Category Archives: Legal Immigration

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.

Share this article, or leave a comment below.

Advertisements

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.

E PLURIBUS UNUM: Latin American and Caribbean Immigration, Workers’ Compensation and Medical Tourism

I received an interesting post today from Peter Rousmaniere’s blog, Working Immigrants, which is described as a weblog about the business of immigrant work: employment, compensation, legal protections, education, mobility, and public policy.

Peter’s post, Extraordinary visual of international migration, directs the reader to the website of the International Organization for Migration. What the reader finds there is a map of the world and buttons that allow you to choose between inward and outward migration to and from any country in the world.

By choosing several countries in Latin America and the Caribbean, I was able to create the following table that shows the country of origin of the migrants and the number of migrants from that country to the US.

Image

And here is the key takeaway from the map and the table: The majority of migrants are coming from Mexico, and the total number of migrants to the US from those countries total 20,564,479 million. This number may or may not include undocumented immigrants, and does not include data from The Bahamas, and many of the smaller islands in the Caribbean.

But let’s go back to the total number of migrants. 20.5 million is a pretty large number. That is more than the total population of New York, Los Angeles, Chicago, Houston, Philadelphia and Phoenix put together, according to the 2010 census.

We can assume that not all of the 20.5 million are able to work or are eligible to receive workers’ compensation benefits, so the number of actual workers out of that 20.5 million is considerably lower. And we can also assume that not all of them will ever file a claim, as I pointed out in an earlier post, Survey says most immigrant workers unaware of Workers’ Compensation: What this means to Workers’ Compensation and Medical Tourism.

Yet, for those who do file a claim, it is likely that some of them will suffer an injury that will eventually require expensive surgery that could be found for a lot less in their home countries or in nearby countries, where language and cultural barriers are not an issue.

In many cases, these countries are less than four hours from most major cities on the east coast of the US, and no more than 8 hours from other cities, depending on how far south one flies.

The question that must be asked is this: If these 20.5 million become permanent residents of the US one day, and have children and grandchildren, wouldn’t it be logical to find a way to provide them with quality medical care at lower prices in their countries of origin, when they are injured on the job, so that their friends and families back home know that they are getting the best care?

And what about those in the workforce who are not from that region? Don’t they deserve the same high quality, low cost medical care when they get injured, especially in a location that provides a restful recovery and maybe a little extra on the side?

If it sounds like I am repeating myself from earlier posts; yes I am, because it needs repeating over and over again until people realize that health care is globalizing, and workers’ compensation, at least the medical side of it, must be a part of that globalization. Not to do so is, well, you know.

—————————————————————————————————————————–

 

I’d like to get to know you better, so please complete the form below and let me know who you are, where you are from (country and city, please), and what you like about my blog.

Thank you so much,

Richard

Immigration and Workers’ Compensation: Round Two

Image

Now that the summer is almost over, and we have had a brief, educational interlude, thanks to my recent quiz and the article about the 1798 mandated health care law for merchant sailors, let’s turn back to more serious and more immediate subjects that are relevant to our times.

One such subject is immigration, and thanks to both Joe Paduda and Peter Rousmaniere, today’s post will build upon that subject, as I have previously written about it in my earlier posts, The Stars Aligned: Mexico as a medical tourism destination for Mexican-born, US workers under Workers’ Compensation, Immigration Reform on the Horizon: What it means for Medical Tourism and Workers’ Compensation, as well as my post, Survey says most immigrant workers unaware of Workers’ Compensation: What this means to Workers’ Compensation and Medical Tourism.

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:

Given these facts, it might be worth the workers’ compensation industry’s while to explore and seriously consider medical tourism as an alternative, but as much of the industry is focused on the issues of opioid abuse and the physician dispensing of drugs, which are certainly important issues, they nevertheless cannot blind the industry to other issues such as the impact of immigration on workers’ compensation, and to the alternatives that are out there to deal with them.

As I have been saying for some time, the implementation of medical tourism into the American workers’ compensation system is not just some fanciful dream or exercise in seeing myself in print. It is a rational, thoughtful and reasoned alternative to the high cost of medical care, not only within the general health care system of the US, but within the niche market that is the US Workers’ Compensation system.

As Joe and Peter so skillfully point out, and as I have done so in the past, the future American workforce will be made up of men and women who either were born in, or whose families came from countries in the Latin American and Caribbean region.

Sending injured workers to these and other countries in the region for medical treatment is a logical idea because of language and cultural barriers, access to quality medical care in the best facilities in their native countries or similar countries, and the ability of friends and relatives living there to visit the injured worker while recuperating from surgery, and therefore making recovery faster and more likely to have better outcomes.

If Peter’s 20% figure is correct, then it is safe to assume that a percentage of those injuries will require surgery at some point in the treatment process.

And if they will require surgery, what guarantees do we have that negotiations and fee schedules will bring down the cost of these future surgeries here at home, when a cheaper, better quality alternative is just a short flight away from the US mainland?

I have tried to get data on costs of certain surgeries common to workers’ compensation from a facility in the Caribbean and from hospitals in Latin America, and while I have also written about how difficult it is in getting such information, it nevertheless is imperative that the workers’ compensation industry gets behind this idea, and pushes for transparency from these facilities so that comparisons can be made between costs here and costs there, as well as quality.

But let me be clear, this is not going to be easy, and I have said it before, and it needs to be said again and again, it will be difficult to implement medical tourism into workers’ compensation, but can you really afford not to?

Recently, I had a conversation with the President and CEO of a surgery benefit management company, who also had the same idea, and in our conversation, he told me that he believed that the savings would have to be greater than $5,000, including surgery and airfare, for medical tourism to be a financially viable alternative to the high cost of surgery. His business model relied on getting the lowest cost domestically for his clients, which is still higher than what might be possible in Latin America or the Caribbean, but without reliable data, it is impossible to prove that claim.

What needs to happen is this, both the medical tourism industry and the workers’ compensation industry need to find each other and begin the process of determining how best they can help each other, and how best they can serve each other’s needs. One way for this to happen is for large, workers’ compensation services companies that already provide various services to the workers’ compensation industry such as medical care, translation services, and transportation services, through an in-house or contracted travel agency, so that their insurance carrier or employer clients can confidently and effectively secure better quality and lower cost care for their foreign and native born workforce in the event of serious work-related injuries.

The workers’ compensation industry needs to get focused on this issue, and the medical tourism industry needs to come clean with just how much it costs to perform surgery X, Y, or Z, and in which countries. Not being transparent and basing costs on multiple factors is like buying a car and being told that the price depends on the color, the time of day it is bought, the time of year, whether or not the salesman woke up on the right side of the bed that morning, and so on.

We cannot shut out the rest of the world, despite what the Tea Party wants, because like their Know-Nothing and Whig Party forefathers, they too will disappear from history if they continue to ignore the immigration issue. Let’s hope the medical tourism and workers’ compensation industries don’t either.

Survey says most immigrant workers unaware of Workers’ Compensation: What this means to Workers’ Compensation and Medical Tourism

Image

Introduction
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.

Report Statistics
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.

Conclusion
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.