-emergent, i.e., non-emergencies or long-range issues, such as knee or hip replacement, chronic back injury and repetitive action injuries, and that it would not be a leading offering. That is when the light bulb went on, and I realized that it could be accomplished as an option for the injured worker to consider.

Initially, my research consisted of finding articles that discussed medical tourism in destinations, such as India, Singapore and Thailand, and my thought then was that it might be a stretch to send injured workers that far away, but that maybe it could be done. Later on, as I got more involved in medical tourism through my attendance at the 5th World Medical Tourism and Global Healthcare Congress in October 2012, and through conversations online with another lawyer, I realized that the best chance for this to happen was in Latin America and the Caribbean, and that given the rise of the Latino population in the U.S., sending patients home to their home countries for treatment would present no language or cultural barriers, and would allow friends and family in those countries to visit them during recovery, which will improve their self-esteem and improve their recovery time.

I have since come to believe that all injured workers could be offered this as an option, not just those of Latin or Caribbean origin.

MTT: How will the integration benefit individuals, health insurance companies, and the entire medical community, both domestically and internationally?

RK: I believe first and foremost that medical tourism will have its most important benefit on the individual because of some of the things I mentioned above, namely little or no cultural or language barriers to overcome between Spanish or English in most cases, or between Portuguese or other languages in the region. Also, as I said, their friends and families back home can visit, which would make their recovery more relaxing, more pleasant and would show them that the patient is not sitting at home just collecting a check. It would also give the patient greater self-esteem and speed recovery. Finally, by being treated in the better hospitals in the home country, a patient’s friends and family will see that their loved one is being cared for by the best doctors and at the best facility in their country.

I think the benefit for the health insurance company or, in this case, the workers’ compensation carrier would be that they will not have to pay for expensive procedures, such as hip or knee repair/replacement, shoulder surgery, spinal fusion surgery or carpal tunnel surgery. This is despite the fact that many states have fee schedules for workers’ compensation, which tells providers how much to charge the carrier for each procedure, and which may be less than the normal fees charged. Nonetheless, as the recent New York Times article indicates, the U.S. has the highest cost for healthcare, and it is not slowing down, nor has the average medical cost for lost-time workers’ compensation claims, as I have written about in my white paper and my blog.

I think for the entire medical community domestically and internationally, it will have several benefits, the first of which will be the realization that healthcare is globalizing and that it is no longer possible to consider that quality medical care is available only in the developed world. Second, it will lead to the development of international accreditation standards, quality standards and other standards that up to now have hampered medical tourism’s expansion and growth.

These standards will take time to be adopted and will be expensive to implement for the medical tourism facilities involved, as it has already been for the implementation of other standards and forms of accreditation, such as from the Joint Commission International.

Thirdly, it will have the benefit of bringing American patients to medical providers in other countries, those who otherwise would never be seen by foreign doctors except for those who have gone to foreign-born doctors practicing here in the U.S., whether in private practice or in a hospital setting. Fourth, and this is more of an issue with workers’ compensation cases, doctors abroad will be able to get broad experience treating work-related injuries that they have never seen, thus adding to their medical experience, and providing their fellow citizens with that experience should they ever require it.

Medical tourism will open up global healthcare to all inhabitants of this planet, not just those looking for cosmetic surgery, or procedures that are too expensive or unavailable in their home countries. It will certainly open it up to those who otherwise could not afford to travel out of their country for treatment.

MTT: What would you say are the steps necessary to take in order for medical tourism to be integrated into workers’ compensation effectively?

RK: First, there has to be a removal of all or many of the legal barriers that I mentioned in my white paper, as well as many others that I could not or did not mention. Also, there has to be some understanding on how the legal issues surrounding medical tourism can be solved such as malpractice, legal liability, privacy issues, medical records transfers, etc.

There are financial steps that need to be addressed, such as which currency the payments will be made in, any incentives to injured workers, referring physicians, treating physicians, destination hospitals, as well as travel insurance coverage for things not covered under workers’ compensation. And lastly there has to be a willingness on the part of employers and insurance companies, third party administrators, and lawyers to accept medical tourism as part of workers’ compensation. I have discussed this with several people recently through emails, and in the past six months since beginning my blog, and have written about this as well.

As the Chinese say, a journey of a thousand miles begins with the first step. An industry like the workers’ compensation industry in the U.S., which is concerned with issues, such as pain medication abuse, physician dispensing of drugs and dealing with cost-curbing strategies that have failed, must come to the realization that the journey for them must begin now — before costs skyrocket any further.

MTT: What can you see being potential deterrents in integrating medical travel benefits into workers compensation?

RK: First of all, let me say that I don’t have all the answers, and I cannot foresee all contingencies and problems associated with traveling abroad for care. But I do want to make this clear so that your readers will not think that I don’t know what I am talking about, or that they will think that integrating medical tourism into workers’ compensation will be easy and not fraught with difficulties and complications.

It will not be easy, there are and will be complications from flying after undergoing surgery abroad, just as there are if the patient was treated at the local hospital. I am not a medical person, so my knowledge of how patients will tolerate air travel after surgery or what complications will arise is beyond my experience. But I can say this: I don’t see a difference between a patient who traveled abroad for medical care as a private patient for cosmetic, body improvement or other forms of surgery usually associated with medical tourism and a patient who is traveling abroad for surgery as a result of an on-the-job injury. Yes, there are differences in the process of treatment and aftercare and recovery, but if the private patient can develop complications, so too can the workers’ compensation patient.

To answer the question then, I think deterrents include a lack of will, fear of lawsuits in countries with laws that do not favor the insurance company or the employer, malpractice insurance and legal liability that does not meet American standards, employee choice to stay at home, and pressure from special interest groups like doctors, hospitals, pain clinics, rehab facilities, trial lawyers, etc.

MTT: During a time of rapid healthcare reform, why do you think medical tourism hasn’t been connected to workers compensation already?

RK: Because there is so much uncertainty over the impact the Affordable Care Act will have, not only on healthcare, but also on workers’ compensation. In my research on that subject, I found that there will be little immediate impact, but down the line there will be, especially as more people get health insurance, and also because of the doctor and nurse shortage, which will affect both healthcare and workers’ compensation.

There are critics of the law who say it will raise costs, and then there are those who say it will lower costs, as some have already pointed out recently. But only time will tell who is right and who is wrong. Finally, I don’t think many in the workers’ compensation industry have ever considered looking abroad, except to plan their next vacation.

MTT: Is there anything else you would like to add at this point that you think is significant in terms of medical tourism, workers’ compensations and/or the integration of the two?

RK: Yes, as I said in my blog post, The Faith of My Conviction, what is needed is the will to do it, the courage to make it happen, the hard work to get it there, and the determination to bring the two industries together. I have had experts tell me that it won’t happen, but I pointed out right away in my post the discussion I found between the four medical professionals, and I believe that as medical professionals they have a better understanding of the issues involved than I do as a layman. I trust their judgment of the issue and defer to them for my belief that it can be done.

So who is right and who is wrong? I don’t know the answer to that, but I do know this: for 20 years, the average medical cost for lost-time claims has gone from around $8,100 to almost $30,000 with no decrease in cost, but with a slowdown in the rate of increase. Is that progress? Is that a sign that all other avenues tried have not succeeded? Perhaps it will take higher costs to wake people up to the reality that medical care, like all other goods and services, always goes to those places where the goods or services can be produced at cheaper cost with better quality.