Tag Archives: Construction

Immigrants in construction — key facts « Working Immigrants

Peter Rousmaniere posted the following fact sheet about immigrants working in construction. While this has no bearing on health care at present, it does have some bearing on workers’ comp, especially in light of the current regime’s draconian policy towards immigrants from Central America.

As this “crisis” progresses, it may be harder for construction companies to find workers to employ on construction sites.

This, in turn would mean that they may be less construction work, and for the insurance industry, less risk and less profit to be made from insuring these projects.

In workers’ comp, that would translate into less frequency of losses, but it would also cut off revenue from carriers covering such risks.

And he promised to create jobs? Hardly.

Source: Immigrants in construction — key facts « Working Immigrants

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.


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.

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


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.


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.


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


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.

How Medical Tourism Hospitals are Developed


Today’s second post is courtesy of Maria Todd, CEO of Mercury Healthcare International.

While her article is about hospital development in Africa, specifically the work she is doing in Nigeria, it is instructive on how hospital development in other regions of the world are laying the groundwork for the expansion of medical tourism.

In the article, she explains why Africa is targeted for financing and why now, how to size the facility and the market, what is different about hospital development and inpatient utlization in Africa, where the money comes from, the investment risk and capital funding in Africa, and some of the pitfalls that can happen when a company like hers is called in to help develop a hospital, and there is not much cash to be had, or as she puts it:

Apples and little green monkeys fall from trees – not cash

Being an expert in medical tourism and healthcare, Maria has made a name for herself, which is why she takes on such a daunting challenge as hospital development in Africa. Perhaps one day, Africa will be known as a shining example of medical tourism, and she and her company will have made it possible.