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January 16, 2013, 12:08 pm
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Richard Krasner: The Stars Aligned: Mexico as a medical tourism destination for Mexican-born US workers under Workers’ Compensation

Thumbnail for Richard Krasner: The Stars Aligned: Mexico as a medical tourism destination for Mexican-born US workers under Workers' Compensation
Sometimes the stars align, and a writer such as myself finds a topic to write about. This is what happened to me this week. The topic I found was Mexican workers getting medical treatment in Mexico for work-related injuries. The topic presented itself when I received a new blog post from Joe Paduda.

This was the first star to align. Joe’s post was about the end of workers’ compensation as a statutory benefit. In it, he discusses a recently released study by Peter Rousmaniere, one of my LinkedIn connections who writes about issues in workers’ compensation. Peter’s study, Workers’ Compensation Opt-Out: Can Privatization Work?, looks at the Texas experience with an employer opt-out model of workers’ compensation, and the proposal that failed in the Oklahoma legislature earlier this year. Under the Texas model, employers have three choices. They can stay in the statutory system maintained by the state, opt-out of the statutory system and create their own “non-subscriber” program, or opt-out altogether and risk legal liability.

The second star that aligned was an article written by Martha R. Gore, a freelance writer in national politics whose article was originally published at Examiner.com. The article was then published in Medical Travel Today, a medical tourism newsletter. The article was titled, Medical tourism in Mexico an answer to Obamacare restrictions for Americans?, and highlighted some of the factors that might make Americans consider traveling to Mexico to get medical services that Obamacare may restrict. These services include heart surgery, dental work, cosmetic surgery, orthopedic treatments and weight loss surgery. Gore pointed out that the Medical Tourism Corporation (MTC) stated that some new Mexican hospitals are state-of-the art and can be compared to the best in the world, with a recent boom in small clinics and surgery centers, as well as high-quality hospitals.

According to the MTC, Gore states, Mexican doctors often have more experience than American doctors, because either the procedure has not been approved by the Food and Drug Administration (FDA), or was only recently approved. She also mentioned a study by University of California, Los Angeles researchers and colleagues that reported that almost a million California residents travel to Mexico each year for medical treatment and surgery. This was expected to increase in response to limitations under Obamacare. Gore’s article also mentioned three hospitals that the MTC listed in their report.
The third star aligned when I read an interview in Medical Travel Today in their SPOTLIGHT section with Maria Todd, founder and CEO of The Mercury Healthcare Companies. Maria is also a LinkedIn connection of mine, and an expert in the medical tourism industry. This interview was prompted by several press releases from Mercury about their work in Nigeria and Mexico, where they were involved with the development of a cancer center. The interview also pointed out that they recently conducted several audits in Guadalajara as part of their work with healthcare clusters.

It then occurred to me that I should write about Mexican workers in the US going back to Mexico for work-related injuries because much of what I had received this week was about Mexico. Although Peter’s study is more involved with insurance rather than medical tourism, the fact that Texas and Oklahoma are Southwestern states, and many of the workers there are Mexican, made this a perfect topic to write about. Add to this the result of the recent election where states like Colorado, Nevada and New Mexico gave Barack Obama a large percentage of the Latino vote. Texas and other Southern states may follow suit in the next cycles, and more Mexican workers will need medical treatment either under Obamacare once the immigration issue is settled, or under workers’ compensation.

So this is when the stars aligned. Peter commented to me in one of our email conversations that Mexican workers might be more receptive to medical advice and instructions if delivered by a Mexican clinician. I told him that this was a good point, and then recalled that I mentioned something like this in one of my earlier posts where I created a fictional case study of a self-funded employer for both healthcare and workers’ compensation that offered medical tourism to their employees from Latin American and the Caribbean as an option. In that post, I mentioned something someone else told me about the employee having better self-esteem, knowing that their families and friends back home could visit them, and that they would be able speak the same language as the hospital staff and be in a familiar culture — all of which would translate into a better outcome and a faster recovery and return to work.

