Case Study: Global Health Coverage

Global Health Coverage

1. What difference did it probably make that BRPP is an ESOP owned by the union members or that the national union is busy recruiting health care workers as members?
2. What are the ethical implications of a reward of up to $10,000 for the employee to go to India for a major procedure?
3. If you were a hospital administrator, how would you react when a num- ber of patients and companies began to ask to bargain about prices, including presenting price quotes from companies like IndUShealth?
4. What would be the difference in the bargaining position of an academic medical center and a large tertiary community hospital system?
5. How might state and national governments respond to this increasingly popular phenomenon?

1. Employee Stock Ownership Plan aka ESOP is a kind of employee benefit plan, it is similar to profit sharing plan. It affords the employees the chance to be owners of the business through stock- option, bonus, receipt or by joining a cooperative (Coren & Rodrick, 2016). ESOP was formally established as qualified retirement plans in the U.S. under Employee Retirement Income Security Act (ERISA) of 1974 almost 7,000 companies are active now, with 13.5 million participants (Staloch, 2015). There are benefits to employee stock ownership plan, like tax benefit to employees, retirement benefits at no monetary cost, encourages intrapreneurship. Though strong management is required for success, as democratic as unions are, they do not always possess great managers at the helm. ESOP through union is longer term investor that will not seek to sell hurriedly unlike individual employees or venture capitalists. Union for BRPP employees afforded them shield and protection; Creates collective power for employees, as some ESOP do not give individual employees power to make relevant decisions. Bargaining power from belonging to a group, to better the work environment and company remuneration. Union will better negotiate for employees for example having patients travel to India for “cheaper” healthcare services. Especially as ESOP requires a level of financial transparency, the Union is aware what the company can afford and protects employees from “cheap” management decisions. Pool rates are available for health insurance, by taking advantage of their numbers. Maintenance of health benefits for union members is paramount to the union as they know that to the company ESOP is be a tax exempt trust/deductible and the company had started to make profit again. On the other hand, “Union control of company policy through stock ownership plans can be weak. A study from the New York Federal Reserve said less than 3 percent of plans give unions a majority stake as was seen with 45% in BRPP. In many plans, employees’ shares don’t carry voting power (as at Chrysler). The stock ownership plans affect union behavior, too. According to the Federal Reserve study, stock ownership plans overall make the union “a less demanding negotiator,” and produce lower wage demands and fewer strikes” (Gaus, 2009). Unions have other ways of getting management's attention, short of selling the company. Some choose the traditional “union” weapon. Union members are conditioned to be suspicious of management (Bell, 2006). 

Reference
Bell, D. (). Worker-Owners and Unions: Why Can't We Just Get Along? Retrieved from http://www.dollarsandsense.org/archives/2006/0906bell.html Gaus M. (2009).
Employee Stock Ownership, But Not Control. Retrieved from http://www.labornotes.org/2009/05/employee-stock-ownership-not-control?language=es
Rosen, C. & Rodrick, S. (2016). Understanding ESOP: How an Employee Stock Ownership Plan (ESOP) Works. National Center For Employee Ownership. Retrieved from https://www.nceo.org/articles/esop-employeestock-ownership-plan
Miller, G. (201, July 5th). Advantages and Disadvantages of an ESOP. Retrieved from https://www.axial.net/forum/advantages-disadvantages-esop/ Staloch, C. (2015).
Employee Stock Ownership Plans: The Pros and Cons. Retrieved from https://www.di.net/articles/employee-stock-ownership-plans-the-pros-and-cons/


