June 2011
Why You Need More Than Medical Evacuation Benefits PG 6
Local Medical Insurance versus International Private Medical Insurance. PG 9
Healthcare: East or West Who is the Best? PG 13
International Workers Need International Insurance PG 18
June 2011 // Issue 6
FEATURES 6
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GLOBAL BENEFITS
Why You Need More Than Medical Evacuation Benefits By Brendan Sharkey
21 Travel Insurance, Who needs it?
By Dr. Iain Corness
23 Understanding the
“Rules of the Game” in Healthcare Reform
Local Medical Insurance versus International Private Medical Insurance. By Paul Weigall
By Dr. Salinder Supri and Prof. Karen Malone
NEWS & INSIGHT
28 Medical Travel Tips By Jacqueline Farley
30 Traveling Well
and Traveling Safe
Healthcare: East or West – Who is the Best? By Rajeev Mudumba
By Katherine Harmon
WELLNESS
34 My Manager Makes Me Sick: Why Unqualified Managers are Harmful to Employees By LaShanda Blissett
International Workers Need International Insurance By Adam Bates
39 Working Past Retirement: Finding Gold in your Golden Years By Mark Roberts
Letter From the Editor
Moving Forward in an Uncertain Future By Jonathan Edelheit
EDITORIAL STAFF Editor-in-Chief
Jonathan Edelheit
Assistant Editor For organizations with global operations the past year has been one of the biggest challenges and learning experiences in the past decade. Global Executives have dealt with everything from natural disasters that affected regions to revolutions and wars. It’s hard enough to balance providing a unique set of benefits and products in different countries without all these conflict and problems. The media and press just make matters worse because they focus on creating “hype” and “fear.” I believe the challenge and difficulties of the past year offer the biggest opportunity ever to Global Executives. While it has been extremely stressful we now are able to deal with almost any situation. We have plans and procedures in place that we didn’t have before, or we learned that our plans weren’t as effective as we had envisioned. Everything is global today, and something that happens in one country affects us all. We need to be prepared for anything to happen anywhere at any time.
Olivia Goodwin
ADVERTISING SALES Info@GlobalBenefitsMagazine.com
PRODUCTION Graphic Design
Marinés Mazzarri
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Jonathan Edelheit
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Copyright © 2011 Global Benefits Magazine. All Rights Reserved. Global Benefits Magazine is published monthly. Material in this publication may not be reproduced in any way without express permission from Global Benefits Magazine. Global Benefits Magazine is in no way responsible for the content of our advertisers or authors.
Chicago, Illinois USA
October 25th - 28th 2011 Marriott Renaissance Schaumburg Convention Center Hotel
The 2nd Annual Global Benefits Conference is the first international conference that focuses on bringing together employers, international insurance companies and foreign governments involved in purchasing and providing global benefits, expatriate benefits and travel insurance to their employees and members. This conference will be dedicated to only the highest level executive attendees involved in the industry. The conference is sponsored by Global Benefits Magazine.
Part of the World Medical Tourism & Global Healthcare Congress Up To 10,000 Pre-Scheduled Networking Meetings 100+ Speakers • 140+ Exhibitors • 400+ Buyers Up To 1,500 Attendees From Over 87 Countries “+” = UP TO
five Leading Healthcare Conferences
one LOCATION
ONE EXHIBIT HALL 5X THE TRAFFIC
AN INTERNATIONAL HEALTHCARE DEVELOPMENT CONFERENCE
www.GlobalBenefitsConference.com • info@GlobalBenefitsConference.com • 001-561-204-6567
FEATURE
Why You Need More Than Medical Evacuation Benefits By Brendan Sharkey
World travelers need to properly protect themselves against financial exposure due to catastrophic medical events. If comprehensive travel medical benefits and assistance services are not secured before they go, travelers may find themselves exposed to huge losses – both physical and financial. Though illness or injury can strike at any time, when severe incidents occur overseas, lack of proper coverage can leave travelers with steep medical bills for less than sufficient care.
Why are Medical Evacuation Benefits Necessary? Global travelers need to be prepared for the possibility that they may find themselves in a location where the medical care is poor or inaccessible and it is necessary to be evacuated to an area where they can receive the appropriate level of care. Medical evacuations can be complicated and costly. However, most travel insurance plans include a medical assistance benefit, which is critical. It gives members 24/7/365 access to a company that will arrange the evacuation and coordinate appropriate treatment along the way.
Do Evacuation Membership Programs Include Medical? Many domestic health insurance plans offer inadequate services and protection when taken abroad. This is certainly a problem for lesser illnesses and injuries, but can be devastating when medical evacuation, which is almost never covered, is necessary. Travelers should understand that the most comprehensive and reliable coverage comes in the form of an A-rated travel health insurance policy. In contrast to benefits provided by medical evacuation membership programs, these policies offer evacuation coverage, but also include routine, urgent and medical benefits necessary to provide travelers with the optimal level of protection and assistance.
Key Considerations Evacuating a patient for medical reasons is a complex process that includes the following:
• Evaluating the appropriateness of local health care providers
• Identifying the closest facility where a high level of care is available
• Determining the risk/rewards of moving the patient
• Choosing the best method of transport (e.g. ambulance, helicopter, fixed wing air ambulance)
• Securing the cooperation of the local treating physician, including a determination that the patient is stable enough to be moved
• Enlisting the most appropriate team to handle the transport (e.g. doctor, nurse, therapist)
• Arranging for speedy and appropriate intake at the receiving facility
Why are Medical Benefits Critical for International Hospitals? Membership plans promising evacuation to “your hospital of choice” often require that inpatients be discharged, transported and readmitted. This means that a patient would be admitted for treatment in an initial location, then discharged for the medical transport, and then taken to a facility and admitted for necessary further treatment. This scenario accounts for less than 10% of the medical assistance cases that arise overseas. For instance, if the patient has an appendectomy, once the appendix is removed, readmission to another facility probably would not be required and so an evacuation would likely not be covered. 7
Comprehensive benefits also allow for an easier admittance and discharge experience when dealing with international hospitals. Some hospitals won't provide any treatment - or won't allow a patient to be discharged - until the hospital has received a guarantee of payment for their services. Without the coverage provided by a company able to secure the guarantee, a traveler who needs immediate care will have to pay the facility in advance, perhaps as much as tens of thousands of dollars. And for those who have to pay with a credit card, there is a risk that the hospital won’t accept foreign credit cards or that the credit card won’t have a sufficient credit limit.
Travel health insurance plans provide evacuation, medical benefits and assistance that address the following issues:
• In a true medical emergency, travelers might not be fit to fly. They will need to get excellent local hospital care first (before transportation home) and an assistance staff that can work with that hospital to arrange the required guarantee of payment for treatment.
• Coverage for necessary physician services, prescription drugs and ancillary medical care
• Referrals and access to the most skilled and appropriate doctors
• Protection that the consumer will have the proper level of benefits and that claims resulting from this coverage will be paid in a timely manner
Healthy, Safe Travel Make sure you travel with a full service, travel health plan that provides a higher level of protection and peace of mind than evacuation membership plans do. Ask your broker or insurance company to send you a sample policy so you can get a complete picture of what you’re buying.
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ABOUT THE AUTHOR Brendan Sharkey is the Director of Individual Products for HTH Worldwide. From the nuts and bolts of travel and international health insurance to the crucial themes of global health and safety, Brendan is frequently called upon to discuss the insurance landscape. He may be reached at bsharkey@hthworldwide.com
FEATURE
Local Medical Insurance International Private Medical Insurance By Paul Weigall
T
he increasing globalization of the world’s economies is leading to an ever increasing demand for expatriate placements as international companies’ second staff overseas to develop markets, offer specialist knowledge or to learn about local market conditions and economies. Employers with international workforces recognize that their expatriate employees have particular needs, including access to suitable housing, work permits and visas as well as support in adapting to a new culture. One of the top demands of all expatriates, however, is for easy access to top quality healthcare. For people living in their home country, accessing healthcare is usually relatively straightforward. People know how their national medical system works; they will be familiar with accessing primary care and they will know whether they pay for care at point of access or whether it is free. They will also know whether treatment is state funded or whether they need their own medical insurance. Moving to a new jurisdiction however can make access to healthcare far more complex. Systems will be unfamiliar, access to good quality facilities may be limited or even non-existent in some remote areas and in some countries proof of the ability to pay may be required before even the most basic of acute emergency care is provided. 9
International Private Medical Insurance
Local Healthcare Only
No wonder then, that expatriates and frequent international travellers value international private medical insurance. It is their guarantee that they will be able to access emergency and routine healthcare for themselves and their families wherever they are in the world. It usually also ensures that they will have emergency medical repatriation back to their home country if they suffer a serious injury or illness.
