Category Archives: Immigrant Workers

Foreign-born Workers on the Rise: What it Means for Work Comp and Medical Travel

Working Immigrants.com posted a report this weekend that indicated that the percentage of foreign-born workers in the US will rise from 16% to 20% of the workforce over the next 26 years.

It will grow for the next 15 years, then the pace will slow considerably. Citing a Census Bureau publication from March 2015, Working Immigrants said that the total population of the US is expected to grow from about 319 million in 2014, to 359 million in 2030, and 380 million in 2040, which is an increase of 19% over the next 26 years.

According to the report, the working age population will grow by 12%.

There is a higher rate of employment among foreign-born, due to the fact that they mainly come here to work, and they are more concentrated in working age brackets ― 80% between 18 and 64, vs 62% among native born.

Modest increases in the foreign-born population will result in higher shares of employment for these workers.

By 2040, foreign-born workers will be one fifth of the workforce.

It is a given that not many of these workers will have a great command of English, and the most likely foreign-born workers will be Hispanics and Asians.

A workforce that does not have a command of English, is mainly from Central and South America and Asia, will no doubt put a strain on an already strained social welfare system, especially workers’ comp, since they are more likely to be injured on the job.

So those of you in the medical travel industry looking for patients and trying to entice well-off Americans down to Latin America for dental work, cosmetic surgery, plastic surgery, and other treatments not available in the US or that are too expensive, should consider expanding your offerings to your fellow Latino immigrants, or change direction and consider doing so by offering to facilitate less expensive surgeries for common injuries found in the workers’ comp space.

And those of you in workers’ comp who have shut your minds to new ideas and refuse to listen to what I am saying, either should learn Spanish or Chinese, or deal with the changing nature of health care globally, and stop worrying about stepping on the toes of the vested interests, and start thinking about the interests of all those new foreign-born workers who will be coming here in the next 26 years (24 now that it is 2016).

They may not feel comfortable going to a hospital for surgery if the staff there does not speak their language, or the food is unfamiliar, and they may even recover faster if they know they are surrounded by friends and family in their home country. That will lead to a more productive and happier employee.

And a happier employee will improve your bottom line.


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 300 articles and counting, many of them re-published in newsletters and other blogs.

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Los inmigrantes latinos sufren lesiones más Construcción

Trabajadores latinos e inmigrantes frente a los riesgos mortales desproporcionados en la construcción, según un informe publicado ayer por el Comité de Nueva York para la Seguridad y Salud Ocupacional (NYCOSH), e informaron hoy en Immigrants.com Trabajo.

El informe, “El Precio de la Vida: 2015 Informe sobre la construcción muertes en Nueva York”, dijo que los latinos constituyen el 25% de los trabajadores de la construcción del estado de NY, pero representa el 38% de las víctimas mortales de la construcción en Nueva York en 2012.

A nivel nacional, las muertes de construcción latinos aumentaron de 182 en 2010 a 233 en 2013, según el informe.

Algunos de los otros resultados reportados por los inmigrantes que trabajan son las siguientes:

• Un estudio de los registros médicos de 7.000 estadounidenses trabajadores de la construcción Latino encontró que eran 30% más propensos que los blancos no latinos trabajadores que se lesionan en el trabajo. Varios estudios han demostrado que la falta de formación es una de las razones por las tasas de lesiones más elevadas de trabajadores de la construcción hispanos.
• Además, muchos trabajadores de la construcción de Nueva York son los no ciudadanos, de acuerdo con la Encuesta de la Comunidad Americana del Censo de Estados Unidos, incluyendo 40% de los 124.240 trabajadores de la construcción de Nueva York, el 36% de los 7.710 instaladores de paneles de yeso, 28% de los 10.405 techadores y el 25% de los 88.475 carpinteros. Ellos, también, tienen menos probabilidades de recibir formación en seguridad.
• Las personas de los trabajadores de color y de la construcción inmigrantes tienen más probabilidades de trabajar fuera de los libros, para ser clasificado erróneamente como contratistas independientes, para trabajar como jornaleros, o tener conocimientos limitados de Inglés que no suele incluir términos técnicos, y por lo tanto es menos probable que recibir capacitación en seguridad.
• El 80% de los trabajadores inmigrantes en la construcción son latinos. Un Centro para la Democracia Popular informe hallazgo mostró que el 60% de la caída de la construcción de Nueva York muertes OSHA investigó 2003-2011 eran latinos y o inmigrante. Además, los contratistas no sindicalizados tienen menos probabilidades de proporcionar condiciones de trabajo seguras, entrenamiento OSHA y equipos de seguridad.
• Los trabajadores indocumentados son menos propensos a negarse a trabajar en condiciones peligrosas o de hablar a favor de mejores condiciones de salud y seguridad por temor a ser despedidos o deportados. En profundidad es la información sobre todos los casos difíciles de conseguir, ya que muchas muertes se anuncian antes de los nombres de ser liberado, y no hay seguimiento de los informes de los medios de comunicación.

