Tag Archives: Medical Malpractice

More Questions, Questions: A Call for Answers from the Medical Tourism Industry

Over the past two and a half years that I have been writing this blog, I have had contact with many individuals in the medical tourism industry. Some I have met online, and others I have met at the three medical tourism conferences I have attended since October 2012.

Most of you are in parts of the world that are too far for many Americans to travel to, especially those who might benefit from going abroad for surgery as a workers’ compensation patient. So I have focused my attention on the Latin American and Caribbean market, since there is a growing Latino population in the US generally, and within the workforce in particular.

So my purpose in this article is to elicit answers to questions that I raised earlier, and that have been raised recently by individuals I have been in contact with who are not sure my idea is viable. Therefore, this call for answers from the medical tourism industry.

Here are some of the questions being raised by these individuals:

How will they achieve post-op follow up sometimes for weeks or months? Will the time and effort of repeated travel discourage people? Will those added costs offset any savings on basic cost of surgery? If a serious post-op complication develops (surgical site infection, pneumonia, cardiac issues, etc.), will there be doctors in the US who are prepared to accept the patient of another doctor’s complication? If malpractice occurs (and it will), why would an American doctor even want to become a participant in such as case and risk being eventually named as a co-defendant? I wouldn’t, and lawyers go after the doctor most vulnerable and easily sued (foreign doctors are safe from American malpractice suits). Where is PT done post-op? What assurances do the employers have that a foreign doctor understands the concept of return to suitable work or even cares about the effects the loss of the worker has on their business? What recourse does the injured worker have if the foreign doctor screws up anything related to the work comp claim?

In order for you to be able to answer these and other questions, I am refreshing your memories of past articles I wrote that covered some of these questions.

Back in January 2014, I wrote an article called, “Questions, Questions — How Medical Tourism Can Become a Real Alternative in Health Care and What it Means for Workers’ Compensation”.

The article discussed several questions that the medical tourism industry had not sufficiently answered, such as legal liability and medical malpractice. I asked these questions so that the implementation of medical tourism into workers’ comp, like its implementation in general health care can be achieved to the satisfaction of all the stakeholders involved in workers’ comp claims.

These stakeholders range from the injured worker him/herself, to their employer, the insurance carrier (if insured through commercial insurance), the risk manager for the company, human resources managers, their broker (again, if insured commercially), and any other entity involved with the placement or administration of the workers’ compensation program. It also involves any third party administrators and physicians.

I also discussed the issue of impairment ratings in the article, and outlined the types of impairment ratings physicians must be certified to assign to patients. An understanding of these ratings is necessary for physicians dealing with injured workers, but not for those who are covered under group health plans or private pay insurance.

In February 2013, I wrote another article entitled, “What Role Can Medical Tourism Play in Physical Therapy and Rehabilitation for Workers’ Compensation?”.

In that article, I discussed the significant differences in the type and duration of physical therapy provided to workers’ comp claimants. I mentioned a study that found three key findings:

  • Corporate physical therapy centers billed for more visits and more units per episode than other practice settings.
  • There was a “large difference in treatment utilization between geographic regions regardless of practice setting, diagnosis, body-part treated or surgical intervention”
  • These corporate centers billed for “a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.”

I then concluded the article by saying that physical therapy and rehabilitation services could be packaged along with the surgery, and would provide the patient with a better outcome.

Finally, so that people in the medical tourism industry can understand what workers’ comp is all about, I wrote an article called, “A Workers’ Compensation Primer for the Medical Tourism Industry” where I gave you definitions for common concepts and terms in workers’ compensation.

So what I am asking all of you to do now is this: provide me with answers to the questions I raised earlier, and that are being raised now by those in the brokerage and medical fields who have critiqued my idea for implementing medical tourism into workers’ comp.

You might say I am asking you to put up, or shut up about how much better medical tourism is and can be, because these individuals need to be sold on this, and you are the only ones who can do the selling.