Local private medical insurance plans are designed to do exactly what they say; to provide access to local healthcare.
In these difficult economic times, when every cost is under review, it is likely that some employers will now be considering whether there are alternatives to international private medical insurance.
Domestic Insurance Plans One option is to buy a domestic private medical insurance policy for the country where the expat employee is going to be based on the grounds that it will be more cost effective to buy a local plan than use a full international private medical insurance policy. In some countries, this can be a relatively viable option. For example, in Japan, all foreign residents with a valid visa allowing them to stay for a year or more can join the Japan National Health Insurance scheme (kokumin kenkou hoken/kokuho). There are however significant differences between international private medical insurance plans, which are designed with the expat in mind and are portable between different jurisdictions, and domestic health insurance plans which are designed to suit the needs of permanent residents of a particular country. The attraction for employers and their advisers of considering a local plan is inevitably cost. The received wisdom is that it is going to be less expensive to buy, for example, a local Indonesian private medical insurance plan for an employee on an expat contract in Jakarta, than it is to buy a full international private medical insurance plan covering the Asia Pacific region. Up to a point, there is some truth in this argument as the upfront cost is likely to be less. For most expatriates however the disadvantages easily outweigh the cost benefits. The main problems center on access to the right quality of hospital, emergency repatriation and the issue of pre-existing or chronic medical conditions.
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That’s fine, provided the local healthcare is of a high enough quality, depending on the ailment and the treatment required. Using our example of Indonesia again, our expat might prefer to fly to Singapore to access the very best regional healthcare rather than receive treatment locally. How likely is it that a domestic private medical insurance scheme would allow a member to fly to a different country to access care? For international private medical insurance plans, this is a normal benefit. Expats will also face the difficulty that a domestic plan will not get them back to their home country when they need long term or specialist care. For a French expat stuck in a hospital in Johannesburg, when their family would prefer to have them home in Paris, repatriation is generally impossible on a domestic plan, but the norm on most international plans.
Relocating to a New Jurisdiction Leaving aside the difficulties of accessing the right type of care, the expatriate lifestyle means that many expats will move from country to country as their skills are required from one jurisdiction to another. A marine engineer could move from the US west coast ports to the Japanese shipyards and then on to Hong Kong or Singapore. A domestic plan would instantly become redundant as the expat moves from country to country and could even delay their ability to move if new arrangements cannot be set up quickly enough in their new host country. An international private medical insurance plan will cover all the countries within an expat’s geographic range of cover and no new arrangements are needed as their work takes them from one country to another. Finally there is the issue of pre-existing medical conditions. If an expat in Rio de Janeiro suffers a heart condition, a domestic plan will most likely cover the cost of their treatment. However, the expat will then have a pre-existing medical condition on their medical records which will make it very difficult for them to change insurer as and when they wish to leave Brazil.
There are also a number of jurisdictions where ‘local’ private medical insurance plans really are only suitable for the local population and would provide too limited cover for an expat, China being a good example.
Domestic Health Insurance Plans in China Despite popular misconceptions, China is not always a cheap location to receive medical treatment and has some of the most expensive hospitals in the world. Its medical system is also geared towards the requirements of the local population with many clinics offering Traditional Chinese Medical services. In this regard, many expatriates could struggle to access Western-style medical facilities outside of the private clinics to be found in the major cities. Domestic health insurance plans are typically sold by the large local insurance companies and generally
offer health insurance coverage in China only, providing relatively limited benefits for an inexpensive premium. These plans are generally geared to the needs of the local population and will almost certainly be inadequate for expats seeking Western-style care.
Reciprocal Arrangements Another, albeit very limited alternative to private medical insurance is to rely on reciprocal healthcare agreements between different countries. Reciprocal arrangements for healthcare are complicated and vary from country
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to country, these are reasonably common across Europe, but are far more limited in Asia and the Americas. The fundamental point to remember about reciprocal arrangements is that the person who wishes to benefit from the arrangement will almost certainly still need to be paying compulsory taxation in their home country. So if an expat member of staff is to be paid and taxed in the country to which they are posted, no reciprocal care is likely to be available. Even where reciprocal arrangements exist, rights to automatic medical care vary and may be costly. Expats may receive no more than basic emergency treatment and may find that any additional treatments are not available. There is certainly no access to emergency medical repatriation to the expat’s home country. The upshot is that while reciprocal arrangements may sound superficially attractive, in practice they are limited in scope and may well present employers with more difficulties than benefits.
Expert Advice There are alternatives for international private medical insurance for expat employees, but their scope is limited and employers considering an alternative would have to be very clear in understanding these limitations. Some reciprocal arrangements provide access to limited emergency treatment and a local insurance plan may well respond as well in the short term as an international plan. The drawbacks however can be serious and could leave an expat employee stranded with limited coverage in a foreign country with a self-funded air ambulance being the only realistic option to return home in the event of a medical emergency. Expat staff is vital employees for international companies, and it is only by providing a full international private medical insurance plan that employers can be confident that their expat employees are properly protected against medical emergencies and routine healthcare treatment.
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ABOUT THE AUTHOR Paul Weigall joined InterGlobal in 2009 as Head of Sales and Marketing. Paul works closely with InterGlobal’s regional sales managers in Asia, the Middle East, Africa and UK to develop sales and build distribution on a global basis. Paul previously worked for Bupa International, where he held the position of Senior Development Manager. Prior to this he was a manager in Bupa’s domestic hospital and consultant contracting operation. In his earlier career, Paul built a strong track record in sales and sales management at Lex Vehicle Leasing and Lombard North Central.
NOW ACCEPTING NOMINATIONS FOR THE GLOBAL BENEFITS LEADERSHIP AWARD! The Global Benefits Association is now accepting nominations for the Leadership Award. This is a chance to nominate someone you think really deserves an award for what they've accomplished in this industry. You can also nominate yourself! Please see below for more details on the award. The Global Benefits Association in conjunction with the Global Benefits Magazine will be awarding a select group of individuals whose achievements have enhanced and brought innovation to the Global Benefits and International Benefits Industry, which has contributed to the growth of ensuring international benefits for employees, expatriates and individuals living, working or traveling globally. This award will be presented at the 2nd annual Global Benefits Conference held in Chicago, October 25 - 28, 2011. This award recognizes a leader in the industry for providing an exemplary program or innovation consistent with the vision of the Global Benefits Association's and Global Benefits Magazine's goal of education by engaging others, promote proven strategies and insurance packages, and advocate for the needs of their employees in multinational offices and expatriates. The award is to honor an individual whose professional accomplishments embody such qualities that drive this industry forward.
Benefits of the award will include: • Receiving a Leadership Award at the Global Benefits Conference • Global Benefits Magazine Feature: If recipient of the award agrees they will be featured in the magazine as a leader and the GBM will include an interview of the recipient in the featured piece in the magazine • A Global Benefits Leadership Award logo to put on a company website or personal profile • Award winners will be publicized in conference materials and will be given a ribbon for their name badge increasing networking possibilities with other attendees
Nominations can be made on the Global Benefits Conference website. Nominees will be reviewed by the Global Benefits Association and Magazine. The award must be accepted by the person receiving it at the conference.
For any questions about the award please send an email to: info@globalbenefitsconference.com
WHO CAN BE NOMINATED All individuals that have proven to have success in the growth of travel insurance. How to nominate an Individual for the Global Benefits Leadership Award Simply complete the survey here! Deadline for 2011 Nominations Call for Nominations starts on May 31st and ends September 20th.
www.globalbenefitsconference.com/global-benefits-leadership-award.html www.GlobalBenefitsConference.com • info@GlobalBenefitsConference.com • 001-561-204-6567
FEATURE
Healthcare: East or West – Who is the Best? By Rajeev Mudumba There are two schools of thought in the U.S. One, which believes that U.S. healthcare system is one of the better systems in the world or perhaps even the best and the other, believes we have a long way to go. If you turn on the TV or the radio, you will hear politicians out there telling you how the U.S. healthcare system is the best in the world irrespective of the escalating costs, myriad complexities of law, growing number of uninsured Americans, Medicare and Medicaid cuts and, if you, like me, tie quality of healthcare with longetivity statistics, U.S. placement as the 50th in a list of 229 countries for which it was tabulated [1]. U.S. healthcare has often been argued as one of the better systems based on some myopic stats such as lesser wait times for care compared to some of the other developed countries, better access to medical technology and vast majority of healthcare innovation happening in the U.S.