Esta no es la primera vez que hablé de la difícil situación de los trabajadores latinos en ciertas industrias de alto riesgo, que incluyen la construcción. Mi post, una alternativa a cirugías de alto costo para los reclamos de compensación laboral en virtud de los programas de recapitulación, discute este tema con más detalle, y señala al lector a los artículos anteriores he escrito, y para artículos de Joe Paduda y Peter Rousmaniere, que escribió hoy pieza.

La gente sigue preguntándome donde la propuesta de valor es para el empleador y el empleado en tener la cirugía realizada en un país distinto de los EE.UU., y especialmente en el país de origen del trabajador lesionado, por lo que no existen barreras idiomáticas o culturales.

Bueno, esa es una propuesta de valor, ya que al ser capaz de entender el proceso de reclamaciones y el procedimiento quirúrgico en el lenguaje de la propia proporciona la confianza de que el paciente está recibiendo la mejor atención médica posible. No siempre tiene que ser un valor en dinero de por qué la cirugía en el extranjero es mejor que recibir en un hospital de Estados Unidos donde la lengua y la cultura son impedimentos.

La segunda propuesta de valor de tener el paciente ir al extranjero, especialmente a un trabajador latino, es que los amigos y familiares que siguen en el país de origen pueden visitar al paciente y hacerle sentir mejor acerca de su ser sin trabajo temporalmente.

Estas son las propuestas de valor intangible que no se puede poner un precio, pero que pueden dar lugar a una recuperación más rápida y un empleado más feliz cuando lo hace volver al trabajo. Eso por sí solo vale la pena la inversión.

Pero como para el empleador, si el costo de la cirugía y la factura total del hospital es miles de dólares menos en un centro médico del turismo extranjero de lo que pagarían en un hospital local, entonces el valor para el empleador es que él está ahorrando un mucho dinero, especialmente si la mayor parte de su fuerza de trabajo es latina.

He hablado con varias personas acerca de esta idea, y, sin embargo, algunos de ellos no ven el valor en el ahorro de dinero en cirugías costosas. Sólo puedo suponer que les gusta pagar por la nariz para la cirugía en una rodilla, cadera, hombro o muñeca.

O tal vez, sienten que está bien para un trabajador para ir al extranjero en virtud de salud de grupo (como una compañía en Carolina del Norte ha hecho), pero no en un borrador de los trabajadores. ¿Eso no golpear de sesgo de clase?

He escrito mucho sobre el alto costo de sistema de compensación de nuestros trabajadores, sus fracasos y deficiencias, pero sin embargo, nadie está dispuesto a admitir a sí mismos, y mucho menos este escritor, que tal alternativa es realista.

Para ser justos, he tenido algunas conversaciones con algunas personas que lo consiguen, pero por desgracia, no hay segundo partido dispuesto a explorar esto. A medida que la fuerza de trabajo se vuelve más latino, y como un borrador de trabajo está bajo asalto en muchos frentes, puede haber algunos empleadores, intermediarios, transportistas por ahí que lo escuche.

Mientras tanto, voy a seguir escribiendo, a pesar de que me estoy haciendo nada para hacerlo. Prefiero ser ganar honorarios de consultoría o incluso un cheque de pago, pero hasta entonces, voy a seguir creyendo que el turismo médico no es sólo para la gente blanca con grandes bolsillos de seguros y profundos, o para grandes empresas con planes de salud de grupo, o para aquellos la búsqueda de la cirugía estética o plástica, etc., pero para todas las personas, ricos y pobres.

