Category Archives: Cross-border Health Care

Cross-Border Medical Travel in Tucson

Happy Holidays to all!

Hope you all had a good holiday.

Here is an article from Fierce Healthcare.com that describes what actions the city of Tucson, Arizona is taking to become a medical travel destination.

Readers of this blog will recall a few past posts that discussed cross-border medical travel, albeit due to an on-the-job injury. The article, NAFTA, Work Comp and Cross-Border Medical Care: A Legal View, discussed a Workers’ Comp claim in Arizona when a Mexican truck driver was thrown from his cab, received medical care first in Mexico, then in Arizona, as the state had changed their laws, and he was able to file a second claim.

A follow-up article, NAFTA, Work Comp and Cross-Border Medical Care: A Legal View: Update, reported the continued status of the driver’s claim.

Several other posts discussed cross-border medical travel into California, and into Mexico.

Here is the article in its entirety:

 

Tucson aims to become medical tourism mecca
by Ilene MacDonald | Apr 10, 2017 11:36pm
Tucson, Arizona, is on a mission to become a healthcare and wellness destination for international visitors, particularly Mexican families with enough disposable income to pay for medical care in the United States.

The Tucson Health Association—which includes Banner Health, the Carondelet Health Network, Northwest Medical Center and Tucson Medical Center—hopes to entice tourists to come to the city for elective, nonemergency services, such as total knee replacements, the Arizona Daily Star reports.

Although some Mexican insurers will pay for certain procedures in the U.S., Felipe Garcia, executive vice president of Visit Tucson, which is also a member of the association, expects most visitors will likely pay out-of-pocket for the procedures.

“If your patient needs a certain procedure we have in the U.S., we’ll take care of it in Tucson, do the surgery and then we’ll send the patient back to Mexico where the provider there can take the next step with recovery,” Garcia said.

Tucson hospitals are hoping their efforts will be as successful as Texas Medical Center in Houston, a group of nonprofit health providers that includes MD Anderson Cancer Center and the Texas Children’s Hospital. Those provider attract 15,000 medical tourists a year, according to the article.

Medical tourism has become a lucrative business, for both healthcare providers and the local community, as visitors usually have extended stays in hotels and leased apartments, according to the article. Josef Woodman, CEO of the North Carolina-based Patients Beyond Borders, told the publication that approximately 250,000 medical tourists come to the U.S. for treatment each year and spend as much as $40,000 per patient.

To attract Mexican patients, Visit Tucson intends to develop a website in Spanish and hire a concierge to help patients connect with medical care in Tucson and navigate the healthcare system. It plans to market heavily to those who live in the Northern Mexico area due to geographical proximity. Eventually the association plans to market medical services to Canadian citizens.

 

Here is the link: https://www.fiercehealthcare.com/healthcare/tucson-aims-to-become-medical-tourism-mecca-for-mexican-patients

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Ashley Furniture and Medical Travel, part 2

As promised last month, here is the Spotlight article from Medical Travel Today.com about Ashley Furniture’s foray into Medical Travel for their employees.

In case you missed it, here is the link to part 1 of the article.

Foreign Patients Get Liver Transplants in US Hospitals First

ProPublica, those lovely folks who published several articles some time back on workers’ comp, are at it again.

This time, they are focusing their ire on how foreign patients are getting liver transplants at some US hospitals ahead of Americans waiting for such transplants.

The story, published yesterday, was co-published with a local Fox station in New Orleans.

From 2013 to 2016, New York-Presbyterian Hospital gave 20 livers to foreign nationals who came to the US solely for a transplant, essentially exporting the organs and removing them from the pool of available livers to New Yorkers.

Dr. Herbert Pardes (I was familiar with his name from living in NY), wrote that, “Patients in equal need of a liver transplant should not have to wait and suffer differently because of the U.S. state where they reside.”

Dr, Pardes was the former chief executive, and is now the executive vice president of the board at New York-Presbyterian.

Yet, according to the story, Dr. Pardes left out NY-P’s contribution to the shortage, as stated above from 2013 to 2016.

These 20 livers represent 5.2 percent of the hospital’s liver transplants during that time, which was one of the highest ratios in the country.