Here are the main areas of concern to address:

Legal Liability and Medical Malpractice

HIPAA (mentioned in my white paper)

Physical Therapy and Rehabilitation

After-care and follow-up

If you want the workers’ comp business, it is you, not me, who needs to answer these questions first. Then I can convey the answers to those in the workers’ comp and insurance industry who are doing the asking.

The Stench of Fraud, Continued

In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.

I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,

But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.

According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:

I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.

[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]

On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.

She goes on to say in her correspondence that:

…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.

Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.

She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:

I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.

The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…

There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.

This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.

To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:

The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.

In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.

A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:

Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.

She also stated in her correspondence that she discovered that:

…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.

Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.

As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.

The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.

Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.

One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.

If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.

How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.

And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.

The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System

The subject of fraud in workers’ compensation usually refers to claimants who fraudulently file claims to get benefits that don’t belong to them.

But there is another kind of fraud in workers’ compensation…the kind of fraud perpetrated by physicians, hospitals, and other medical facilities, either against the injured workers or against the system itself.

Why this kind of fraud exists is for the same reason that fraud conducted by larcenous and bogus claimant’s exists. Greed.

In a post today on his blog, CA attorney, David De Paolo mentions several cases where physicians or hospitals were charged with using phony or unapproved implants on patients.

Kickbacks, defrauding of insurance companies, and compounding problems are just the tip of the iceberg. One individual, who I will call Ms. X, has been a victim of not only of fraud, but of abuse by the medical providers she was forced to go to under CA work comp laws.

To summarize her experience, let me just say that she endured three epidurals that not only hurt her, they may have damaged her muscles and nerves, and even a defense attorney, in a letter to convince her to settle for a few thousand dollars, said that she was being harmed. Anesthesia was administered against her will, and the legal system took advantage of her as well.

Medical records and forms were changed, doctors treated her with contempt, and her life has been turned upside down and would have been homeless if not for her sister.

Those of you who have read my blog these nearly two years, know that I have been passionate about giving injured workers the best medical care available, and at the lowest cost possible. I know that the American health care system is broken and dysfunctional, but now it seems that it is actually harmful to those whose medical condition is the result of a workplace injury.

Those who criticize my idea to implement medical tourism into workers’ comp should look themselves in a mirror and ask themselves this question: do we really provide injured workers with the best medical care possible, given our broken and dysfunctional health care and workers’ comp systems, and because we have been strait-jacketed into this situation by antiquated state statutes and laws that actually perpetuate this fraud and abuse?

To the medical tourism industry, I am asking the following question that you need to answer, and answer affirmatively so that the health care industry will take you seriously. Will you follow the lead of these fraudsters and hucksters and use phony or unapproved implants on your medical tourism patients, or will you guarantee that you will use FDA approved and legitimate implants and will dispense drugs that have not been compounded in suspect labs? And will you agree to weed out those providers, mostly in the cosmetic and plastic surgery arena, and see that they are turned into the appropriate authorities in their home countries, because they are giving medical tourism a bad name.

And will both the medical tourism and workers’ comp industry promise that patients such as Ms. X will not be maimed and battered by a corrupt and fraud-prone workers’ comp and health care system?

Maybe it is time to get rid of the bad doctors, medical facilities, lawyers, and workers’ comp personnel who care more about their jobs and the profits of the companies that provide services to the workers’ comp industry, than the health and welfare of every single injured worker. And maybe it is time to seriously look at some out of the box solutions to the problems our broken, corrupt, and dysfunctional system is causing injured workers. Medical tourism could be one of those solutions.

 

Questions, Questions — How Medical Tourism Can Become a Real Alternative in Health Care and What it Means for Workers’ Compensation

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You may have noticed that I changed the name of my blog recently to Transforming Workers’ Comp.  I did this because I wanted to show how serious I am about changing the way workers’ compensation is conducted in the US and to prove that implementing medical tourism into workers’ compensation is not an academic exercise from an author without the credentials to support his ideas.