Latino Immigrants Incur Most Construction Injuries

Latino and immigrant workers deal with disproportionate deadly risks in construction, according a report issued yesterday by the New York Committee for Occupational Safety and Health (NYCOSH), and reported today on Working Immigrants.com.

The report, ”The Price of Life: 2015 Report on Construction Fatalities in NYC”, said that Latinos make up 25 % of NYS construction workers, but represented 38% of construction fatalities in New York in 2012.

Nationally, Latino construction fatalities increased from 182 in 2010 to 233 in 2013, according to the report.

Some of the other findings reported by Working Immigrants are as follows:

  • A study of the medical records of 7,000 U.S. Latino construction workers found that they were 30% more likely than white non-Latino workers to be injured on the job. Several studies have shown that lack of training is one reason for the higher injury rates of Latino construction workers.
  • In addition, many New York construction workers are non-citizens, according to the U.S. Census’s American Community Survey, including 40% of New York’s 124,240 construction laborers, 36% of the 7,710 drywall installers, 28% of the 10,405 roofers and 25% of the 88,475 carpenters. They, too, are less likely to receive safety training.
  • People of color and immigrant construction workers are more likely to work off the books, to be misclassified as independent contractors, to work as day laborers, or to have limited English proficiency that does not often include technical terms, and therefore are less likely to receive safety training.
  • 80% of immigrant workers in construction are Latino. A Center for Popular Democracy report finding showed that 60% of New York construction fall fatalities OSHA investigated from 2003 to 2011 were Latino and or immigrant. In addition, non-unionized contractors are less likely to provide safe work conditions, OSHA training and safety equipment.
  • Undocumented workers are less likely to refuse to work in hazardous conditions or speak up for better health and safety conditions for fear they will be fired or deported. In-depth information on all cases is difficult to come by, as many fatalities are announced prior to names being released, and there are no follow-up media reports.

This is not the first time that I discussed the plight of Latino workers in certain high-risk industries, which include construction. My post, An Alternative to High Cost Surgeries for Workers’ Compensation Claims under Wrap-Up Programs, discusses this issue in greater detail, and points the reader to earlier articles I wrote, and to articles by Joe Paduda and Peter Rousmaniere, who wrote today’s piece.

People keep asking me where the value proposition is for the employer and the employee in having surgery performed in a country other than the US, and especially in the home country of the injured worker, so that there are no language or cultural barriers.

Well, that is one value proposition, since being able to understand the claims process and the surgical procedure in one’s own language provides confidence that the patient is receiving the best possible medical care. There doesn’t always have to be a money value to why surgery abroad is better than getting it in a US hospital where language and culture are impediments.

The second value proposition from having the patient go abroad, especially a Latino worker, is that friends and family still in the home country can visit the patient, and make him feel better about his being out of work temporarily.

These are intangible value propositions that you can’t put a price on, but that may result in a faster recovery and a happier employee when he does return to work. That alone is worth the investment.

But as for the employer, if the cost of surgery and the total hospital bill is thousands of dollars less in a medical tourism facility abroad than what they would be paying at a local hospital, then the value to the employer is that he is saving a lot of money, especially if the majority of his workforce is Latino.

I have spoken to a number of people about this idea, and yet, some of them fail to see the value in saving money on expensive surgeries. I can only surmise that they like paying through the nose for surgery on a knee, hip, shoulder or wrist.

Or perhaps, they feel that it is okay for a worker to go abroad under group health (as one company in NC has done), but not under workers’ comp. Does that not smack of class bias?

I have written extensively about the expensive cost of our workers’ comp system, its failures and deficiencies, but yet no one is willing to admit to themselves, let alone this writer, that such an alternative is realistic.

To be fair, I have had some conversations with a few people who get it, but alas, there is no second party willing to explore this. As the workforce becomes more Latino, and as work comp comes under assault on many fronts, there may be some employers, brokers, carriers out there who will listen.

In the meantime, I will continue to write, even though I am getting bupkis for doing so. I’d rather be earning consulting fees or even a paycheck, but until then, I will continue to believe that medical tourism is not just for white people with great insurance and deep pockets, or for big companies with group health plans, or for those seeking cosmetic or plastic surgery, etc., but for ALL people, rich and poor.

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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.

