Wednesday, October 11, 2006

A few weeks ago the media was abuzz about a paper mill worker from North Carolina who was being sent by his company to India for a rotator cuff repair and a cholecystectomy. He was excited as he had a few days of sightseeing planned before his surgery. There were also significant cost savings involved. From the Christian Science Monitor, Companies explore overseas healthcare
Carl Garrett, a paper-mill technician in Leicester, N.C., is scheduled to travel Sept. 2 to New Delhi, where he will undergo two operations. Though American individuals have gone abroad for cheaper operations, Mr. Garrett is a pioneer of sorts.
He is a test case for his company, Blue Ridge Paper Products, Inc., in North Carolina, which is set to provide a health benefit plan that allows its employees and their dependents to obtain medical care overseas beginning in 2007.

"It's brand-new and nobody's ever heard of going to India or even South Carolina for an operation, so it's all pretty foreign to people here," says Garrett. "It's a frontier."

Garrett's medical care alone may save the company $50,000. And instead of winding up $20,000 in debt to have the operations in the US, he may now get up to $10,000 back as a share of the savings. He'll also get to see the Taj Mahal as part of a two-day tour before the surgery.

His two operations could cost $100,000 in the US; they'll run about $20,000 in India.

First off, I have no idea what the professional or facility fees are for rotator cuff surgery, but rest assured this man could come to River City and have his gallbladder out for much less than $50K. The "outsourcing" of patients is becoming more popular.
Insurers Health Net of California already contracts with medical clinics on the Mexico side of the US border.

A West Virginia state legislator introduced a bill this year that would encourage state workers to seek treatment overseas using incentives such as cash bonuses and family travel.

United Group Programs in Florida, which administers self-insurance programs for small companies, has contracted with a Thailand hospital for its employer clients.

Inquiries from self-insured employers are brisk at IndUShealth in Raleigh, N.C., which specializes in offshoring serious medical cases such as rotator cuff surgery and gall bladder removal to India.
Mr. Garret was excited about the trip. But as it turns out, the United Steelworkers of America threw a flag on the play. From today's New York Times, Union Disrupts Plan to Send Ailing Workers to India for Cheaper Medical Care:
A few weeks ago, Carl Garrett, a 60-year-old North Carolina resident, was packing his bags to fly to New Delhi and check into the plush Indraprastha Apollo Hospital to have his gall bladder removed and the painful muscles in his left shoulder repaired. Mr. Garrett was to be a test case, the first company-sponsored worker in the United States to receive medical treatment in low-cost India.

But instead of making the 20-hour flight, Mr. Garrett was grounded by a stormy debate between his employer, which saw the benefits of using the less expensive hospitals in India, and his union, which raised questions about the quality of overseas health care and the issue of medical liability should anything go wrong.

"I was looking forward to the adventure of being treated in India," Mr. Garrett said the other day. "But my company dropped the ball."

The union, the United Steelworkers, stepped in after it heard about Mr. Garrett's plans, saying it deplored a "shocking new approach" of sending workers to low-cost countries as a way to cut health care costs. Its officials insisted that Mr. Garrett be offered a health care option within the United States.

"No U.S. citizen should be exposed to the risks involved in traveling internationally for health care services," Leo W. Gerard, the president of the union, said in a recent letter to the Senate and House committees that oversee health care. He expressed his concern about the willingness of employers to offer incentives to employees to go overseas.
The union's objection has to do with the liability question. Mr. Garrett had signed a waiver of liability for the company should anything go awry:
Still, cross-border medical liability in countries like India could prove to be a major hurdle, the experts say. In the case of Mr. Garrett, Blue Ridge Paper asked him to sign a release saying that he was "on his own as far as medical liability," said Bonnie Blackley, the benefits director at Blue Ridge.
The union is just shocked, shocked that such a thing would even be considered:
But United Steelworkers, the largest industrial union in North America with over 850,000 members, said it would fight any effort by American companies to send employees abroad for treatments. "We are confident that we are in a position to block any employees being exported to India, Thailand or Mexico," said Stan Johnson, a spokesman. "The ailing American health care system cannot be cured by sending patients abroad."
But as the CSM article points out, it was not for a lack of trying on the part of his employer:
Blue Ridge Paper Products, which makes the DairyPak milk carton, pleaded unsuccessfully with providers for discounts for its 5,000 covered workers. In the past five years, the company established its own clinic and pharmacy. Blue Ridge decided to try overseas healthcare after it heard that hospitals "rolled out the red carpet" to American patients based on news reports and personal accounts from a North Carolina medical traveler brought in by IndUShealth.
According to the transcript from a Marketplace interview Mr. Garrett, despite the quote above about his company "dropping the ball", probably feels he isn't being treated well by the USW:

ASHLEY MILNE-TYTE: Carl Garrett is 60. He's worked as a technician at the same paper mill in North Carolina for 40 years. When I first spoke to him he was a week away from having his gall bladder removed and a rotator cuff mended at the Apollo Hospital in New Delhi.

GARRETT: "I'm not nervous. Matter of fact, I'm just excited and anxious to get going."

His employer, Blue Ridge Paper, can save tens of thousands of dollars if an employee has an operation in India rather than North Carolina. But their nascent healthcare option saves Garrett money too. The luxury package to India is completely covered by the company: he'll even get a portion of their savings. To have both operations done at home, he says, he'd fork out up to $10,000 in deductibles and out-of-plan costs.......
....Still, Carl Garrett says he can't wait that long. Instead of two free operations in India, he says he'll have to borrow the money to have them done at home.

CARL GARRETT: I'm still in a, kind of a state of disbelief. It's a crying shame that, uh, I don't have that option, simply because of a union that I have supported for 40 years. And as far as I'm concerned they have taken money out of my pocket." The irony, he says, is that the other union members he works with couldn't wait for him to get back, to decide whether to sign up for an overseas operation themselves.

I can understand the liability concerns expressed. I also have other problems with this as well. Patients who I know that have had rotator cuff repair require several weeks of physical therapy. I personally would feel very put out if a patient had gone overseas for the procedure but I was the orthopedist back home who was asked to supervise the rehabilitation and deal with any complications that may develop. Most assuredly I would think twice about assuming care of this patient had things gone wrong with the cholecystectomy. It would also be easier to serve papers on a local physician involved with taking care of the complication, rather than finding a process server in Bangalore.
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