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WHO compared each country’s healthcare system to upper limit of what can be done with the level of available resources in that country. It also compared each country’s healthcare system accomplishments with those of others. The WHO report concluded that health and well-being of people depend critically on the performance of the health systems that serve them. However, there is disparity in performance, even among countries with similar levels of income and health expenditure. Virtually all countries were underutilizing their available resources. The goal of the analysis was to provide a comparative guide to help countries learn from each other and thereby improve the performance of their health systems. In 2009 & 2010, The Commonwealth Fund conducted studies comparing the United States with about 10 other advanced nations through surveys of patients and doctors and analysis of other data. Its report ranked the United States on most measures of performance, including quality of care and access to it. The 2009 survey [3] concluded that there were wide differences across countries in access, healthcare technology, priorities and quality care. U.S. stands out for reporting cost-related access problems, lack of after-hours care, and lag in IT adoption.
The Worlds Health Systems Ranking The World Health Organization (WHO) conducted the first analysis to rank the world’s health systems in 2000. Using five performance indicators to measure health systems in 191 member states, it concluded that France provides the best overall healthcare followed among major countries by Italy, Spain, Oman, Austria and Japan. United States was a dismal 37th [2]. The five indicators were: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs). In other words, the quality of healthcare systems is based upon factors such as accessibility, affordability and the level of care and qualifications achieved by the professionals working within.
The 2010 survey [4] reflected cross-cutting themes and implications for U.S. Reform. United States stood out for access problems because of costs, difficulty paying medical bills, insurance complexity, and disparities by income. Symptoms of weaker primary care were seen in U.S., Canada, and Sweden. Germany, Switzerland, U.S., Netherlands and U.K. showed rapid access to specialists. Swiss were notable for rapid access to primary and specialized care. According to the survey, U.S. health reforms will make a difference. This includes many elements seen internationally such as premium assistance for low and modest income people; Medicaid expansion, Benefit standards with limits on out-of-pocket spending and Insurance exchanges and standards to reduce complexity. The Commonwealth Fund's 2011 International Health Policy Survey is currently in progress. French medical care is deemed to be one of the best in the world. While it is true that you can get excellent care in France, it comes at a price. Individuals who are not French nationals pay extremely high rates while French nationals are taxed extremely heavily. That being said, France still has one of the longest life expectancies in Europe, with 81 years of age.
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The U.S. Healthcare and Spending The U.S. has been on the forefront of healthcare in terms of the % of GDP spent, innovation and cutting edge advancement in medical technology. The U.S. has produced the best of drugs and innovative surgery practices, but when it comes to making them economically viable for end consumers, it has failed miserably. From an economic perspective, such medical treatments are increasingly out of reach to many Americans. Healthcare costs are multiplying with each passing year, rising twice or faster than inflation and health insurance is getting to be out of reach for more Americans.There is a major disconnect between the progress made in health technology and its affordability for Americans. Healthcare as a fundamental right is an ongoing debate in the U.S. while most of the developed countries are already there, although they have their share of issues to contend with. Most of these developed countries have universal publicly funded healthcare. Not to say, that universal healthcare is the silver bullet for healthcare woes, but it is an interesting point to note. World healthcare ranking may not be a true indicator of the U.S. quality of care in comparison to the rest 16
of the world based on the subjective nature of these studies. But, with the U.S. leading the world in total spending; the question arises as to whether the quality of healthcare is comparable to the amount of money spent on that care. Studies have shown that some of the reasons for United States spending a larger percentage of its GDP on healthcare include higher labor, administrative and malpractice insurance costs. These studies; though subjective, do reflect that there are no particular areas in which U.S. healthcare quality is truly exceptional. Instead, the available data depicts that the US health system performance is a mixed bag, with the United States doing relatively well in some areas, such as cancer care and medical technology and less well in others such as mortality, accessibility etc. Although, the U.S.; like other countries has its own share of strengths and weaknesses in terms of the healthcare it imparts to its citizens; the value obtained for money spent on healthcare is drastically lower than the other countries. Important lessons can be drawn from countries doing better than the U.S. in various realms of healthcare. While U.S. is a trendsetter in healthcare innovation and technology, these lessons will take it on the path of a true healthcare trendsetter
in terms of providing efficient, accessible and quality healthcare to its citizens. The hope is that the healthcare reform (estimated to cost nearly $2 trillion over 10 years) will decrease healthcare costs and effectively provide millions with affordable insurance options. Healthcare reform provides an opportunity for us to build on strengths, correct weaknesses and improve our framework. Perhaps, then, the U.S. healthcare system will improve quality and care statistics to measure up to other countries. The healthcare overhaul we have all been hearing about over the last couple of years underscores the need to take steps towards quality improvement; further, reform is needed to improve healthcare delivery, propagation of prevention over care, employment of technology and innovation to facilitate cutting edge health management, and help consumers demand focus on a health based economy than a sickness based economy which will pave the way for better health dynamics.
ABOUT THE AUTHOR Rajeev Mudumba works with a leading HRO/ Healthcare organization. Rajeev has over 16 years of leadership experience in the HRO, Healthcare and Technology consulting industries. His distinguished record of accomplishment and innovation includes high level strategy and ideation, precise execution and enhanced focus on efficiencies through the use of technology in business across various verticals. He can be contacted at: rajeevsagar@gmail.com.
References • The World Factbook https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html • World Health Organization Assesses the World’s Health Systems http://www.photius.com/rankings/who_world_health_ranks.html • 2009 Commonwealth Fund International Health Policy Survey http://www.commonwealthfund.org/Content/Surveys/2009/Nov/2009-Commonwealth-Fund-International-Health-Policy-Survey.aspx • 2010 Commonwealth Fund International Health Policy Survey http://www.commonwealthfund.org/Content/Surveys/2010/Nov/2010-International-Survey.aspx
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International Workers Need International Insurance By Adam Bates
When we think of some of the most popular computers, electronics and automobiles, “Sold in the USA” is rapidly replacing “Made in the USA” as the new norm. While the expansion of many US corporations slowed as a result of the recent recession, business is booming for emerging markets around the globe. Multi-national corporations competing for global customers have thrown their hats in the ring by establishing subsidiary offices with local sales, manufacturing and distribution channels. In the race for global presence, foreign corporations have flooded the US market to capture the highly prized American customer—in fact; there are over 3,000 foreign-domiciled corporations with subsidiary companies, branches or sister offices within the US, according to Uniworld Business Publications.
status, are being enrolled on their US company’s group health insurance and benefits plans. But this is rarely the best method.
With a hybrid workforce comprised of US citizens, foreign nationals and key executives from overseas, foreign corporations’ human resources and benefit directors are tasked with managing a myriad of benefits over growing geographic areas and across wildly varying international regulatory bodies.
Seasoned international human resources managers know the difficulties of educating their foreign employees regarding policy benefits, deductibles, copays, PPO and HMO networks. Traditional domestic group health insurance assumes employees are familiar with understanding insurance terminology, locating participating doctors and hospitals, seeking referrals, getting prequalified and submitting claim paperwork.
Benefit directors new to the US market are simply unaware of the many insurance options when insuring foreign nationals working in the US. In an attempt to simplify the matter, we find that most employees, no matter their origin or citizenship
Foreign employees arriving from countries with socialized or national healthcare are unfamiliar with navigating the complexities of US healthcare system and, for good reason, become overwhelmed by the process of seeking medical care in the US.
Example Scenario In the next two years, six executives from a prominent Asian stock exchange will work six months in the corporation’s New York City branch office. They will return to Asia for three months before coming back to the New York City office for another nine months. The company’s US health insurance policy is not designed to accommodate the executives’ frequent travel schedule. What’s more, the additional enrollment and termination forms add an encumbering, albeit necessary, task for the human resources department.
The solution for providing necessary benefits without overburdening the human resources personnel: an international health insurance policy.
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Two affordable options are
Temporary Travel Medical Insurance
Blanket Travel Medical and Accident Policies
These policies provide short-term coverage from five days to 12 months and are specifically designed to insure foreign nationals visiting and working in the US. Most are guaranteed issue, can become effective within 24 hours and give foreign workers the freedom to choose any doctor or hospital. Easeof-use is the most attractive feature for policyholders.