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. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

Some Late Afternoon Reading Before the Weekend

Here are a few links to articles found today on Twitter:

http://www.businessinsurance.com/article/20150508/NEWS08/150509850/young-hispanics-at-small-construction-firms-at-highest-safety-risk?tags=|338|308|92|304

http://www.jdsupra.com/legalnews/the-oklahoma-option-benefit-plan-follows-84596/

Have a good weekend!

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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.

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. Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: richardkrasner.wordpress.com. Share this article, or leave a comment below.

 

 

Immigration Reform Revisted

Tomorrow evening President Obama is to unveil his plan to grant millions of undocumented immigrants a form of legal status by executive action.

As reported in two articles today, one in Health Affairs blog, and the other in The New York Times, access to health care will not be a part of the President’s plan.

In “The Case For Advancing Access to Health Coverage And Care For Immigrant Women and Families”, Kinsey Hasstedt said that a web of policy barriers to public and private insurance options effectively keeps millions of immigrant women and their families from affordable coverage and the basic health care, including sexual and reproductive health services that coverage makes possible.

Of course, this sounds all too familiar to anyone who has read my articles in the past about immigration reform, medical tourism/travel, and its implementation into workers’ comp.

Ms. Hasstedt also said that many lawful immigrants are ineligible for coverage through Medicaid and CHIP (Children’s Health Insurance Program) during their first five years of legal residency. And as reported in today’s New York Times, undocumented immigrants are barred from public coverage, and the ACA prohibits them from purchasing any coverage, subsidized or not, through the exchanges.

In The New York Times article, Obama’s Executive Order on Immigration Is Unlikely to Include Health Benefits, the president will use his executive authority to provide work permits for up to five million people who are in the US illegally, and shield them from deportation. But his order will not allow them to be eligible for subsidized, low-cost plans from the government’s health insurance marketplace.

Ms. Hasstedt noted in her article that past immigration policy reforms, both executive (something the GOP forgot about because it was Saint Ronnie who did it) and congressional have failed to address the health care needs of immigrants.

I know there are many in the immigrant community, and among their supporters in the rest of the country who applaud the President for taking this long-overdue action due to the inaction of a Congress more in tune with the sentiments of those who like wearing white sheets, than a party whose last occupant of the White House preached “Compassionate Conservatism”.

And there are many within the Insurance and Risk Management and Workers’ Comp industry who downplay the impact immigration reform and the granting legal status to undocumented workers will have on the number of claims filed under workers’ comp.

But as I said in many previous posts, there is no way that workers’ comp can handle all of the claims that will be filed not only by legal residents, but by immigrants and those who are granted legal work status, as the President will do tomorrow night.

The medical tourism/travel industry is not perfect. Name me one industry that is. But the reality is that I have found, having attended three different conferences in the span of two years , that there are highly professional and dedicated people out there, physicians, hospitals and clinics who not only are seeking patients for private pay or group health insurance, but would probably consider taking on patients under workers’ comp, especially in the areas of orthopedic surgeries from work-related accidents, repetitive motion injuries such as Carpal Tunnel, and even weight-loss surgery, as I mentioned in my last post.

So while many in the industry are gambling in Las Vegas this week, which as the commercial says is where their money is going to stay, and where many Hispanics once called home before we showed up, it is high time to seriously consider medical tourism/travel as an option.

The influx of immigrants, and the soon-to-be announced legal status of the undocumented will put a terrible strain on an already strained health care system. It’s time to open the safety valve and let injured workers, many of them Latino, receive care in their home countries and in neighboring countries so that there are no language or cultural barriers to contend with.

Opening up a safety valve and immigration is nothing new. It’s how millions of Europeans came to America in the 19th and 20th centuries. I would not be here writing this today if my grandparents could not use the safety valve of immigration to escape what would have been a terrible fate. Thousands of Irish would have starved if they could not immigrate to the US and other countries. And millions of Chinese would have died in labor camps, famines and revolutions in the early 20th century.

But so long as the US workers’ comp system is locked away in a “padded cell”, the increased number of legal and undocumented workers with legal work status will add more demand on an already overburdened health care system.

The choice is yours. You can go with the flow of history, or stay in Las Vegas and party your way to irrelevance.

Primary Language-Speaking Physician Ruled Not Medically Necessary

I came across an interesting article today from David DePaolo on his blog, DePaolo’s Work Comp World. The article, Comunicación No Es Médicamente Necesario, discussed a recent workers’ compensation case in Florida that involved the right to bilingual treatment.