2. Risking patient’s life (in this instance Carl Garrett): a. Standard of care is not the same and can not be accounted for with certainty ie there is guess work involved in selecting a foreign provider. b. Even with local healthcare services, there are unforeseen variables that the providers have no control over despite rigorous regulatory over watch and well trained providers, a foreign healthcare service just increases the odds of mishap at different points and c. Higher chances of risk to patient’s life with the strain of traveling on someone needing treatment. Medical tourism as it is referred to, may serve as a powerful force for the inequitable delivery of health care services globally (Johnston et al, 2010). Cutting costs is not a good enough reason to export care of staff, there should be ways to leverage on the company’s 2,000 plus staff strength through pools. Especially as it is clear that other investigations and findings that should be done are reviewed with the cheaper price blurring the objectivity of the employers. This affects a national revenue source, the nation loses incomes even local insurance companies lose current/potential clients and providers(hospitals) lose clients and incomes. Even though payments for procedures GLOBAL MEDICAL COVERAGE 4 and post will be done in India, the BRPP staff still have to come to the US for follow up care that will not accurately reimbursed for. “A study conducted by the European Union shows that in the United Kingdom there has been a rise in hospital infections of patients who have recently returned from a hospital in India and Pakistan” (Clark et al, 2013). Employers should not expose their employees to such for lower healthcare cost. “The Centers for Disease Control and Prevention (CDC) estimates that up to 750,000 United States residents travel abroad for care each year” (“Traveling for Treatment”, n.d.). These numbers show it is tried by more than just a few people, even insurance companies offer this to individual patients but the responsibility and ethical expectations conferred on a an employer is way more and different from that on an insurance company. Alternatively there are cities with providers within the U.S. with relatively lower cost for example South Florida or lower cost providers like Bridge Health.

Reference
Clark, P.A., Adegunsoye, A., Capuzzi, K. M. & Gatta, D. J. (2013). Medical Tourism: Winners and Losers. Vol 14. Retrieved from http://ispub.com/IJH/14/1/2962
Johnston, R., Crooks, V.A. & Kingsbury, P. (2010, September 24th). What Is Known About The Effects Of Medical Tourism In Destination And Departure Countries? A Scoping Review. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987953/#!po=3.40909
Traveling for Treatment: Weighing the Risks of Medical Tourism (n.d.). Retrieved from https://hcahealthcare.com/hl/?/620199/Traveling-for-Treatment--Weighing-the-Risks-of-MedicalTourism

 3. The first thing will be to explain the differences between IndUShealth and the hospital I run: Firstly, IndUShealth is not as regulated as hospitals in the US, IndUShealth answers to only JCI which has no teeth unlike the several strict regulatory bodies US hospitals answer to. Second, Lower standard of care, despite affiliation GLOBAL MEDICAL COVERAGE 5 with world class hospitals like Johns Hopkins in the US, it is not the same as being world class itself; IndUShealth is not an island, it is within a system that, for all intents and purposes is a third world nation, riddled with problems associated with third world systems. Thirdly, medical tourists have little legal recourse if things go wrong during procedure or post-op, but in a US hospital, there are often many recourses. According to Dr. James Stuzin, "The liability and the responsibility that physicians have to their patients in America is very high, and that doesn’t necessarily exist in foreign countries if you have a problem" (as cited by Mahar, 2008). Fourthly, Cultural and Linguistic differences, its harder to communicate your ailments before procedure and harder achieve follow up with a long distance physician. Fifth, Privatization of healthcare road has been on the up and up, hence these organizations even with seemingly costs savings have the ways they make up for some of the differences that wont be to the patients benefit (Cortez, n.d.). Sixthly, Cost which is the main driving factor for medical travel/tourism hinges on cheaper labour, lower taxes, money exchange rate differentials, local equipment etcetera but the cost of high standards is not cheap, which is what is obtainable in US hospitals. Still I will not want to lose clients for my hospitals, be it individuals, employers or insurance companies. IndUShealth is designed to attract those seeking cheaper medical procedures, hence has the luxury of providing VIP treatment for medical tourists and ignoring the “local” cases which they are obligated to perform but US hospitals just offer a standardized quality of care for all including medical travelers.

