Richard Krasner
The following virtual dialogue was composed from comments made to me by individuals who have read my White Paper on implementing medical tourism into workers’ compensation, or by individuals in a social media discussion group I participated in late last year. The point comments will primarily come from those who read the paper, and one individual in the group discussion. The counterpoint will come from me and two other individuals in the group discussion, one of whom is a nurse who has her own medical tourism company and provided a few of the point questions as well.
POINT 1: Only about 1% of all workers’ compensation claims are catastrophic and these usually require high dollar emergent care. There is some room for controversy concerning follow on procedures and whether these need to be handled within the same clinical realm as the original or earlier procedures.
COUNTERPOINT: This would only apply to non-emergent care, but it would depend also on how large that 1% of all workers’ compensation claims was. If we are talking about 1% of a 100 claims, then yes, that would be a small number of claims, but if we are talking about thousands of claims every year, 1% of that number would be considerable, and thus large enough to permit some claims to benefit from medical tourism.
POINT 2: Workers’ comp tries to avoid paying for knee or other joint replacements except in the rare instance of traumatic injury requiring joint repair. The great majority of joint replacements are due to chronic, co-morbid conditions which are not work related and it is the job of a good workers’ comp TPA to deny coverage for these procedures.
COUNTERPOINT: Much of the joint surgery performed with workers’ compensation claims are arthroscopic joint repair surgeries, which also is quite expensive, and would be natural procedures that medical tourism could offer at lower cost and the same or better quality that in the US.
POINT 3 (This point was raised by three people, two who read my paper and one who did not.)
A. You have not looked at the cost of airfares, family participation and other costs attendant on overseas medical care. This is handled by medical tourism brokers or facilitators, who include airfare, accommodation of one other person and other costs.
B. What about adding on the travel expenses (e.g. airfare, meals, including a family member’s hotel and related expenses? (I see you note that even with this added in, it’s still cheaper.) What if the claimant has small children and they’re suddenly being shipped away for treatment? What happens to the children and who pays for that?
C. Regarding the provision of travel aid for loved ones, my experience is that job or family care demands of the loved one are as big a barrier to their traveling…To my knowledge no medical tourism program provides income replacement to replace income a spouse loses to travel abroad to be with a patient getting care through medical tourism. I would also note that this problem may be more manageable when a patient travels domestically away from home to get care but exists here too. All that it takes to test the theory that traveling for care undermines the availability of family support and presence is to visit patients getting care several hours from home whose visits from family are limited by these proximity and other demands of life challenges. These issues are only magnified when the care is provided abroad. As a result, the families that can attend a patient getting care abroad are usually those with more resources.
COUNTERPOINT
A. That is the benefit of medical tourism, it is a package deal. You should learn more about it by checking into some of the medical tourism companies out there.
B. The airfare, hotel and expenses are covered in the total cost. The basic package is generally the patient, one companion, airfare, hotel, and expenses. If you saw the hospitals I have seen online, they look like hotels, and even have rooms for the guest to stay in so that they are not far from the patient. These hospitals have food courts like shopping malls here in the US with all the major food groups, McDonalds, Burger King, Wendy’s, KFC, and even local fare, but if the patient is there for heart surgery, I would not think they’d let them eat that. You keep using the term “shipped away” as if traveling abroad is some kind of torture or punishment. Don’t you think that working people deserve to see a little bit of this planet of ours? Don’t you think that such travel will bring better understanding of foreign cultures and people, and will benefit both the patients and those who care for them? I think it is a great way to bridge the gap between the west and the east, and to see that everyone wants the same life we all take for granted. As for the issue of small children, while that was never mentioned in any articles I used for my paper, I am sure that some accommodation could be made, or barring that, another family member or neighbor or friend of the family could watch the children while the patient and spouse or companion are away. This is not a big deal, nor should it impede the implementation of medical tourism.
C. The Family Medical Leave Act of 1993, signed into law by President Clinton requires covered employers to provide employees job-protected and unpaid leave for qualified medical and family reasons. Qualified medical and family reasons include: personal or family illness, family military leave, pregnancy, adoption, or the foster care placement of a child. While it does not include salary for the family member, even if an employee were to stay home and take care of an ill family member, they would lose their salary for that time period, but still have a job when the illness was over, or the employee could no longer stay home. As medical tourism is usually a planned event, the family could always make some provision to cut back certain expenses so that going abroad will not impose a financial burden on the family.
POINT 4: Re: the statement that workers comp claimants are generally in lower-middle class–claimants are in a range of “classes” but they’re not treated differently based on their “class”. They don’t receive different medical care based on class. Evidenced based medical treatment guidelines are applied to all claimant/patients regardless of “class”. In workers comp, claimants don’t care how much medicals cost because they’re not responsible for the bill so their “class” is irrelevant – it’s “free medical care” for them.