A roofer in 2012, suffered a head injury when he fell 30 to 40 feet off of a ladder. His employer accepted the compensability of the injury and authorized treatment from several doctors, including a neurologist, Dr. Angelo Alves.

Dr. Alves recommended that the claimant undergo a neuropsychological evaluation for his memory, cognition and emotional state. The employer then arranged an appointment with Dr. Arthur J. Forman. Because Dr. Forman did not speak Spanish and the claimant only spoke limited English, his employer arranged for an interpreter for the claimant’s office visits

The claimant objected to the interpreter, and filed a petition for benefits, seeking authorization for an evaluation by a Spanish-speaking neuropsychologist. His reasoning was that he did not want to do it through an interpreter and talk about the intimate details of his life through another person.

Dr. Alves supported the claimant’s claim and testified that the claimant needed to have a neuropsychological evaluation performed by a Spanish-speaking psychologist. It was Dr. Alves’ position that having the evaluation through an interpreter was not the same as with a Spanish-speaking doctor, because the doctor could get the wrong information.

However, the Judge of Compensation Claims was not persuaded by that argument. The claimant appealed, but a split panel of the First District Court of Appeals agreed with the JCC.

The finding of the court was that while a Spanish-speaking provider was preferable, the evidence did not establish medical necessity.

Judge Scott Makar, an appointee to the First District Court of Appeals by current Tea Party-backed Florida governor, Rick Scott, in a concurring opinion, addressed the challenges of meeting health care expectations within the limited resources of any health care delivery system.

According the Judge Makar, “In an ideal world with unlimited resources patients would have health care information published in their own primary languages, and their health care service providers would speak their primary languages.” He went on to add, that since this ideal is “unattainable”, “the trajectory of the language access movement in the United States currently has gravitated to the use of translators (for written communication) and interpreters.”

The dissenting opinion, by Judge Bradford Thomas, an appointee of former governor Jeb Bush (who by the way speaks Spanish and is married to a Hispanic woman), argued “that no medical testimony supported the JCC’s view that the Spanish-speaking psychiatric evaluation was not medical necessary, and that the JCC had failed to give a “reason” for rejecting Dr. Alves’ opinion.”

David pointed out that Judge Thomas had the burden of proof backwards and ignored the substantial evidence standard. But, he also pointed out that the majority opinion seemed to take the position that Spanish is a “minority” language, which David points out in the rest of his article, it isn’t.

Before I tackle that issue, I would like to explain why I mentioned who appointed the concurring and dissenting judges, and what struck me as I read the court’s ruling in this case. Had Judge Makar been appointed by any other governor besides Rick Scott, I would have been puzzled as to why they would go out of their way to annoy a growing segment of Florida’s population such as Latinos, especially since they are sensitive to any form of discrimination against their community, such as restricting their right to vote.  This is especially true of non-Cuban Latinos who generally vote for Democrats.

That Rick Scott is a Tea Party-backed politician, and knowing that the Tea Party has elements in it that despises immigrants, both legal and illegal, who are usually Hispanic, Judge Makar’s opinion shows obvious Tea Party bias towards Spanish-speaking people in the state.

His characterization of Spanish as a “minority” language is certainly not true to this former New Yorker who had gone through several areas of Miami, Fort Lauderdale and many other cities in South Florida and felt like I was in the minority. Also, his statement about an ideal world is typical of right-wing conservatives who are opposed to any accommodations to non-English speaking people.

I say this as the grandson of four immigrants who had to learn English and had to speak their native language, Yiddish, at home amongst themselves and other family members and friends, so that the “kinder” would not know what they were talking about. And since my family also came from what was once the Russian Empire, they had to know a smattering of Russian and maybe Polish to converse with neighbors and officials of the government.

But that was a different time in the US, when the National Civic Federation sponsored night classes in English to newly arrived immigrants so that they can assimilate. But it is different now with Latinos, and as has been pointed out before, the younger generation of Latinos already here, speak English and Spanish. I have had classmates in my MHA classes, and have met many others in all areas of South Florida who do.