ProPublica reported that unknown to the public, or to sick patients and their families, organs donated domestically are sometimes given to patients flying in from other countries, who often pay a premium. Some hospitals even seek them out.

A company from Saudi Arabia said it signed an agreement with Ochsner Medical Center in New Orleans in 2015.

The practice is legal, according to the story, and foreign nationals must wait their turn in the same way as domestic patients. The transplant centers justify this on medical and humanitarian grounds, but at a time when we have an Administration touting “America First”, this may run counter to the national mood.

The  director of the transplant institute at the Mount Sinai Hospital in New York, Dr. Sander Florman, said he struggles with “in essence, selling the organs we do have to foreign nationals with bushels of money.”

Between 2013 and 2016, 252 foreigners came to the US purely to receive livers at American hospitals. In 2016, the most recent year for which there is data, the majority of foreign recipients were from countries in the Middle East, including Saudi Arabia, Kuwait, Israel and the UAE. Another 100 foreigners staying in the US as non-residents also received livers.

At the same time, more than 14,000 people, nearly all Americans, are waiting for livers, a figure that has remained very high for decades, they report. By comparison, fewer than 8,000 liver transplants were performed last year in the US, an all-time high. National median wait time is more than 14 months, and in NY, the time is longer.

In 2016. more than 2.600 patients were removed from waiting lists nationally, either because they died or were too sick to receive a liver transplant.

All this is happening at a time when the party in power is seeking to take health care away from those who recently received care for the first time in a long time from the ACA, and at a time when the medical travel industry is focused not on transplant surgeries, but on boutique treatments and surgeries for wealthy or upper middle class Americans to go abroad for bariatric, plastic or reconstructive surgery, knee surgery, dental care, etc.

And yet, when the very idea of medical travel is broached in the medical community, it is disparaged and discouraged by physicians and others as unsafe, impractical, and not worth the effort, Obviously, it is well worth the effort on the part of foreign patients to come here and take organs meant for Americans, so why not allow Americans to take their organs?

Is it because the hospitals that supply these organs to foreign patients are making huge sums of money, and the poor schnook American with liver disease (or kidney disease, as in the case of yours truly) must die so that an American hospital can improve its bottom line?

It is high time to cut the crap and promote medical travel the right way and for the right reasons, not only for those who can afford it, but those who need transplants and can’t get them here.

That is the true nature of the globalization of healthcare…a two-way street.

 

Time For Medical Tourism Industry to Clean Up Its Act

An article in Arizona Central (see link below) highlights the problem with weight-loss surgery in Mexico.

https://www.azcentral.com/story/money/business/health/2017/11/16/mexico-gastric-sleeve-weight-loss-surgery-deaths-arizona-medical-tourism-risks/576309001/

This isn’t the first article on this subject, and won’t be the last, but the industry must clean up its act, stop patting yourselves on the back at all these fancy conferences around the world, come together to lay down guidelines and industry-driven protocols and standards of care and legal protections, and lastly, get rid of the crooks (you know who they and you are), charlatans, con men, and carnival barkers who promote medical travel, and give it a black eye.

Naturally, there are risks to any surgery, no matter where it occurs, but if medical travel is to be marketed as less costly, with better outcomes, the quacks and thieves must be removed from the industry.

Stop dissing each other, start cooperating with each other, and cut back on the conferences. Nobody of any real importance to the growth of the industry attends; only those who talk a great deal or are promoting their own businesses.

Here is a video that goes along with the article.

https://uw-media.azcentral.com/video/embed/106607688?placement=embed

 

 

Ashley Furniture and Medical Travel, part 1

From the One Hand Washes the Other department comes the following Spotlight article from Medical Travel Today.com.

Ashley Furniture, based in Wisconsin, is one of the largest manufacturers of home furnishings in the world.

I met Rajesh Rao in 2014 when I attended the Costa Rican Medical Travel Summit in Miami Beach. Rajesh’s company was also instrumental in convincing another furniture manufacturer, HSM in North Carolina, to first send patients to India, then to Costa Rica for medical care. I have written about this in previous posts.

This article is part one, and part two will run next month.

