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 8: One last point, medical tourism is not intended to take the place of primary care or treatment of workers’ comp injuries. That will, of course, happen in the days right after an injury occurs.
COUNTERPOINT: Yes, that is true, but when surgery or treatment can be delayed, then one factor that will necessitate the implementation of medical tourism is the cost savings. The main point I wanted to make was that there is an alternative to high cost, post-primary treatment of certain work comp injuries such as knee, hip, or back surgery, or as Dr. Merrell points out, repetitive injuries such as carpal tunnel and the like. It is not for everything or for everyone, but it should be an option nonetheless.
POINT 9: Does the risk of blood clot increase during a long flight?
COUNTERPOINT: Of course, that’s why we have medications that substantially lower such risk. In addition when a person has surgery abroad, they cannot travel home immediately due to the risk of embolism. That’s why one must relax after surgery before returning home. The doctor in charge makes the determination concerning when it’s safe for the person to return home on a long flight… to help reduce the risk of such complication.
POINT 10: I won’t know the doctor overseas.
COUNTERPOINT: When you are admitted to a hospital in the USA, you don’t know that doctor either. Plus in today’s world, as an inpatient, you will probably be assigned a hospitalist. This is a doctor that is employed by the hospital and its common practice for the hospital to actually pay “outside” doctors to not visit their patient. This allows the hospital to make more money. Of course you may know the surgeon, because if this is non-emergent care, more than likely you had an office visit or two before the surgery. Again this is no different from medical tourism procedures; here too you will meet with the surgeon a couple of times before surgery. It’s the same…
Before anyone goes abroad, they should at least get to know the doctor who will oversee their treatment, even if they are not physically there to do so. Long distance communication through Skype and other such resources are making the world smaller, so that is no longer an issue.
POINT 11: I won’t know the people.
COUNTERPOINT: If you are a patient in an American hospital, you’ll be lucky if you are even acquainted with any of the hospital staff. Normally the hospital staffs are people you don’t know. Of course patients who participate in medical tourism are encouraged to bring a travel companion, so the patient does know someone else. A travel companion lowers stress levels, which strengthens the healing process. Even when you factor in the cost of travel for two, you still save thousands of dollars. So how does this compare to hospitalization in the USA? Not much different, so obviously this too is a weak argument.
POINT 12: As for your question concerning worker’s compensation, I am curious as to why an employer would want to limit such an advantage to worker’s compensation?
COUNTERPOINT: As for workers’ compensation, I never said that employers would limit themselves to that for the advantage medical tourism offers them. My research showed that there are companies offering medical tourism as part of their health plans to individuals as well as employers. There have been issues with union objection and some state governments, particularly West Virginia, that have explored it, but have never passed bills to allow their workers to get medical treatment abroad. And when I attended the 5th World Medical Tourism & Global Healthcare Congress in October, I learned that large employers like American Express and Google, and smaller companies like Phillips Services Industries (PSI) are offering it as an option to their employees as part of their health care plans. Two individuals I connected with from the Congress are working on self-funded employer health care plans in Latin America with Aetna to offer medical tourism.
POINT 13: A key challenge for those who advocate that medical tourism options be used for US based workers needing occupational injury treatment as well as those advocating that Medicare/Medicaid and other government systems pay for medical tourism options is the regulatory restrictions on those treatments and their reimbursements. In the case of US worker’s compensation programs, most states regulate both what insurers and employers can do to require or influence the care provider and site, as well as in many instances restrict the provider to an approved provider except for emergency treatments.
COUNTERPOINT: As for the subject at hand, my paper was on the legal barriers to implementing medical tourism for WC. There were many legal barriers that I found, some of which seemed outdated given the ease of travel today in the US, and the ease of communication between doctors in one state and specialists in other states, especially at larger, more prestigious and better equipped hospitals. However, the three cases I cite in the paper, two on medical tourism to a foreign country (Mexico) and one on domestic medical tourism, opens the door slightly to allowing medical tourism for WC. The two cases concerned Mexican workers in CA and FL, respectively, who received treatment in their hometowns in Mexico, and the courts in both states, granted claimants petition to have Work Comp pay for it. FL law even recognizes that claimants will travel to their country to have care, so it was granted by the Supreme Court. It may take time, but there is no stopping the process of globalization, and that includes the globalization of medical care for Workers’ Compensation, because the costs will become so high here, that an alternative will have to be found, and that will break the dam, IMHO.
See COUNTERPOINT 5 regarding Washington and Oregon.