On the other hand, Judge Thomas’s appointment by Jeb Bush did not surprise me, given his dissenting opinion. It recognizes the reality of life in Florida, and in other states, with regard to Hispanics, and does not, like the Tea Party often does, seek to turn the clock back to a time in the US when only one language was spoken.

Going back to David’s article, demographic research he points out, shows that the Hispanic population has outgrown that of the white population in David’s home state of California and New Mexico, as well as a few other states, according to a Pew Research Center study. The projections, David cites, are that these demographics will be reflected in the overall US population by 2040.

California has about 14 million Hispanics out of an overall population of 33 million. 47% of New Mexico’s population is Hispanic, and while the white population of Texas is still the majority that is projected to change soon, as the Hispanic population growth represents nearly 64% of all population growth since 2000.

Florida, by contrast, David states, has 4.5 million Hispanics, which represents 23% of the population. He notes that because workers’ compensation is state specific, relative to the overall population of the state, the decision by the First District Court of Appeals makes sense. However, that he says can change.

I have discussed the issue of immigration reform and its impact on workers’ compensation and medical tourism in earlier posts, and have cited statistics about the Hispanic population growth in such articles as Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, Immigration and Workers’ Compensation: Round Two, and E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism.

It also occurred to me that the court that decided this recent case was the same court that decided an earlier case that I mentioned in Legal Barriers to Implementing International Providers into Medical Provider Networks for Workers’ Compensation: A White Paper.

In that case, AMS Staff Leasing, Inc. v. Arreola, FL 1st DCA, 2008, the First District Court of Appeals ruled that Arreola, who had been injured loading a truck, was entitled to get treatment in his hometown in Mexico.

The court ruled that “that state law did not preclude the foreign physician’s treatment of the claimant in Mexico. They stated that Florida workers’ compensation law contemplates coverage for non-citizens, and they cited an earlier case in which the court held that undocumented workers were entitled to workers’ compensation coverage in Florida…”

The court “also stated that Florida law indicates that an injured worker is not prohibited from moving from his pre-injury residence in the state, and receiving treatment outside of the state.”

This would appear to indicate that the court in 2008, before Rick Scott became governor, was willing to have workers’ compensation claimants get treated by physicians in their home country who could speak their language, but the court in 2014, with an appointee of Tea Party-backed, Rick Scott, ruled that the claimant in this case had no right to a physician who could speak his language, even if the claimant was seen here in Florida and not in his home country.

It would appear that judges appointed by Tea Party-backed governors, especially in a state like Florida, are trying to deny the rights of Hispanic claimants to Spanish-speaking doctors. Such a ruling in light of future increased Hispanic population growth is not only unconscionable, it smacks of racism and discrimination. But David DePaolo is correct in citing Bob Dylan’s song, “The Times, They Are A Changing.” Hopefully, future courts in Florida and elsewhere will correct this travesty of justice, and when medical tourism in workers’ comp becomes a reality, evaluations by Spanish-speaking physicians will be commonplace occurrences.

An Alternative to High Cost Surgeries for Workers’ Compensation Claims under Wrap-Up Programs

Introduction

Are you a Contractor or an Owner who has a CCIP or OCIP program? Are you concerned about rising workers’ compensation claims costs? Do you worry about the high cost and poor quality outcomes of surgeries for injuries sustained on the job by your employees, your contractors’ employees, your sub-contractors’ employees, that end up costing you more money when premium audits and insurance renewals come around, and that impact your claims severity and Experience Mod? If you answered yes to these questions, this article is for you.

This is not a sales pitch, nor is it an advertisement for any particular product or service. What it is, is a way for you as a businessperson to learn about an alternative to high cost and poor quality medical care for injured workers that will actually save you and your insurance company money, which in the long-run will be beneficial to you, your carrier, your employees or your contractors’ employees.

Medical Tourism

The alternative I am proposing is called many names; some people call it “Medical Tourism”, others call it “Medical Travel”, or “Health Travel”, or other similar names. For sake of convenience, we will call it Medical Tourism, despite the vacation-linked connotation the word “tourism” has. People are travelling all over the world seeking health care that is lower cost and with equal or better quality than what they can get at home for a myriad of procedures and treatments, mostly either not covered by private health insurance or unavailable in their country.

The hospitals and clinics in these countries are accredited by the Joint Commission International (JCI), the international arm of the Joint Commission, which accredits US hospitals and other medical facilities. The doctors in most of these facilities have either been trained in the US, or in other Western countries, and the facilities are equipped with the latest medical technology found in today’s American hospitals.