Today’s post has two parts to it. The first part deals with the fact that the medical tourism industry has yet to sufficiently answer certain questions regarding how the issues of legal liability and medical malpractice are to handled, and which forums, American or foreign, are the proper forums in which to bring lawsuits, in case patients are wrongfully injured by foreign medical providers.

Who is liable for damages and how that liability is resolved between the patient’s home country’s laws and the laws of the destination country needs to be answered, as does who will pay when a medical provider causes harm to a patient. For most doctors in the US, medical malpractice insurance, which is incredibly expensive and has driven many physicians out of medicine, covers medical mistakes. But how these mistakes are dealt with when a patient seeks care in another country is vital, not only for health care patients, but for workers’ compensation patients as well.

This is something that I mentioned in my blog post last year, Legal Barriers to Implementing International Providers into Medical Provider Networks for Workers’ Compensation: A White Paper, when I said the following:

Medical malpractice and liability laws

One major criticism of medical tourism is the lack of legal remedy for patients claiming injury from medical malpractice.[91] Medical malpractice and liability laws in foreign countries are not as strict as laws in the U.S.[92] Awards for malpractice are generally not as generous either as those in the U.S.[93] Physicians overseas do not typically have the same amount of malpractice insurance as their American counterparts.[94] And the threshold for determining malpractice is higher outside the U.S.[95] Limited recourse through the court systems of many countries is a problem, and the right to sue may not exist for injured patients.[96] In India, even though the court system is similar to that in the U.S., medical malpractice awards are rare and never reach the multi-million dollar amount common in U.S. court systems.[97]

Before recognizing a suit, an American court must have personal jurisdiction over a foreign provider.[98] The issue of personal jurisdiction over the foreign provider is a difficult burden for anyone initiating a suit.[99] U.S. courts are reluctant to assert personal jurisdiction over physicians who are not residents of the U.S. and do not practice in the forum state.[100] Minimum contacts sufficient to exercise personal jurisdiction could be difficult to establish over a physician who performed a harmful procedure outside of the forum state.[101] If a U.S. court does find evidence to support personal jurisdiction, the case could be dismissed on the grounds of forum no conveniens (not suitable to the forum).[102] If the case is not dismissed, then choice of law conflicts arises.[103],[104] If a court recognizes a valid claim against a defendant, it is likely the defendant will be successful challenging the location of the suit.[105] Most jurisdictions would apply the laws of the country where the malpractice occurred, decreasing the likelihood of a finding of malpractice, and a reduction of damages.[106]

These questions may not be much of an issue for individuals contemplating or actually pursuing medical tourism as an alternative to expensive or unavailable medical care. But for employee benefit managers, corporate risk managers, corporate financial officers and top executives, as well as insurance company and third-party administration personnel responsible for the handling of claims and the medical issues involved with these claims, it does matter a great deal and will need to be resolved before medical tourism expands its market into workers’ compensation.

But there are other questions, more pertinent to the implementation of medical tourism into workers’ compensation that involve the issue of impairment, which maybe something that medical tourism providers are not knowledgeable about, since health care in the US is not as regulated as the American workers’ compensation system is, and foreign physicians who have not practiced in the US may not have experience with patients who were injured on the job, or are familiar with state workers’ compensation regulations and rules pertaining to impairment.

So my purpose here is to explain to the medical tourism industry what is involved with impairment in workers´ compensation so that medical tourism physicians will be able to deal with this issue as more Americans go abroad for health care, and especially if their employers pay for them to do so, as one company in the southern US is already doing and when the injuries being treated are work-related. Once physicians are aware of how impairment is covered under workers’ compensation.

Impairment is defined in an article by Rebecca Shafer, J.D. as a problem in the function of a body part. It can be either temporary or permanent. When it is temporary, the employee is unable to work while recovering from the injury. When the impairment is permanent, the employee retains a residual of the injury after the medical treatment has ended. A permanent impairment’s impact on the employee’s life can range from a very mild impact to a life altering impact.