These policies cover all employees and executives traveling abroad without any citizenship or country restrictions. A blanket policy ensures no employee is without coverage when working and traveling overseas.
As the world shrinks and global business grows, accommodating foreign employees will prove a must for retaining valuable international workers. If your company doesn’t currently provide international healthcare policies for your international employees, now is the time to reevaluate your benefits methods for a quicker, more satisfying experience for everyone on your global roster.
ABOUT THE AUTHOR Adam Bates is Vice President of ISA Insurance Services of America. With over 13 years in the international insurance business, he’s a member of the Association of Corporate Travel Executives and a constituent member of Overseas Security Advisory Council. He has traveled over 500,000 miles, and serves clients in over 150 countries. He may be reached at: adam@isaglobalbenefits.com ISA Insurance Services of America is a nationwide leader in international health, life and travel insurance for multinational organizations employing expatriates, third country nationals and key local nationals. ISA provides individual customer service with a focus on your employees’ unique international insurance needs. For more information, please visit: www.isaglobalbenefits.com.
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Travel Insurance, Who needs it? By Dr. Iain Corness Many travelers have a somewhat cavalier attitude to insurance. By the way, this is not travel insurance to cover your lost baggage, but to cover medical emergencies, and your lost health. Many people travel under the misconception that the travel insurance they took out is going to cover them for all eventualities. Sadly it is not. Most people take these out at the travel agency and the days included are enough to give you coverage from the day you leave until the day your flight returns. Simple and easy to understand – but is it enough? Unfortunately, it may not be.
Worst Case Scenarios to Consider 1 You are in Bangkok and on the day you’re leaving you’re hit by a taxi, leaving you with a head injury and a broken leg. You are taken to ICU and then graduate to a recovery ward after three days. Your travel insurance expired three days ago. Where do you stand? It appears that most, but not all, travel insurance companies will continue to pay for your hospital treatment – but for a limited time only. “Get well soon,” as the sympathy card says! But here is another part of the above scenario. You have now graduated to walking on crutches, you are back at the hotel and will be fit to travel in the next three days, but unfortunately you develop Dengue Hemorrhagic Fever and need more hospitalization. Your travel insurance period has already expired, and the insurance company is more than justified in rejecting this new claim.
2 But things can get worse. The following is a true story, taken from an Australian medical journal. A gentleman with a leaking heart valve, which was under investigation and examination by a cardiologist, has to make a business trip to America. He takes out travel insurance from the travel agent, but says nothing about the on-going cardiologist’s review. Two days after getting to San Francisco he gets very short of breath and is admitted to hospital. The insurance company was contacted which then gets a report from the American hospital, and a report from the patient’s usual doctor in Australia. The history of the cardiac condition now comes to light, and the insurance company state (justifiably) that if they had known of this situation, they would not have accepted the man
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as a reasonable risk and would have refused cover. Meanwhile, the man deteriorates rapidly and has to have an emergency heart valve replacement. All was not plain sailing and he ended up having 42 days in intensive care. Total cost came to USD 576,500, for which the businessman was totally liable. To raise the sum of over half a million dollars he had to liquidate his company and sell his house at “fire sale” prices.
3 A young woman is going to the UK for a working holiday. Like many people, she has asthma, but it is reasonably well controlled. Since she was flying directly to the UK and there is a reciprocal medical agreement between the UK and Australia, she decides she “logically” doesn’t need travel insurance. Six hours into the flight she gets an acute attack of asthma and has to be off-loaded in Singapore. Complications occur and she ends up being in Singapore for six weeks and then has to be medically evacuated back to Australia with a doctor and nurse escort team. Her stay in Singapore and the Medivac came to AUD 390,000 and her parents have to sell their farm to raise the money. So you can see, just because you are covered at the other end of your flight doesn’t mean to say you are not “at risk”. The moral of these two tales is simple – take out good travel (medical) insurance and make sure you declare any pre-existing conditions. Insurance companies are in the business of “risk” assessment. Forgetting to declare your medical history is not thought of as being an acceptable risk. This omission could prove deleterious to both your health and your wealth.
The bottom line is that no one would expect these extreme situations to happen, but it is a good idea to be prepared just in case. Think about ensuring you have appropriate travel insurance before your next trip!
4 But there are even more snags for the
overseas travelers, and one is personal transport. Those big bikes for rent at the side of the road just look so tempting for the average young adventurer and the renting process is so simple. Leave your passport as security and ride away. Ignoring the stupidity of leaving your passport with anyone, do you have a license to ride a big bike in your own country, for example? And is that license valid in Thailand? I have seen the same young chap who hired from the side of the road brought into the hospital by ambulance with broken legs. The intrepid rider then finds out that his travel insurance has refused to accept the claim as he did not have a license issued from anywhere to ride a 1,000 cc motorcycle.
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ABOUT THE AUTHOR Dr. Iain Corness is a Consultant at the Bangkok Hospital Pattaya and acts a liaison between expat patients and the Thai medical system. He is the author of “Farang, Thailand through the eyes of an ex-pat.” Bangkok Hospital Pattaya is a JCI accredited 400 bed hospital.
Understanding the
“Rules of the Game” in Healthcare Reform By Dr. Salinder Supri and Prof. Karen Malone
United States’ medicine, once regarded as the best in the world, is in a sorry state of health. Although U.S. life expectancy has risen by 8.3 years over the last half century, compared to medical progress in the rest of the developed world we are falling enormously behind. In 2010, the Commonwealth Fund ranked the U.S. last in its international comparison of healthcare systems, behind Canada, Germany, the Netherlands, Australia, New Zealand and the United Kingdom. Another report, by the editor of the Real-World Economics Review, ranked the U.S. 28th out of 30 countries, lagging behind not only Western Europe and Australasia, but also Poland, the Czech Republic, and Slovakia.
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What does this really mean for the average American? It means that twice as many Americans die before the age of 60, as compared with Europeans. Greeks have access to twice as many doctors, and in Japan there are over three times as many acute care hospital beds. Infant mortality in the U.S. is more than double that of many countries in Europe, and life expectancy at birth is lower. America has a healthcare system that is frankly third-rate. To add insult to injury, the U.S. has by far the most expensive healthcare system in the world – indeed, spending is the only category of healthcare in which the U.S. ranks first. Annually we spend more than double the OECD (Organization for Economic Co-operation and Development) average on healthcare – $7,290 in tax dollars for every man, women and child in America. To make matters worse, only a paltry proportion of this figure is actually spent on health – the remaining monies are siphoned off all across the medical system, in multi-billion dollar leakages of which the public is largely unaware. How do we explain the paradox that we have the most expensive health system in the world and one of the lowest performing? In search of answers, we need to take a different perspective from those ordinarily rehearsed. To gain a better understanding of the situation, we need to take a perspective that focuses on the U.S. institution of medicine as a whole, and exposes the hidden rules by which this institution operates. As an economist and an academic working in the international health arena, with knowledge and experience of healthcare in the U.S. and across the world, we discuss how powerful organizations shape, control and perpetuate an ailing system that serves their own ends, and not America’s health needs.
The U.S. Institution of Medicine
Setting the “Rules of the Game”
The U.S. institution of medicine is not a single, comprehensive and cohesive system of healthcare. Instead, it is comprised of a myriad of large and powerful organizations, including the insurance companies, HMOs (Health Maintenance Organizations), corporate for-profit hospital chains, and pharmaceutical companies.
Not only is the institutional structure large, it is dynamic. That is, the structure itself actively creates shapes and maintains the institution of medicine. It does this through what we label setting the “rules of the game,” that is by imposing the terms by which the system operates.