For over the past year, I have been writing a blog about implementing medical tourism into workers’ compensation because I believe that it can offer lower cost and high quality medical care to injured workers. Having now written over eighty blog articles on the subject, with topics ranging from Employee/Employer Choice, Immigration Reform, Rising Hospital Costs, and how workers’ compensation is charged more for certain surgeries that general health care is being charged for the same exact surgery, I believe that Contractors and Owners such as yourselves should look into this new and growing industry to help you save money.

The Changing Demographics of the American Workforce

Much of medical tourism involves patients going to countries like India, Singapore, Thailand, and other countries in Asia, Europe, the Middle East, Australia, and even some places in Africa, like South Africa. However, I have been writing about implementing medical tourism for workers’ compensation in this hemisphere, particularly in Latin America and the Caribbean.

This is because the American workforce is becoming more Hispanic and Caribbean, as I have pointed out in an article earlier this year, Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation; a portion of that article appears below:

“According to the IIABA White Paper, which cited a Pew Hispanic Center report published in 2006, there are probably 11 to 12 million undocumented immigrants in the US, depending upon how many “self-deported” recently due to the current US economic slowdown, of which demographically, this represents 5.4 million men, 3.9 million women, and 1.8 million children. In addition, there are 3.1 million children who are US citizens having been born here (64% of all children of the undocumented) from one or more parent… Undocumented immigrants account for almost one-third of all foreign-born residents of the US, and about 80% of these are from Mexico and other Latin American countries…The report also states that out of the total number of undocumented adults, 9.3 million, 7.2 million (77%) are employed and account for around 5% of the US workforce. They comprise a disproportionate percentage in some industries, such as 24% of farm workers, 17% of cleaning workers, 14% of construction workers, and 12% of food preparers…These industries typically account for much of the claims filed under the US workers’ compensation system. Within a particular industry, undocumented workers comprise a higher percentage of more hazardous occupations, e.g., 36% of insulation workers and 29% of all roofing employees are estimated to be undocumented.”

In another article I wrote back in March, Survey says most immigrant workers unaware of Workers’ Compensation: What this means to Workers’ Compensation and Medical Tourism, I cited a report from New Hampshire that stated that:

“…227 participants out of 366, or 62%, were not aware of workers’ compensation. Only 76 individuals, the report states, out of 126 who said yes to understanding workers’ compensation wrote down who told them about it. This included supervisors, human resources personnel, family members, friends, doctors, co-workers, teachers and the New Hampshire Coalition of Occupational Safety and Health (COSH) through classes on safety…Twenty-nine of the 366 participants said they had been injured at work, with injuries to common body parts such as hands, fingers, wrists, backs, knees, feet, elbows, and abdomen. The majority of these injured had been in the US for either 4-6 years, or more than 6 years. 17 of the 29, who said they were injured on the job, had lost time claims…23 participants had told their supervisors about their injuries, 4 did not report because they left the job due to the injuries, a cut finger was not considered “serious”, one felt that if the injury was reported, “nothing would change”, and one said they would be fired.”

When they listed their continent of origin, “most of the respondents indicated that their continent of origin was Asia (44%), followed by the Dominican Republic/Haiti/Cuba at 14%, South America at 11%, Central America at 10%, Africa at 11%, Europe and the Middle East at 4% each, and 1% blank. If you add the Dominican Republic/Haiti/Cuba, South and Central America, you get 35%, indicating that the second largest region of origin is Latin America and the Caribbean…”

In a follow-up to the Immigration Reform article, I wrote, Immigration and Workers’ Compensation: Round Two, and cited additional statistics on the changing makeup of the workforce in the US provided to me by two bloggers I have sourced in the past, Peter Rousmaniere and Joe Paduda. The following paragraphs from that article expound on the implications of the changing nature of the American workforce and what it means for workers’ compensation.

“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:

  • Most of these workers likely won’t know much about the US health care system or workers’ comp, and will get that information from people they know and trust – their fellow countrymen.
  • Many may not have primary care physicians, so will seek care at the most convenient/nearest location.
  • The language issues are both obvious and subtle; even those with passable English skills may not fully grasp what they’re hearing and reading, leading to misinterpretations and misunderstanding.”