Cross-Border Dental Care in Mexico

On Sunday, NBC Nightly News ran a video report on dental care in Los Algodones, Mexico, south of the border from Arizona, and west of Yuma.

According to the report, during the winter months, up to 7,000 Americans travel to Los Algodones for dental care.

Los Algodones, also known as “Molar City”, is the self-proclaimed dental capital of the world. While that sounds like hype, I can tell you from personal experience that it is not the only town on the border where one can find dozens of dental offices.

When I presented at the 5th Mexico Medical Tourism and Wellness Business Summit in 2014, I visited a town east of Reynosa called Nuevo Progresso where I saw some of the dental offices, along with some of the other attendees.

Here is the video from NBC.

http://www.nbcnews.com/widget/video-embed/1018704963518

And here are some pictures from Nuevo Progresso.

I took these pictures in a small medical center on the main street of Nuevo Progresso, just over the border from Texas. To the left of the picture on the left, is the bridge crossing the Rio Grande (Rio Bravo) into the US.

And the people I saw on the street were not Mexicans, they were Americans.

Still think medical travel is a stupid and ridiculous idea? Try telling it to the thousands who go across the border.

Washington State Workers’ Comp Accepts Foreign Medical Providers

Seven years ago, when I was working on my MHA degree, I wrote a paper which has become the basis of this blog.

During that time, I found the website of the Department of Labor & Industries for Washington State, and was surprised to find landing pages that listed physicians in Canada, Mexico, and other countries. These countries were mentioned in my paper, and I have referred to it in subsequent posts from time to time.

However, in the period since, I have noticed that the landing page for other countries was removed. I contacted WA state a while back and was told they were updating it. Yet, as of recently, it is still not been replaced, so I contacted them again yesterday.

I received a reply from Cheryl D’Angelo-Gary, Health Services Analyst at the WA Department of Labor & Industries. She indicated in her response that she is the business owner of the Find a Doctor application (FAD).

According to Ms. D’Angelo-Gary, “our experience showed that most of Washington’s injured workers who leave the country travel to one of these adjacent nations. Workers who travel further afield are advised to work with their claim manager to locate (or likely recruit) a provider. All worker comp claims with overseas mailing addresses are handled by a team of claim managers who have some extra training to help the worker find a qualified provider.”

I asked her to clarify this statement further in my next email by asking if this means that any claimant who travels outside of North America will have to ask the claims manager to find them a doctor.

She replied, “interesting questions!” She also differentiated between an injured worker who is traveling versus one who has relocated out of country.

She went on to say that, “a worker who is traveling and needs claim-related care would be instructed to seek treatment at an ER or urgent care clinic, where the providers do not need to be part of our network and would not be providing ongoing treatment. To be paid, the provider would have to send us a bill and a completed non-network application (available online). Under no circumstances should the provider bill the worker.”

However, she continued, “a worker who has relocated overseas must send in a change of address (required whenever a worker moves). That allows us to transfer management of the claim to a unit that specializes in out-of-country claims. The claim manager would work with the injured worker to help the worker find somebody in their new location. It’s critical (per state law) that the worker choose their own provider, though the provider must meet our requirements and standards of care. Proactive workers tend to handle this well, and find a provider in very little time; less proactive workers can find this challenging. We’re currently looking at this process to see how we can do this better.”

And in final emails to her last night, I tied the first scenario to medical travel, and the second scenario to ex-pats living abroad, but needing medical care. I also asked about workers who wanted to travel back to their home country for medical care, and said that I write about medical travel for workers’ comp.

As of today, I have not heard back, but it is early, and there is a three-hour difference between us.

It must be pointed out that WA state is what is termed a ‘monopolistic state’ in that the state does all the work of handling workers’ comp insurance and claims. Thus, when Ms. D’Angelo-Gary says that worker must work with the claim manager, the claim manager in question is a state employee, and not an employee of a commercial insurance company.

It may be possible, therefore, for medical travel to be implemented in workers’ comp, and it should be something that the medical travel industry and the state should explore together. Ms. D’Angelo-Gary did say they were looking at this process to do better. What better way to improve the process then by utilizing medical travel?