This institutional structure is large and vast, and has over the years has become ever more labyrinthine. Take for example the health insurance industry. There are hundreds of health insurance companies, each with a bewildering array of policies. This is a system of health insurance so vast that many of the insured have no real idea of the type and extent of coverage they are buying, and what care they may ultimately receive should they fall ill. No wonder that many Americans have to carry more than one health insurance policy, or have Supplement Insurance Plans, to ensure that they are adequately covered. However, despite such an elaborate insurance system, many Americans are failed by the insurance companies. Between third and a half of personal bankruptcies result from the medical bills that insurance does not cover. 24
Insurance companies have set the rule “restrict choice and coverage.” They enact this through the creation of an elaborate system of co-payments and deductibles, exclusion clauses and loopholes, which are designed to deter patients from claiming the healthcare they need, and to override medical judgment as to the treatments patients receive. HMOs have set the rule “manage care.” This rule serves to restrict patients’ utilization of healthcare, by limiting the number of treatments patients can have, the number of days spent in hospital, patients’ choice of provider, and even the specific doctor(s) patients can see. These rules deny patients access to the full range of treatment options and to the quality of treatment they require and to which they have a right. The pharmaceutical industry has set the rule, “charge as much as we want, because insurance will pay.” This
rule has resulted in prescription drug prices that are much higher than anywhere else in the world – nearly 60 percent higher than in Canada and nearly 100 percent higher than in Europe. Not only that, it has led to patients being prescribed sometimes unnecessary, often useless, and even potentially dangerous drugs – a recent study found that 85 percent of all new U.S. pharmaceuticals either do not work, or have serious side-effects. Corporate hospital chains have set the rule “test as much as we want, because insurance will pay.” Under this rule, they try to extend the insured patient’s range of tests and procedures. However, this can be damaging and costly to patients. Americans are routinely exposed to excessive x-rays, tests and operations. For example, unlike in much of the developed world, routine chest x-ray screening in America often involves the administration of x-rays both frontally and laterally, even where a single frontal x-ray may be sufficient for basic screening, unnecessarily exposing patients to higher radiation doses. By each setting their own “rules of the game,” the large and powerful organizations that make up the U.S. institution of medicine shape the system to their own interests and distort healthcare. In creating the system
they want, the institution of medicine has shifted the balance of healthcare provision in its own favor, to the disadvantage of patients. The average American plays little part in this process of determining the shape of U.S. healthcare, and gets what he or she is given. We are neither in charge of our own healthcare, nor of the healthcare system.
Complexity and Quagmire As each organization is acting largely independently and setting its own “rules of the game,” what has emerged is a bloated and inefficient healthcare system, now mind-boggling in its complexity. This complexity has created confusion for patients, administrators and physicians alike. It has led to the emergence of a huge administrative quagmire, which generates a mountain of paperwork inconceivable in any other health system in the world. Johns Hopkins Hospital for example, has to bill more than 700 different payers and insurers, each with their own stipulations regarding services covered, reimbursement, documentation, and pre-approval. Is it any wonder then that administrative costs account for more than 30 percent of our healthcare spending – and even as much
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as 50 percent according to some estimates – compared with other advanced nations whose expenditure on health administration is only 10 percent?
Opportunistic Behavior and Taking Advantage This complexity is highly conducive to opportunistic behavior, allowing organizations to take advantage of the system, and to make “supernormal” profits. We only have to look to the U.S. drug industry to appreciate the levels of profits that can be made. U.S. pharmaceutical companies’ profits are the largest in the world, and at a median profit rate of nearly 20 percent, are four times higher than those of the average Fortune 500 Company. As each organization has created its own “rules of the game,” the institution of medicine has grown into a complex entity that few really understand. This very complexity actually works to the advantage of the organizations that comprise the system, creating an operating environment that allows them to siphon off billions of dollars. So, not only does this complexity make it extremely difficult for patients to obtain appropriate high quality healthcare, but they end up paying for it through the nose. It is one of the main reasons why the cost of healthcare has spiraled out of control. Indeed, over the last five years contributions to company health insurance have soared by 143 percent, and out-ofpocket costs by 115 percent. Moreover, the complexity is designed to restrict policy makers’ ability to reform the U.S. healthcare system, since it makes it almost impossible for them to see through the impenetrable fog of a system that has been created, and to identify where to start to disentangle it.
Preserving the Status Quo This large, highly complex and confusing system of healthcare creates the ideal operating environment for the organizations that have created it. The complexity and resulting confusion help these organizations to perpetuate the current system and preserve the status quo. Although each organization sets their own “rules of the game” individually, they are at the same time strongly and deeply interlinked. When necessary, they will cooperate and collaborate to protect the system of healthcare that they have devised, so that it remains intact and continues to serve their own interests.
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Whenever reforms threaten, they band together. For example, they oppose the formation of a regulatory authority – the proposed American version of the UK’s National Institute for Clinical Excellence – which seeks independently to test and evaluate the relative merits of drugs and medical procedures. They do not want these ever tested by an independent body, since losing such decision making power would weaken their control, and ability to shape the healthcare system. So, not only do they set the “rules of the game,” but through these strong and entrenched relationships, they work together to stabilize the system and create institutional inertia. Through the creation of this impasse and their strong motive to maintain the status quo, it is almost impossible to dismantle the system, and easy to resist reforms to healthcare.
Real Reform Requires Understanding the “Rules of the Game” The sum of the “rules of the game” devised by the collaborating organizations, and shaped by their interests, has resulted in the fragmented, haphazard and broken system of health care in the U.S. Reform is long overdue. To make any inroads toward meaningful reform, we need to begin by first identifying and understanding who is setting the “rules of the game,” what the rules are, and how these rules are being used to exploit the system of medicine. Only in this way can we truly understand how the system is being shaped, and begin to treat and heal our ailing healthcare system. Real reform demands a fundamental transformation of the “rules of the game” that govern the prevailing institution of medicine. Until then, any reform, whosoever proposes it, will merely amount to tinkering with the system, and is ultimately doomed to fail. It is only through such root and branch reform
that we can ever hope that our tax dollars are spent on health, instead of propping those organizations with a vested interest in maintaining the status quo. If fundamental reform of the “rules of the game” of U.S. healthcare is not forthcoming, and institutional inertia is allowed to persist, the cracks in the system will become critical. If unchecked, by 2015, one-fifth of the country’s expenditure will be spent on healthcare, and yet at the same time we face the looming possibility that we will fall still further in international rankings of healthcare quality. Even worse, we may actually find ourselves overtaken by China, which in three years’ time will have extended healthcare to all its citizens. For how long are Americans going to have to do without the quality of healthcare that so many other countries now simply take for granted?
ABOUT THE AUTHORS They have worked at senior and executive levels in the United Kingdom and New Zealand, and have published together and separately, on a variety of topics and areas including Enterprise and Entrepreneurship; Economic and Business Development; Institutional Economics; Health Policy; and Education Reform. Most recently the authors have published “On the Critical List: The US Institution of Medicine,” in the American Journal of Medicine, March 2011 issue. This can be downloaded from: http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934310009988.pdf Karen Malone may be reached at: Karen.m.malone@gmail.com
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Medical Travel Tips By Jacqueline Farley
Weddings, anniversaries, birthdays and the holidays are all occasions for celebration. Many people celebrate by going on trips or cruises out of the country. Winter is a popular time for those “snowbirds� to head south to Florida or the Caribbean. Many hours and a great deal of thought can go into planning a weekend getaway or the trip of a lifetime. Typically people don’t consider the possibility of current health issues worsening or an accident of some sort.
I have been a flight nurse and am now clinical director of a private air ambulance company. We transport patients by Learjet both domestically and internationally. Their conditions range from a case of appendicitis, to falls resulting in fractured hips, congestive heart failure, heart attacks and strokes, and motor vehicle accidents. In the total of approximately 6 years in this business, I have seen many a vacation come to an unexpected end due to serious accidents or health issues. What can you do to prevent something like this happening, and if it does happen, how do you get home from overseas, or even another state?
While Planning your Trip, also Plan for your Health Make sure you have enough of your daily medications and any supplies, such as test strips for diabetic testing, to last through your trip. Your doctor and pharmacist can do a vacation override to make sure your prescriptions last through your vacation. Most importantly, pack them in a carry-on and make sure you have access to them at all times.
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Do you have a living will or do not resuscitate order? It is very important to take copies with you. This will ensure your wishes are followed and make it much easier on your loved ones accompanying you, as well as the medical staff caring for you. Do you have a healthcare surrogate? Make sure that someone on the trip with your wishes and best interest in mind is designated to make healthcare decisions for you. In the event that the worst does happen and you do end up with a medical condition that requires you to be transferred back home to the states, how will that happen? First of all check with your insurance carrier and ask what your coverage would be in such a situation. How was your trip booked? Some credit cards will pay for illnesses and medevac while on vacation if your trip was paid for with that credit card. If you go through a travel agency, ask about medical travel insurance. Be sure to specify that you want to be able to get all the way home. If you are out of the country, some will only get you to the closest American port. Are you going on a cruise? They offer medical insurance at a nominal fee that will pay for hospital and medevac expenses. Wishing you all safe and healthy travels.