COUNTERPOINT: I never said that claimants are treated differently based on their class…That is not the point I was trying to make. I was trying to bolster the point made prior to that that medical tourism will benefit those without adequate health insurance coverage. I pointed out that lower-middle-class individuals will benefit most from medical tourism, and which is why I cited the study by Du and Leigh about claimants generally being lower-middle-class…yes, sometimes, the wealthy do file comp claims, but the bulk of claims I handled as an adjuster and as the Claims Administrator for a OCIP “Wrap-up” program in NY were with middle-class and lower-middle-class claimants, and many of the No-Fault claimants I handled were the same, and some were even immigrants. Finally, you are correct that medical guidelines apply to all. But I think that at some point, some claimants may come to accept medical tourism, especially if the insurer or employer has contracted for it as part of their health plan, or by sheer cost considerations.
POINT 5: But if we ever tried to ship a claimant overseas for treatment, state laws governing would certainly prohibit this particularly noting that most states have specific requirements that providers be located within ‘X’ number of miles from a claimant’s home. Additionally, what about recovery, follow up care, complications, etc.? While some countries report on their quality standards, not all do and finding this information (much less establishing the validity of such data), is a daunting task. Not all facilities are going to opt to participate in Joint Commission accreditation because it is prohibitively expensive.
COUNTERPOINT: Again, these state laws you mention here will need to be changed or modified. I did, however, bring up the fact that Oregon and Washington State allow claimants to choose doctors outside of the US, and even mentioned that Washington State has a page on their website with doctors in foreign countries the claimants can choose from. How different is that from the panels we looked at during my internship? If GA has a panel of six or so doctors and WA has a list of several doctors in countries around the world, is that any different, other than the fact that those doctors are overseas? As to recovery, follow-up and complications, recovery is covered in the basic medical tourism package. They don’t do the surgery and then fly you home saying “bye-bye”. They allow you to recover in the hospital in rooms that make US hospitals look like college dormitories. There are always going to be complications, whether here in the US or abroad, that cannot be helped, but given the fact that JCI is accrediting more and more hospitals, and nations becoming medical tourism destinations are eager to adopt international standards of quality, which is more than I can say for US based hospitals, which I also point out in the quality section. You say that not all facilities are going to opt to participate in JCI accreditation because of expense; however, those hospitals already accredited like Apollo Hospitals or Bumrungrad in Thailand, are already accredited, many are collaborating with US medical schools, and those that aren’t are either not going to be destinations, or will get help from those medical tourism experts such as a woman I know from the social media site I am a member of, and from a company that I learned of at the 5th World Medical Tourism & Global Healthcare Congress recently in Florida.
POINT 6: Medical tourism doesn’t necessarily disproportionately benefit the under/uninsured. These people may not even have the financial means to travel away for care. I would hypothesize that people who are wealthy are much more likely to use services like this and yes, they would also make a vacation out of it.
COUNTERPOINT: That may be true, but not all of the more than 500,000 Americans who have gone abroad for medical tourism are wealthy. And your hypothesis is not holding up to the fact that many Americans who have health insurance, but cannot get certain procedures performed here in the US or paid for by their insurance company, are going abroad, even if they are not wealthy as those who can afford it. Medical Tourism is for everyone.
POINT 7: Expenses in the US are positively exorbitant. There are many other things that need to be done to control costs.
COUNTERPOINT: Yes, and that is why I wrote the paper, to make it clear that this is one way to bring down costs. If you saw the chart I based my Introduction figures on from NCCI, you will see a clear twenty year upward trajectory of medical costs in comp, but so far, they have only managed to slow the rate of increase, not move the line down towards lower medical claim costs. Most of what the industry is trying to get a handle on, the re-packaging of drugs by physicians, opioid use abuse, better case management techniques, better software to monitor losses and experience mods, and the myriad other services offered by the workers’ compensation services industry have not, according to the annual NCCI State of the Line reports, moved the average medical cost per lost-time claims trend line down to a more manageable level. It currently is just below $30,000, so it is obvious that these measures are meager at best.
Check back tomorrow for Part 2
Richard Krasner has worked in the Insurance and Risk Management industry for more than 30 years in New York, Florida and Texas in the Claims and Risk Management spheres, primarily in Workers’ Compensation Claims, Auto No-Fault and Property & Casualty Claims Administration and Claims Management. He has experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management. Received my Master’s in Health Administration (MHA) degree from Florida Atlantic University in Boca Raton, Florida in December 2011. I am looking for new opportunities that will utilize my previous experience and MHA degree. I am available for speaking engagements and am willing to travel. Contact Richard or read Richard's blog.