No doubt what you say is true at the present time, but you should know, and I mention this in my paper, that medical costs of WC claims is rising, and as of the latest figures I got from NCCI, the average medical cost per lost time claim was $26,000 in 2008, and medical losses in 2008 represented 58% of all total losses. Given that, don’t you think there will come a time in the near future that insurance carriers will say ‘enough”, pressure legislatures to change laws and open the market to medical tourism to bring down costs? And as for choice of which facility is best, it would have to be one accredited by the international arm of the Joint Commission, such as Bumrungrad in Thailand, or those in India, Singapore, etc. I also think Americans need to be more globally aware that the rest of the world is not only catching up to us, but in many respects is passing us by. We can no longer hide our collective heads in the sand that the US is number one in everything, because it is not so. The doctors in these hospitals are trained in western medical schools, including US schools, and these schools are partnering with these hospitals. We are foolish and naive to think “America is No. 1″, and therefore we should not seek the best care wherever it may be. And as for leaving loved ones, these hospitals provide accommodations for loved ones or friends to stay with the patient until they have recovered enough to return home. It is a new world out there, and Americans must learn to embrace it, or we run the risk of becoming a third world nation ourselves.
POINT 14: For workers compensation care, promotion of medical tourism as an option is a problem because most US worker’s compensation laws require that the employee have choice, or otherwise restrict the ability of insurers and others to restrict employee choice of care. Add to that, except for workers already working abroad, most workers don’t want to leave their families and communities for care and recovery in a foreign country where they don’t know the provider or the people. Existing worker’s compensation laws are not generally going to allow an insurer or employer to force an employee to go abroad for care because it’s cheaper. What regulatory restrictions don’t obstruct, these and other practical barriers likely will also limit the options. While there are many wonderful facilities around the world, most US based Americans are not sure how to tell which ones are top notch and which ones are not. While this already presents some challenges, the widely held skepticism of injured employees about the care provider choices of insurers and employers would generally go through the roof if the recommendation is made because the insurer or employer can get a cheaper rate by sending the worker oversees. Furthermore, while some Americans are willing to travel, most don’t want to leave their counties, much less their countries to get care unless they feel that the care provider is extraordinary or they have no other choice. In worker’s comp, employees have even more options to allow these and other concerns to control their care choices.
COUNTERPOINT: Actually, the truth is, the majority of states allow employers to decide choice of physician, in whole or in part, as the following graph shows. The difference lies in whether or not there is a medical provider network (MPN) or a health care organization (HCO), as in CA, or in those states that require an employee to choose from a panel of doctors selected by the state, or the employer.
I am not saying that employers or insurers should force employees to choose medical tourism, but rather offer it as an option with the understanding that it will be more cost-effective and will be good for the employee and his recovery. Regulations can be changed, and since two states are already allowing employee choice abroad, shouldn’t that choice be made available for all workers? Medical tourism facilitators should be part of the conversation to implement medical tourism, as they are the ones who know the hospitals and the destinations that are best suited to handle the care and treatment of the patient. And yes, there will be many people who will not want to travel, but for those who would, especially those who are from some of the newer medical tourism destinations like the Latin American and Caribbean countries I saw at the Congress, it will be easier for them to be treated in a culture they understand and where the people speak their language.
CONCLUSION
I am trying to lay out a possible scenario for the future of medical tourism and Workers’ Compensation. Do I have all the answers? NO, but I have some knowledge of both, and have a belief that all things are possible if people only apply themselves to finding the answers and setting out policies and procedures for this to happen. Maybe yes, or maybe no, but we have to try. Not trying is failure and that is worse than trying.
Nothing is perfect, but to hide one’s head in the sand when there are alternatives that are better and more affordable is just plain silly. Obstacles can be overcome; they should not be written in stone that it cannot be done. Laws can be changed and rules can be put in place to make medical tourism work effectively through approved medical tourism facilitators recognized by the Workers’ Compensation Boards or Industrial Accident Commissions of states, and by the insurance carriers paying for the claims. Also, the employers, whose WC Experience Modification Factors (Mods) are determined by the frequency and/or severity of their claims, which impacts the premiums they pay for Comp insurance, have a stake in making sure the employee gets the best treatment for the lowest cost, because in the end, they will pay for it in the form of higher insurance premiums. Saving money should be paramount for any employer in this day and age, and if they want to do the right thing for themselves and their employees, medical tourism offers them the opportunity to do so.
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.
