Back in January, you may recall that I wrote a post about immigration reform and had invited a guest blogger to write about immigration as well. Also that month, I wrote about the hospitals located in Latin America and the Caribbean that I saw at the Medical Tourism Association Congress last October.
My purpose in writing those two posts was to tell people in the workers’ compensation and medical tourism industries that immigration reform was going to happen, that it could have an important impact on both industries, and that as far as the workers’ compensation industry was concerned, it would be a wise thing for them to consider medical tourism, especially to the “rising stars” of medical tourism in Latin America and the Caribbean, as the number of Latinos in the US is growing and more and more workers are of Hispanic descent, and because of immigration reform, more of them will become legal citizens able to come and go from the US to their countries of origin without fear of not being able to return or being deported once they did return.
Immigrant Survey Report
Now comes a report from New Hampshire, courtesy of David De Paolo’s blog, De Paolo’s Work Comp World, which says that a majority of immigrants to the US do not know that if they are injured on the job, they can get their medical care paid for by workers’ compensation. According to De Paolo, the New Hampshire Department of Health and Human Services (DHHS) reported that a recent survey of immigrants showed that most of them never heard of workers’ compensation.
The participants in the survey were asked if someone in the US ever told them that their medical bills would be paid for by workers’ compensation insurance, if they suffered an injury on the job. If they said yes, they were told to write down who had told them about workers’ compensation.
The report, Occupational Health Surveillance Immigrant Survey Report, conducted in February, indicated 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.
The report includes several tables and graphs detailing respondents work experience in the US, population change in New Hampshire from 1990 to 2010 by ethnicity, demographics, continent of origin, race and ethnicity, education, jobs they held in the US and other employment data, as well as knowledge of workers’ compensation, number of weeks out of work, who paid the bills, treatment of injuries, working conditions and safety at work, supervisor support, and if they experienced bad treatment.
182 or 50% of respondents said they now worked for pay in the US, whereas 135 or 37% said they never worked for pay in the US before their present employment. The population change in NH from 1990 to 2010 saw a decrease in the White population from under 100,000 in 1990 to 40,000 in 2010, while the Black, Hispanic, Asian population increased, but not as much as the White population decreased. There was a decrease however in the Other category from 1990 to 2010. The largest group increase was among the Hispanic population.
The demographics showed that of the 366 immigrants, 41% were men and 58% were women (1% did not answer). The majority of respondents were between the ages of 21 to 60, with the 21 to 30 group representing 21%, the 31 to 40 group representing 24%, the 41 to 50 group representing 21%, and the 51 to 60 group representing 17%. The Under 21 group was 3% and the 60-plus group was 12%, with 1% leaving age blank.
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, something medical tourism facilitators for that region should be aware of.
What does this mean for the Workers’ Compensation and Medical Tourism Industries?
It should be fairly obvious that for the workers’ compensation industry, this report means that they have not done a good job of keeping up with the changing face of the American workforce, and have ignored the immigrant worker for far too long, so that many of them do not know that when they are injured on the job, they can get their medical bills paid for, and can be compensated for lost time from work, which would help them get them back on their feet and keep their families secure.
It also means that labor unions and advocates for immigrants and workers have not done as good a job as they should have in getting the legal, and even the illegal immigrants the proper legal remedies they are entitled to under our laws. Perhaps it is fear that if the immigrants know about workers’ compensation, they will file more claims and thus raise their employer’s claims frequency, resulting in higher costs and premiums. Or perhaps they are afraid if they tell immigrants about workers’ compensation insurance, that somehow they will be deported for having made a claim. Whatever the reason is, it is quite obvious that there is a breakdown in communication between employer and employee, between unions and workers, between advocates for immigrant rights and the legal system and those they are dedicated to serve.
Some of the things that can be done are as follows:
- When I did my internship for my MHA degree, the company I worked for had me check their database to update workers’ compensation rules and regulations regarding wall cards or panel cards that are required to be placed in an area of the employer’s workplace where workers can see it that will tell them what to do in case of an injury and how and where to file a claim, as well as to list any doctors chosen by the employer or insurer, or the state work comp agency that the claimant must use. It should be mandatory for all states to post wall cards, even if that state does not require a panel of physicians to be posted.
- The wall cards should be written in several different languages, depending on the predominant ethnic and language groups in the particular state.
- Allow advocates of the poor and immigrants, such as churches, unions, and advocacy groups to file claims for those injured immigrant workers who are too afraid to report claims to their bosses, or don’t know how to file, or who to trust. This should be in conjunction with legal personnel versed in the state’s workers’ compensation laws.
As for the medical tourism industry, this is an opportunity for the industry to step out of the shadows and open up to an underserved market of recent immigrants to the US from many of the same regions of the world in which the medical tourism industry is already sending Americans overseas for less costly and better quality healthcare. It is also an opportunity for the medical tourism industry to move away from being solely a province of affluent or middle class patients, and help serve those at the bottom of the social scale to get the same quality care the affluent and middle class are getting in medical tourism.
I have written some on the region more than a third of the respondents said they came from, Latin America and the Caribbean. With the majority in the survey saying they are from Asia that would mean that medical tourism could be implemented in workers ’ compensation by facilitators and destinations already providing medical care services in Asia, Latin America and the Caribbean. So it would not mean that they would have to do anything different than what they are already doing, just doing so for a different patient population.
It would require training and educating all levels of medical tourism to understand the difference in treating patients who are coming for care because they cannot get or afford such care back home, from those who get injured on the job and need care coordination, utilization management and review, and aftercare. But most important, it would require a change in direction for those facilitators and medical tourism destinations that only serve the well-to-do or middle class client.
It is apparent from the New Hampshire report that there is a serious problem in this country with regard to the awareness and knowledge of the laws and rights workers have when they are injured on the job. It was more than 100 years since the Triangle Shirtwaist Factory fire that took the lives of over 100 young women and girls, many of them Italian and Jewish immigrants, not unlike the immigrants of today.
Every state in the union eventually passed workers’ compensation laws as a result of that tragic fire, and workers won other rights such as unemployment insurance, the right to join the union of their choice as my grandparents did, the right to strike and collective bargain, and the right to have a decent retirement paid for by money they and their employers put into pensions and social security funds. All that is being, or has been lost or eroded over the past forty years, and there are people today in this country who would like nothing more than to eliminate all the gains workers have made in the last one hundred years.
The survey indicates just how fragile these gains are, because if future workers don’t know they have these rights; then it is much easier for the opponents of these reforms to get rid of them altogether and claim they never existed. The threat this survey poses to workers, employers and the workers’ compensation industry is not as great as the opportunity it affords for better workers, better productivity and less time lost from accidents on the job, and even lower claims costs if medical tourism is added to the mix.
The threat to the medical tourism industry from this survey is minimal, since right now it mainly deals with patients who can afford to go abroad or whose insurance companies will allow them to do so. The opportunity it represents is enormous, so it is in the best interest of all parties that the medical tourism and workers’ compensation industries work together, so that all patients can get the best and most cost-efficient healthcare available.