This year we are taking networking to the next level with our new and improved Interactive Networking Software Prescheduled One-on-One Networking Meetings Rated the best benefit of attending the conference. The number of face-to-face meetings that you can hold in 3 days of the conference would take years of traveling to different countries and cities to accomplish. Harvard Business Review Analytic Services found that of the 2300 readers polled, 95% believe that face-to-face meetings are the key to success in building long-term relationships and 89% agreed face-to-face meetings are essential to sealing the deal. Utilize the innovative online networking software to request dozens of private one-on-one networking meetings while at the conference. In three days you can network with health insurance companies, employers, medical tourism facilitators, governments, and top hospitals and healthcare providers from around the world. Customized Connections
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ABOUT THE AUTHOR Jacqueline Farley, RN has been an ER/ICU RN since 1994 and has 6 years of experience in the air ambulance industry. She is currently Director of Clinical Services for Air Ambulance Professionals, Inc., based in Ft Lauderdale, FL, which has been in business since 1989 doing domestic and international air ambulance flights. It is an owner operated business, with Brian Weisz, a former paramedic, the President and founder of the company.
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Traveling Well and Traveling Safe By Katherine Harmon On many occasions when we pack for trips, business or pleasure, medical and health kits are not at the forefront of our minds. We often take our health for granted, especially when traveling to other industrialized or Western nations that healthcare will be available or readily accessible to take care of our needs. However, that is not always the case. In many other nations, there are strikes of public workers which can include healthcare; doctors and nurses who may join staff walk outs, or massive public transportation strikes that make getting to a healthcare facility next to impossible. Weather related events or situations requiring sheltering-in-place may also require you to provide your own temporary medical care and advance preparation can certainly ease your stress both physically and mentally. What is the best way to go about that in a time where airline baggage space and cost is at a premium? In this travel economy we are dwindling down the number of shirts to pack let alone excess bottles of medication and cotton swabs. With practical matters to weigh in, there are some reasonable solutions that will meet both a travelers needs and a budget conscious consumer.
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that requires evacuation where medical care may be difficult to obtain immediately. Quite a bit can be packed into a small shaving kit/make-up bag should you decide to assemble your own, and surprisingly to many, the suggested supplies to not weigh much at all. As suggested by the U.S. Centers for Disease Control and Prevention (CDC) as well as many other authorities, there are many things that should be part of every personal medical kit regardless of destination. Pain relievers and fever reducers such as acetaminophen tablets, individually packaged, multiple doses, as well as ibuprofen, also individually packaged for use in the event of injury or illness. Bismuth Subsalicylate or loperamide as an anti-diarrheal comes in tablet form as well and is sold individually prepackaged. Mild antacids and mild laxatives come in single dose forms as well as oral rehydration salts. Diphenhydramine as the antihistamine of choice is good for both upper respiratory complaints as well as other allergic manifestations. Throat lozenges, decongestants and cough suppressants in varying amounts dependent upon your destination, time of year and current circulation of disease. Basic first aid supplies are an important component to your kit.
Medical Travel Kits Pre-packaged Health and Medical Travel Kits are available online at a multitude of sites and most contain essentially the same products at varying prices. All should have a net weight associated with them, with most variances being in the amount of product available in each unit and the type of encasement the product is packaged in. Ranging from leather to vinyl or plastic roll out similar to a medic for space saving, once products are consumed, they can be replaced easily once a traveler arrives home, then utilized again for the next trip. Some people want to consider where they are going and what their needs may be when purchasing these. The most useful products will be "pick up and go" kits, ones that can be easy toted in an emergency and carried, should there be an event
These should include: Several pairs of disposable gloves, various sizes of adhesive bandages, gauze 4x4's (as these can be cut smaller and the remnants used for redressing), a gauze roll, adhesive tape, elastic bandage wrap, antiseptic wipe, tweezers, small sharp scissors, antifungal and antibiotic creams, hydrocortisone cream, moleskin, a digital thermometer, saline eye drops, after-bite lotion for insect bites, consider aloe gel for sunburn (although this is generally heavy and bulky), as well as a First Aid Reference card or booklet if you are not already trained. Consider a class at your local healthcare facility, Red Cross or college/university, to feel comfortable administering first aid to yourself or instructing others on bandaging to avoid panic in a stressful situation.
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There are multiple other useful items to go into a medical travel pack. These would include; insect repellant containing DEET, picaridin, lemon/eucalyptus oil or IR 3535. Some of these some in a handy wipe form in lieu of the pumps or bottle for stowage in a kit as well, however, coverage cannot be assured as it may take more than one wipe and may need to be reapplied. Depending on destination and time of year for travel, sunscreen can also be a necessity as dealing with sunburn and the consequences of potential secondary infection or loss of movement when evacuation is critical can compound problems.
healthcare provider's information (including after hours call as time zones will come into play), area hospitals and clinics and the U.S. Embassy or Consulate should you run into difficulty. Knowing your destination ahead of time can greatly reduce your stress level which will assist healing efforts and minimize any trauma potentially suffered. Knowing what you may have been exposed to also can assist you in your decision as to whether you may be able to self-treat or should seek professional care. Importation of a foreign disease into the United States is an unfortunate consequence, at times, of business and pleasure travel.
Antibacterial hand wipes or alcohol based hand solution (>60%) to clean hands is also suggested as access to clean water can be a challenge in an emergency. In some instances, packing latex condoms in an emergency kit can serve many purposes and not just the primary one they were manufactured for. Condoms can serve as vessels for ice packs in a clinch, may make a tourniquet in the event you are instructed only by a trained healthcare provider to utilize one and can also be used as a barrier for one or two fingers if a waterproof bandage is needed to avoid contamination of an open wound or blister. If space is available, water purification tablets or a water filtration unit is an addition to consider if traveling to a more remote area or one in which compromised water systems are frequently an issue.
Exposing family, friends and co-workers to something potentially contagious is a risk no one would like to take. However, not many travelers would like to "over react" and seek medical care in unfamiliar settings for something simple they can self treat. Having the knowledge and resources to do that can make a trip go much more smoothly or in a period of unrest or unexpected disruption be an indispensable corner in your carry-on.
It is important to carry any and all prescription medications with you along with a written prescription describing the medicine and what you take it for. Some countries have a rather extensive list of medicines that are not allowed into their nation. Certification and clearance for entry with your prescription can be a long and arduous process with their Consulate and Ministry of Health that requires much advanced planning. Be sure to keep copies of all documentation with you and a copy at home with a trusted friend or relative. Also pack in your kits and on your person, contact information for a family member or close friend at home, your
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Extra Preparation, In Case of an Emergency For ex- pats living abroad, particularly those who are planning to stay in developing nations for an extended period of time, the stakes grow a little higher. In addition to a medical kit, there may be a few other items to consider having at hand just like you might want at home. Unlike living in the U.S. or another industrialized country where a department store is readily available and conveniences are well placed, replenishing things such as batteries might become difficult. "Rolling black outs" in many countries are common place and not only done when emergency strikes. Having a hand crank LED flashlight as well as a hand crank radio, or solar rechargeable batteries, is a wise investment, as is a solar charging adaptor for your cell phone to ensure communication. Should cell lines go down, a
the event you should need to light a gas source or build a fire. Remember that in the event of a natural disaster such as an earthquake, you should not use a gas appliance fed by a municipal line until given the permission by authorities as there may be a rupture and use of such could cause an explosion. Duct tape (consider some reflective striping) is also a good item to keep on hand in the event of a toxic release to seal windows and cracks, or for general use in lieu of a rope in securing objects. Having some that is reflective will ensure again, that you are visible to rescue crews working an area and can signal your whereabouts.
loud whistle and small mirror for emergency signaling stowed away in event of a natural disaster could signal aid from rescue groups. Storing several days of nonperishable food (approximately 1200 calories worth per person) and water (1 gallon per adult) is advised. Making the food as high in protein and light in weight as possible is highly recommended in the event evacuation is required and you need to carry it with you. Protein bars pack well, do not need to be cooked and have a high nutritive value. A blanket in the cabinet can serve many purposes. Rolled tightly it can take a modicum of space yet prove helpful as a floor cover, ground cover, sunshield, privacy barrier, or merely as a cover for warmth. However, the most valuable item to own is a multipurpose tool. Akin to the "Swiss Army Knife" and still manufactured as such, these are made by multiple companies and have many features. In addition to several blades - straight edged and serrated at least, the multi-purpose tool should have a can-opener, fold into pliers and have a built in wire cutter, and a device to use as a screwdriver. Some of the more advanced units allow for an interchangeable bit adapter and come with multiple tips that can be swapped out for a unique purpose. Many have small scissors that fold out. They are heavy enough to hammer small things with and generally quite durable. Another thing advisable to have handy is a supply of waterproof matches or a magnesium flint (which will spark despite rain) in
Although in no means a comprehensive list, a few wise purchases do not have to be cumbersome and take a great deal of room or financial expenditure to ensure safety and security. Considering the general usefulness of the items you will keep on hand for emergencies, these products can be used frequently and returned to a regularly designated "emergency place" whether it is a cabinet or backpack. Rotating the food and water stocks to guarantee their freshness is advisable and practicing an emergency plan with other co-workers as a drill semi-annually would make a true event easier on all. Designate a rally point, a role for each member and make certain that someone is trained in basic first aid for a worry free experience. In this world of uncertainty between man and nature, these are steps to take when traveling well and traveling safe.