According to Rebecca, impairment in a workers’ compensation claim can be further defined this way:

      1. An inability of the employee to use his musculoskeletal system — his limbs, joints, muscles, bones, tendons and ligaments at the level prior to the injury, or
      2. An inability of the employee to control his/her neurological functions — the brain, spinal cord, and peripheral nerves at the level prior to the injury.

Dr. Nachman Brautbar, in an article on Environmental Diseases.com, explains that in evaluating the individual, “the physician should use clinical judgment regarding normal structure and freedom and estimate what is normal for the individual based on the physician’s knowledge or estimate of the individual’s pre-injury or pre-illness condition.”

Eight states have set up state specific disability ratings for injured workers, according to Rebbeca. These ratings are, according to Dr. Brautbar, developed by medical specialists …that reflect the severity of the medical condition and the degree to which the impairment decreases an individual’s ability to perform common activities of daily living (ADL), excluding work. These ratings are expressed as percentages of impairment, for example, from 10% – 18% impairment. Forty-two states use the AMA Guides to the Evaluation of Permanent Impairment.

But whichever guide is used, if the treatment plan includes surgery of any kind, the surgeon must take into consideration what level of impairment the patent will have post-surgery. For patients suffering work-related injuries this is very important because the outcome of the surgery will determine their final impairment rating, and thus the amount of benefits they will receive after recovery.

However, for patients undergoing surgery for injuries not sustained on the job, such ratings are not important, and for the medical tourism provider, it is also not a factor in the final outcome of the surgery. The patient is seeking medical care abroad because it is too expensive at home, unavailable at home, or is experimental. And because most physicians in the US who treat injured workers are utilizing evidence-based medicine, the American medical community will only treat patients with certain treatments like spinal fusion for back injuries, whereas physicians in countries like India are performing disk replacement surgery, which allows the patient more mobility than fusing.

Finally, there is one more definition of impairment that has not been mentioned; that of Maximum (Maximal) Medical Improvement, or MMI. MMI occurs when an injured employee reaches a state where his or her condition cannot be improved any further or when a treatment plateau in a person’s healing process is reached. It can mean that the patient has fully recovered from the injury or that the patient’s medical condition has stabilized to the point that no major medical or emotional change can be expected in the injured workers’ condition. At that point, no further healing or improvement is deemed possible and this occurs despite continuing medical treatment or rehabilitative programs the injured worker partakes in.

Then a determination is made as to the amount of future compensation the employee will receive, based upon the following categories of disability:

  1. Temporary total disability (TTD)
  2. Temporary partial disability (TPD)
  3. Permanent partial disability (PPD), and
  4. Permanent total disability (PTD)

If an employee fully recovers from the injury, then he returns to work and the TTD ends, according to Rebecca.

So it would seem that before medical tourism can be implemented into workers’ compensation, these and many other questions and issues must be understood, addressed and satisfactorily dealt with. By doing so, the globalization of health care that is medical tourism will be able to handle all facets of medical care, not just those that involve cosmetic surgery, weight-loss surgery, heart disease, cancer, fertility and a host of other new medical treatments and procedures, but workers’ compensation injuries as well.

Since I began my blog, I have heard from a small number of professionals in the medical tourism industry. Some have commented on my writing, others have invited me to connect with them on LinkedIn and even work with them, believing that I have a medical tourism business and can provide them with patients. And still others have ‘liked’ my articles, but do not comment.

So here and now, I would like all of you who have commented, invited me to connect, and who have “liked” my articles to help me answer these and other questions that have been raised throughout my articles. It would a tremendous way for all of us to learn just how medical tourism can change the lives of millions of people who otherwise would receive less than adequate health care at home. It would also allow those who are interested in expanding the reach of medical tourism into a market that so far has resisted the benefits of medical tourism.

Once that is accomplished, American employers will be more comfortable with the idea of paying for employees to leave the country to get treatments that will change their lives, as I know the company in the southern US has already learned. And, the employee will be compensated for traveling abroad from the savings the employer will realize. That too is a question that needs to be answered, but that is a discussion for another time.

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Richard