Tag Archives: Immigrants

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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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.

Labor Day, Immigrants and Medical Tourism: An Essay

Labor Day in the US is generally noted by parades, barbeques, a day off for some, retail sales and the end of the summer vacation season. However, the origin of Labor Day goes back to the late 1800’s when the Haymarket Massacre prompted then President Grover Cleveland to make the first Monday of September a day to mark the contributions of labor to the country.

This is in stark contrast to that other day of labor that is celebrated in 80 countries today on the first of May, which is called International Workers Day, or May Day (not to be confused with a distress call at sea, or a female Bond villain played by Grace Jones), and certainly not celebrated today by a display of intercontinental nuclear missiles passing by a reviewing stand of old men in Red Square.

The fact that in the US, we celebrate workers on the last day of summer, and not the first day of May is what I’d like to call “American Exceptionism”, which is not the same as “American Exceptionalism”. “American Exceptionism” is the fact that there are many things that people all around the world do that Americans do not. For example, while the rest of the planet goes nuts over something we call “Soccer”; our citizens go crazy over a game rightly called “American Football”.

Another form of “American Exceptionism” is the fact that we have refused to sign certain treaties and agreements, like the Universal Declaration of Human Rights, the Kyoto Treaty, and so on. So in moving the day we celebrate workers and their contribution to our economy, we are the exception and not the rule that the rest of the world follows.

What does this have to do with medical tourism and implementing it into workers’ compensation, you may ask? That is a very good question, and the point of this article is to answer that question.

Over the weekend, I spent considerable time researching the origins of my family after receiving the death certificate of my maternal great-grandfather, who died before both I and my mother were born. For a number of years I have been researching both sides of my family tree, and like many millions of American families, I can trace my family back to immigrants and their families in the late 19th and early 20th centuries.

All four of my grandparents were immigrants from what was the Tsarist Russian Empire, with two grandparents immigrating under Polish passports, and the other two with Russian Empire passports. My maternal grandparents both came from towns that are now in Belarus, as did my paternal grandmother. Her husband came from a town in what is now Moldova.

At one time or another, these four people worked in the garment industry. My paternal grandmother owned a restaurant with her sister serving old world Jewish food, before going to work in a tie factory before she retired, and my grandfather worked driving an ice cream delivery truck. It occurred to me that if either of my grandmothers had been one of the one hundred or so, young Jewish women and girls who perished in the Triangle Shirtwaist Factory fire of 1911, I probably would not be writing this article right now.

It was because of that tragedy that many states adopted laws to compensate workers who sustained injury on the job through no fault of their own. It has been over one hundred years since that tragedy, and the system put in place to prevent and ameliorate the suffering caused by workplace injuries has saved countless lives and kept thousands of families from going broke from having to pay for expensive medical care.

Workers’ compensation is by no means perfect, nor is it working the way it should or the way it was intended, but nevertheless it does work, so the sacrifice and loss of those immigrant Italian and Jewish women and girls in 1911 was not in vain. Naturally, it would have been inconceivable and impossible to get better treatment at lower cost for these and other workers if they were given the chance to return to their homelands for care while they recovered from their injuries.

Many immigrants were fleeing oppression, poverty and perhaps the authorities back home, and may have been an important financial resource for the family, so a trip across the Atlantic was not only arduous, long and expensive; it was also a symbolic break with the past. Going back across the Atlantic was out of the question for most, but some did.

However, with modern air travel and the many immigrants now coming from Latin America and the Caribbean, it is much easier, cheaper, and faster to travel back and forth from the US to their home countries. And since many of these same countries are becoming medical tourism destinations, it is more conceivable now to implement medical tourism into today’s workers’ compensation system than it was a hundred years ago.

So as we settle back into our routine lives after the Labor Day weekend, let us remember that we owe a lot to our immigrant ancestors and the workers of the past century and a half who came here seeking a better life for themselves and their families. We owe them the respect and admiration for their courage in crossing an ocean to seek a better way, and we owe them and other immigrants, more recent to these shores, a workers’ compensation system that respects them as individuals, workers, family members, and most of all, as human beings. One way we can do this is to find the way to provide them with the best care at the lowest cost and highest quality, even if that means going home to their countries of origin so that they and their friends and families will know that America cares about them.

Immigration and Workers’ Compensation: Round Two

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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.