Reference
Cortez, N. (n.d,). Patients Without Borders: The Emerging Global Market for Patients and the Evolution of Modern Health Care. Indiana University. Retrieved from http://ilj.law.indiana.edu/articles/83/83_1_
Cortez.pdf Mahar, M. (2008). Medical Tourism: The Big Picture. Retrieved from http://www.healthbeatblog.com/2008/08/medical-tourism/


4. Academic medical tertiary community hospital system provides specialized consultative care, usually on referral from primary/secondary medical personnel, it has personnel and facilities for special investigation and treatment. (“Patients’s Care: Tertiary Care”, n.d.). The bargaining power it has with BRPP is that it has a broader range of services and more physicians, cheaper than what BRPP currently runs inhouse. And a tertiary is more specialized in its focus areas due to the variety of specialities: psychiatric, pediatric,, cancer treatment etcetera. BRPP mostly had male workers above age 48 and this means several health risk factors which is the bargaining edge for tertiary hospital system. Another edge is, now that the BRPP must find local options for union members, it will have to come up with better ways to get the desired discounts where/when possible especially because tertiary hospitals can accommodate more patients due to a larger pool of patients to spread cost over.

Reference
Patients’s Care: Tertiary Care (n.d.). Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/patient_care/billing-insurance/insurance_footnotes.html



5., Some speak for medical tourism, for example “Assuming risks are effectively communicated, medical tourism offers a net positive gain on the United States‘ health care system and should be supported” (Muzaurieta, n.d.) or “Medical tourism will help drive costs down in the U.S.,” - the CEO of GlobalChoice (counterpart of IndUSHealth) etcetera. Some against, according to Deloitte’s consumer survey, the people most willing to consider going abroad for care are young and healthy—the very people who cross-subsidize care for the old/sick by paying into the health care system (as cited by Mahar, 2008). Whatever the myriad of reasons, governments responses should factor them in: these majorly includes but is not limited to a. Lower cost of healthcare procedures in some other countries. b. Insurance initiative and proposed the idea to customers (reduce insurance companies’ spending. c. Employers initiative backed by promises of bonus. d. The procedure(s) not having been approved by the FDA in the US yet. e. Procedures that are not covered by insurance and its paid for out of pocket by patients, so he/she seeks cheaper GLOBAL MEDICAL COVERAGE 7 alternatives. It is worthy to note that these exclude US patients who seek treatment abroad under collateral care (those already on holiday/tour when the healthcare need came up) or expatriates living abroad. Through creation and enactment of relevant policies, non-monetary incentives for local healthcare insurance companies, intensified efforts on reviewing procedures still on the queue for FDA approval, programs to increase number of physicians through subsidized academic training etcetera. There are no tangible advantages to the US government from outbound medical tourism as most healthcare costs are related to supply-side factors hence there are barely savings when demand is reduced. Infact if patients receive bad treatment abroad, they still come back home to correct these issues if it doesn’t lead to loss of life. On the flip side the government of the provider nations bear the brunt of certain losses for example, 1. Redistribution and misappropriation of the local amenities to foreigners. 2. Inequality of service and access to services for its citizenry. 3. Brain Drain of healthcare professionals from rural and local hospitals to urban-tourist serving medical centers. 4. Causes price increases for the care available, medical tourism results in a two-tier system of health care in the destination country, one tier for the local poor and one for medical tourist foreigners etcetera Whichever national government is under purview, none has a duty of care to create policy to prevent medical tourism affecting the other(s). Global Medical Coverage is a reality of globalization, it’s growth may be slowed by individual governments improving their state healthcare system gradually but it can not be stifled or stopped.

Reference
 Mahar, M. (2008). Medical Tourism: The Big Picture. Retrieved from http://www.healthbeatblog.com/2008/08/medical-tourism/
Muzaurieta, J.L. (n.d.). Surgeries And Safaris: Creating Effective Legislation Through A Comparative Look At The Policy Implications, Benefits, And Risks Of Medical Tourism For The American Patient. Retrieved from https://sites.temple.edu/ticlj/files/2017/02/29.1.Muzaurieta-TICLJ.pdf