ABOUT THE AUTHOR Katherine L. Harmon PA-C is the Director for Health Intelligence at iJET Intelligent Risk Systems, Inc. a 3iMind Company. She and her staff monitor for global outbreaks of infectious diseases as well as health issues and publish alerts for an array of clients to advise of potential problems and proposed solutions. http://wwwnc.cdc.gov/travel/yellowbook/2010/ chapter-2/travel-health-kits.htm http://www.mydr.com.au/travel-health/travelmedical-kit-checklist
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My Manager Makes Me Sick: Why Unqualified Managers are Harmful to Employees By LaShanda Blissett Competence versus Incompetence Children are taught a good education and hard work can lead to success as a working adult. When those children become adults and pursue formal degrees or training in a particular field, it can be predicted the combination of education and relevant experience will yield a competent professional. Though it is often assumed competent and high-performing professionals will be valued and respected in the workplace, some recent studies have directly and indirectly revealed such individuals could be at a higher risk for being negatively targeted by incompetent, bullying managers. Workplace bullying is an international problem that is characterized by consistent acts that involve intentional attempts to harm individuals at work. In Europe, the term mobbing is most often used to denote the phenomenon (Leymann, 1996). According to the Workplace Bullying Institute (WBI, 2010), over 54 million (over 37%) of the entire United States (U.S.) workforce has been bullied at work. In fact, researchers have noted the worldwide phenomenon often involves incompetent managers bullying the most competent, highly productive, and most charismatic workers (Chen, Fast, 2009; Clarke, 2010; FischerBlando, 2008; Namie, Namie, 2009; WBI, 2007; WBI, 2010; & Yamada, 2008).
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Managers that bully employees at work assert false allegations about performance, assign work that is well below the employees’ skill levels, assign too much work, and often publicly humiliate the employees in meetings and other group settings at work; to name a few of the harmful actions. The harmful acts have negative effects on targeted victims’ physical health and emotional wellbeing, and eventually force the targets to quit jobs. Incompetent managers bully direct reports and abuse power for personal gain, primarily to feel a sense of control, due to low self-worth and feeling threatened by highly competent employees. Managers who lack the skills and qualifications to do their job and perform as effective leaders channel energy into humiliating and forcing competent direct reports to leave organizations. When the employees fight back and cannot be forced to leave, managers ensure the employees are eventually terminated from organizations.
Does this Story Sound Familiar? In 2010, when Eliani was offered a new job position, she was excited about the new project. After working in the position for 6 months, it was no longer a surprise to Eliani that the Director of a large staff training department was repeatedly unable to facilitate and manage meetings. According to Eliani, one meeting the Director hosted “was downright embarrassing and I wanted to just leave! I felt sick in my stomach during and after that meeting!” Apparently, the Director’s speech pattern was muffled by extreme nervousness and visible trembling throughout the meeting, during a failed attempt to describe a new initiative. Not only had Eliani been frustrated and stressed out about working with the embarrassing Director, she had been harassed by the newest member of the team, a Team Leader that was even less competent than the Director. According to Eliani, the Team Leader could never answer questions about work assignments, constantly made false allegations about Eliani’s performance, and sought to punish Eliani and other employees for mistakes that were never made. Eliani further reported the unfair treatment to the Director and Deputy Director numerous times, and was informed the Team Leader was not capable of doing the job properly and there was uncertainty about how to handle the bullying. When Eliani departed the organization, with a sigh of relief she admitted, “A big red flag should have popped
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in my head during the interview, an interview during which both the Director and Deputy Director seemed more interested in my shoes than my job experience. The Deputy Director was always making weird statements about me dressing too professionally”. Eliani added, “not only are the managers in the group extremely incompetent and unskilled, they allow illegal and unethical behaviors to persist. For example, the newest Team Leader is a bully that torments people. Everyone knows one of the other Team Leaders actually choked a member of his team last year, and he makes ethnic and religious jokes about all of his team members. No one trusts the Director or the Deputy Director, and everyone knows neither has qualifications to be in the positions they have. They won’t do anything about the bullying team leaders who harass people daily. People talk about it every day. It is sad because really smart people are not willing to give suggestions or contribute to any initiatives there. If a smart employee gives a recommendation or asks a relevant professional question, they will get fired, like I did! Everyone is sick and tired of it!”
Why Eliani’s Story Matters Eliani’s story is not uncommon. Many organizations are plagued with unqualified managers. Such leaders perpetuate some of the worst problems for teams of employees, such as refusing to penalize people
who engage in incivility acts and maintaining a track record of bullying and terminating competent workers. Researchers have revealed a consistent pattern of incompetent managers being more likely to engage in and do nothing about incivility acts, such as workplace bullying (WBI, 2010). Such individuals lack the emotional intelligence to recognize problems that contribute to individual and broader organizational performance issues, and have limited understanding of the implications for allowing bad workplace behavior to persist without consequences. Listen to a group of professional employees talk about current experiences working in toxic work environments, and a particular theme is likely to surface - employees report being sick and tired of working under the direction of poor leadership, particularly the issue of dealing with bullies. The commonly used phrase “sick and tired”, it is not just a figure of speech to denote being highly annoyed about working on a job. It is often a literal admission of emotional or physical illness and ailments from dealing with excessive workplace stress. An unqualified manager’s behavior coupled with bullying not only frustrates and sickens employees mentally and physically, it hinders individual and organizational performance. The incompetent leaders might not be aware employees know about the ineptness. However, employees recognize and discuss it often. Unqualified managers lack basic functional skills, such as the ability to give clear direction and clarification of assignments, inability to articulate the purpose of new initiatives or explain requirements for new projects, and show signs of being confused when employees use industry relevant terms or jargon in the workplace. Those managers also act defensively when employees ask for clarification of expectations, and refuse to support practices that include accountability measures. Health related problems and lack of energy from dealing with job stress are typical among employees working under unqualified leaders and bullying managers. Health conditions range from clinical depression to heart disease (McFarlane, 2010). Overall job dissatisfaction, high levels of resentment toward upper management for hiring and retaining bad managers, and low morale are commonly shared feelings among employees who report to unqualified mangers. The end result includes dysfunctional teams that are made up of individuals who experience high amounts of job related stress and often call out sick; overuse leave;
spend a high percentage of the work day searching for another job; and contribute only minimally, and usually unwillingly, when at work. From a legal perspective, it is likely workplace bullying will remain a widespread problem in countries where there are no existing laws to provide protection to victims. For example, the U.S. has not passed any laws to prohibit bullying in the workplace, though bills are currently being reviewed in 20 of the 50 U.S. states (Cohen, 2010). As a result, many U.S. victims end up filing employment discrimination claims to address bullying incidents. However, the litigation process can be lengthy and challenging, given discrimination claims must be presented specifically for cases in which a victim has been discriminated against; not necessarily to cover acts characterized only as workplace bullying.
Solutions to the problem Companies can do a better job of promoting and enforcing legal hiring practices, and implement evidence-based leadership practices that help build an ethical work environment. When hiring officials make unethical decisions to hire and promote unqualified candidates to management positions, the unqualified managers and other employees suffer. Individuals can thrive much better in positions in which the necessary skills and qualifications more closely align with the individuals’ skills and abilities. Increased competence can improve a manager’s confidence and ability to perform as a valuable employee and successful contributor. An unqualified manager can focus on quickly learning core job and leadership skills. The manager can discretely work on building skills by reading industry-specific books, attending training sessions, participating in leadership and management programs, requesting a mentor, and making a conscious effort to strive toward proficiency as a leader. Employees have two options for combating a workplace bully that is a direct manager - either quit the job to separate from the bullying boss or make attempts to outsmart the bully. According to Chen and Fast (2009), one way to outsmart a bullying boss is with excessive flattery, which is alleged to reduce defensiveness. If an employee feels it is might be more frustrating and sickening to play such mind games with a bully, alternatively, answering a few critical questions can help determine if getting a new job is best. The first
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question to ask would be - is working with the manager worth the psychological and physiological stress and problems that result from the working relationship? Second, is the situation likely to change? Third, will the manager’s boss protect an employee from retaliation, in the event the manager’s behavior is reported? If the answer is yes to all three questions, an employee might be able to survive in the less than perfect job. If the manager’s boss is not likely to implement any efforts to support changing the manager’s behavior, attempts to report the manager or seek assistance from human resources will be unsuccessful. Employees will end up staying and becoming more stressed out, get tired and quit the job, or get fired for being strong enough to fight back.