As more US states follow Texas’ example and allow employers to opt-out of statutory workers’ compensation, the possibility that medical tourism can become a part of their “non-subscriber” program increases. While many of the services mentioned in the Gore article are not generally covered by workers’ compensation, there are rare cases where cosmetic surgery, dental work and weight loss surgery, — especially since the National Council on Compensation Insurance, Inc. (NCCI) recently released a report on co-morbidities in workers’ compensation — are covered. Even orthopedic treatments such as spinal fusion, knee and hip replacement or repair, which is covered under workers’ compensation, would be lower cost and have better quality in Mexico compared with the US. So, the future of medical treatment in Mexico for workers’ compensation looks promising, as soon as more Mexican workers here, both documented and undocumented, get healthcare coverage or are given an opportunity to gain citizenship under immigration reform. This would be a boon for medical tourism.

About Richard Krasner

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. In addition, he has experience in Risk and Insurance Business Analysis, Risk Management Information Systems, and Insurance Data Processing and Data Management.

Krasner is available for speaking engagements and consulting.

Phone: 561-738-0458
Cell: 561-603-1685
Email: richard_krasner@hotmail.com
Skype: richardkrasner

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3 Responses to “Richard Krasner: The Stars Aligned: Mexico as a medical tourism destination for Mexican-born US workers under Workers’ Compensation”

  1. Bruce Gilbert | January 17, 2013 at 12:55 pm

    Mr. Krasner, you missed one very important difference which separates Texas non-subscription and traditional workers compensation coverages. Unlike traditional workers compensation legislation, there are no statutory attorneys fees available under the Texas system. An attorney who represents an employee of an ‘opt out’ company finds himself working on a contingency fee basis and – since most prorgams have adopted ERISA plans – must litigate the claim in the federal court system. Limited attorney involvement, combined with a benefit structure which lacks the endless tail of traditional workers compensation, has allowed the Texas non-subscription system to prosper.

    Also, keep in mind that Texas non-subscription has been around for many years. It’s doubtful that other states would be able to withstand the lobbying of plaintiff lawyers and unions to create similar programs today.

  2. Jim Arriola | January 20, 2013 at 5:13 am

    Good for you for thinking out of the box on Workers Comp in Mexico!!

    Although I see the potential for Workers Comp in Mexico that you mention, I don’t see the clear alignment and do not see it as low hanging fruit.

    What has actually sprung up in Texas are cases of Group employers via a self-funded Trust offering their employees group health coverage benefits services in Mexico. I am aware of at least one case in which a US Employer has established a network arrangement with a TPA to allow employees to access their regular health benefits (doctor consultants, RX, hospital stays, etc) in Mexico. The Employer has set up US access via Cigna Network and Mexico access via Sekure Healthcare.

    Texas is a difficult state for cross-border healthcare coverage due to legislative interests. California on the other hand, is a much more fertile group of opportunity for cross-border healthcare coverage.

    Perhaps unbeknownst to many in the Medical travel space, there are tens of thousands employees in California using their US employer-sponsored health benefits coverage to access healthcare services in Mexico. Some of the big carriers (Aetna, Cigna, HealthNet, Blue Shield of Calfiornia) as well as some small regional carriers (SIMNSA, MediExcel Health Plan) offer cross-border health coverage plans to US employers in the southern part of California. Some large agriculture trusts do so as well. Additionally, several CA dental carriers (such as Delta, United Concordia) also offer dental care benefits via dental providers in Mexico. CA has regulated cross-border healthcare coverage and it is currently saving US employers and their employees millions of dollars a year in healthcare coverage premiums. Cross-border healthcare coverage will boom in CA under ACA.

    Since there are many group healthcare brokers, health plans, and employers in Southern CA already familar with and some already enrolled in group cross-border healthcare coverage programs, it would seem that this is where medical travel to Mexico for Workers Comp medical benefits would likely originate. However given the complexities in CA’s Worker Comp system, there would have to be a few more critical stars needed (WC carriers and ability for Attorneys to prosper) for alignment before such a noble concept could be viable. Interestingly, it could be in the CA’s unionized private sectors using CA’s WC carve-out arrangements under CA law where this concept could emerge.

  3. Richard Krasner | January 30, 2013 at 12:41 pm

    Bruce,

    It was not my intention to delve into the Texas non-subscriber program, so you will have to excuse me for not mentioning that difference.

    My intent was to get the idea that medical tourism can be implemented into work comp, especially with regard to Mexican workers here.

    I only used the Texas program as an example of the articles that came to my attention and “aligned the stars” so to speak.

    Thanks for your comment.

    Richard

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