Based on these statistics, Latin American and the Caribbean is a logical place for medical tourism to be implemented into workers’ compensation. However, I am not the only one who has discussed the increasing Hispanic and foreign-born workforce and what challenges they present for workers’ compensation. A book published by Peter Rousmaniere with the assistance of Concentra and Broadspire, was reviewed this week by Tom Lynch of the Workers’ Comp Insider blog.

The review entitled, Review: Work Safe: An Employer’s Guide to Safety and Health in a Diversified Workforce, points out that of the 15 occupations that are expected to see the largest growth, numerically, between now and 2020, foreign-born workers, immigrants are over-represented in eight of them. And within the Construction industry, 65% of all “reinforcing iron and rebar” workers are immigrants. They only make up about 15.8% of all US workers, but they account for 20% of all reported injuries.

Peter is a fellow blogger with a Harvard MBA, and I have cited some of his blog articles in my online posts, and his blog, Working Immigrants, has been a source of some very important information in the past. He is also a connection of mine on the LinkedIn social media site, and we have corresponded by email in the past. To illustrate just how valuable a source his blog has been, my recent post, E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism, has a table I created from the International Organization for Migration website Peter alerted his readers to. The table appears below.

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The table is quite self-explanatory, and the grand total of 20.5 million migrants should be of considerable interest to any current or future employer, because those migrants will no doubt have children and grandchildren, and for the foreseeable future, many of them will find their way to employment in those industries like Construction that account for many of the injuries that give rise to workers’ compensation claims.

Cost of surgery in US vs. Latin America and Caribbean

Last November, I wrote a fictional case study, A ‘Case Study’ in Implementing Medical Tourism into Workers’ Compensation, in which I described how a company self-insured for health care and workers’ compensation, could implement medical tourism when three of its employees were hurt on the same job site. I compared the cost of surgeries for both hip and knee replacement in the US with the cost for the same surgeries in Colombia, Costa Rica and Mexico.

The table below illustrates the difference in cost between the US and Latin American countries. The figures shown are not the actual costs for these surgeries, but for our purposes, they will suffice to point out the cost savings that are available through medical tourism.

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Recently, I had a phone call with the president of a new medical tourism facilitator company that is looking to bring employees of self-insured companies to the -Lake Chapala/Guadalajara, Mexico area for medical and dental procedures. His company’s website, MexAmericare.com, compares costs between the US and Mexico for Hip Replacement, as well as for Dental implants. The comparison in prices and the cost savings are as follows:

In the US
Hip Replacement and Hospital Fees                                          $27,000
In Mexico
Hip Replacement                                                                           $10,000
Bed & Breakfast (six days)                                                                 $720
Company Fee                                                                                    $1,500
Round-trip airfare (Est.)                                                                      $728
Total Cost if going through Company                                         $12,948
Cost Savings                                                                                    $14,052

Conclusion

So now we have to ask this question, what is the benefit to the injured worker, his employer, your insurance company and to you as the Contractor or Owner of a project covered under a wrap-up?

The answer is threefold; one, by having the employee agree to seek treatment for surgery in his former country, in a medical tourism facility that caters to medical tourists, not only will he have the benefit of being treated in an environment that speaks his language and in his culture, or in a similar culture, his friends and family back home in that country can visit him and it will aid in his recovery and return-to-work, but also he and they will have the satisfaction of knowing that he is being treated in the best facility in their country.

Second, the cost of airfare and accommodation for the patient and usually one other person, a spouse or friend, is included in the price of the surgery, if going through a facilitator company. And third, with the savings from the cost of the procedure in that medical tourism destination, compared with the cost of that procedure in the US, a portion of that savings can be remitted to the injured worker as an incentive to seek treatment abroad.

A number of large and mid-size US companies like American Express, Google, Disney, Phillips Services Industries, etc., are already exploring or offering this option to their employees as part of their employee health plan, but it would be a logical step for workers’ compensation to follow, especially with regard to wrap-up programs in the Construction industry. All that needs to happen is for one or more companies to “get it” and explore medical tourism as an option to the high cost of workers’ compensation surgery. Anyone wishing more information can contact me at richard_krasner@hotmail.com. Feel free to check out my blog at richardkrasner.wordpress.com.