Organizations will eventually be penalized more frequently and severely for unethical practices, such as hiring incompetent managers and tolerating bullies in the workspace. In the meantime, those organizations will continue to lose money, have high absentee rates, encourage social deviance at work, and influence high turnover rates. As more researchers began to focus on workplace bullying and share facts about the phenomenon with the world, individuals will be empowered to recognize and deal with the issue to avoid serious damage to overall health and well-being.
Conclusion Worldwide, employees are bullied, harassed, and terminated by bullying managers that are unqualified for leadership positions. Many companies ensure the proper training and mentorship are provided to help new leaders learn essential skills to succeed in organizational leadership roles. On the other hand, there are a large number of organizations that ignore the importance of preparing leaders, and promote and hire individuals based on friendships or other factors unrelated to qualifications and performance ability. When qualifications and capabilities are not valued, employees suffer from dealing with unnecessary stress while working within organizations where incivility and bullying managers are tolerated and rarely penalized. Within large companies, departments with bad reputations have difficulty attracting valuable internal candidates for vacant positions.
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ABOUT THE AUTHOR LaShanda Blissett is the Chief Director of Operations at The Blissett Group, Corp, a management consulting firm based out of Rockville, MD, near Washington, DC. LaShanda has an extensive background in workplace learning and performance improvement. She also offers workplace bullying assessment and customized workplace bullying prevention program services. Her professional roles have ranged from instructional design consultant to Vice President of Business Development. She is also a PhD student at Capella University, working toward a Doctorate in Education with a specialty in Training and Performance Improvement. LaShanda can be reached via email at lb@theblissettgroup.com or by phone at (301) 296-4525.
Working Past Retirement Finding Gold in your Golden Years By Mark Roberts
Retirement has long been seen over the past century as the beginning of your Golden Years. However, for many individuals, retirement has been seen as the beginning of the end. Some celebrate not having to work anymore—to remove themselves from the daily grind of the workaday jungle and relax in their own private Shangri La. Others see retirement as an end game, and they focus on that goal every single day of their employed life. Retirement has its benefits and its challenges. It also paves the way for you to manage your remaining days without reporting to a boss or anyone who you answer to at your job including shareholders or partners. However, if you are not the kind of individual who is ready to hang up your spurs, or ride off into the sunset on Old Paint, then retirement can be a blessing for additional income and satisfaction of a job well done for years to come. Just because you turn 65 doesn’t mean that you are automatically turned out to pasture. There are some companies that have mandatory
retirement ages for employees. However, there are many companies who employ individuals who are well past that retirement age and who are serving useful careers. Based on the employment policy of your company, you can continue to work until you are ready to leave.
Out Living your Savings As baby boomers begin to turn 65, many expect to keep working well past retirement age. Nearly one in five working Americans tapped into retirement accounts in the past year, and some now worry they will outlive their savings. Others may not need to work, but choose a so-called "encore" career, according to NPR. Who says 65 is the magic age to stop working? With today's longer life expectancies, few can afford to rest on their laurels -- or savings -- for 20 or more years, according to BankRate online. Even if you can stash away enough cash, do you want to completely leave
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the working world? Employment has rewards beyond the financial. Baby boomers have found the fountain of youth. They have tons of energy, and they're not going to be willing to quit. If they can play golf three days a week and still be CEO, that's what they're going to want to do. Of course, not every retiree rejoins the work world merely for creative fulfillment. Many stay on the job to take pressure off retirement savings. Then there's the benefit of employer-provided insurance. Medicare doesn't kick in until you're 65. If you stop working earlier, you and a spouse or other dependents probably will have to find your own insurance.
A Back-Up Plan Nearly 40% of people surveyed by the Transamerica Center for Retirement Studies say they plan to work past age 70 or simply never retire. Many said it was because they either can't afford to retire or because they need the health benefits. That may seem like the best strategy — or the only strategy — available to some people. But it assumes a lot: that their job will be there and that they'll stay healthy enough to keep working. On the other hand, there are some advantages: if you expect to live to be 95 and you retire at 75 versus 65, that gives you an extra 10 years to generate income and save, and 10 fewer years that you need to save for, according to MarketWatch. Planning not to retire is not a retirement strategy, though. Too often, life’s unforeseen circumstances can dictate otherwise, be it through a job loss, health issues or life’s other obligations. It's not just how long you work; it's also how you get paid. Companies increasingly are connecting pay to employees' performance, in part as a strategy for growing their business in uncertain economic times. While an employer might see variable or performancebased pay as a flexible and fair arrangement, workers may view it instead as less-than-reliable. But that's not a problem for everyone. Yet 87% of those workers who plan to keep working said they don’t have a back-up plan if for health or other reasons they’re unable to continue working. And 82% of all workers in the survey said they don’t have, or aren’t sure if they have, a back-up plan; creating a back-up plan requires some creativity. Trying to stay as healthy as possible is one idea. Another idea: Take a page from the “Golden Girls” and consider living with a roommate or two in retirement. Necessity isn’t driving these high-net-worth people to continue working: many said they want to start a second career or new business. Fifty-five percent said they will volunteer in their community, according to 40
MarketWatch. But the kids of these wealthy individuals might face some retirement-savings challenges of their own: Just 49% of the parents surveyed said it’s important to leave an inheritance to their children. How much will you need to retire? The median amount workers in the Transamerica Center survey said they’ll need is $600,000, but just 30% of those surveyed now have more than $100,000 total in their household’s retirement accounts. A few people feel the single greatest fear about retirement is that Social Security benefits will be cut, or disappear entirely. Others feel they will outlive their money altogether and be forced to live on significantly reduced income or charity from family or social services. According to QuintCareers.com, the U.S. Bureau of Labor Statistics reports that baby boomers are reaching the age of 60 at the rate of one every seven seconds. Many of these folks will be searching for something beyond a leisurely retirement. For many, retirement will indeed no longer signal the end of working, but more so a career and lifestyle transition, where the retiree has multiple options -- such as continuing to work (though perhaps at a different pace), returning to school for additional training or education, changing careers, venturing into entrepreneurship, becoming more involved in volunteer work, or simply enjoying leisure and travel possibilities -- a mix of working, learning, relaxing, and trying new things. So, how can older workers facing retirement find a new job or career? One of the keys, of course, is finding an employer that both respects older workers and offers job flexibility options. And there are already a handful of employers gaining a strong reputation for hiring and valuing older workers, such as Bonne Bell, CVS/pharmacy, Farmers Insurance Group, HoffmanLa Roche, John Deere, Radio Shack, Volkswagen of America, and Wal-Mart. Healthcare, security, retail, temporary agencies, and other service sectors seem to be the norm for older workers. AARP, an organization dedicated to people aged 50 and older, suggests 10 positions suited for mature workers: bank teller, consultant, customer greater, English instructor, floral assistant, home-care assistant, mystery shopper, security screener, teacher assistant, and tour guide. A worker nearing retirement age might also look to his or her current employer for options, such as bridge positions, phased retirement, part-time employment, telecommuting, or freelancing.
Tips for Retirees that have to Work Whether you're heading back to your old company or looking for a job with a new employer, you'll need to be ready for today's working world. According to Bank Rate, here are a few suggestions to consider: Polish your computer skills: Virtually every job demands at least rudimentary computer knowledge. Within areas of expertise, knowledge of proprietary software is also important. Management skills alone might have been enough in your previous situation, but most postretirement assignments will be more hands-on. If you're going to work in your field post-retirement, you need to master some basic technology skills. Build a sophisticated resume: A post-retirement resume is different than the one that landed you your first or even your most recent job. Concentrate on what you can do, not what you've done. If you're in doubt about what to include, get expert advice. Be flexible: Give various opportunities a try. If something doesn't work out, so what? Take a breather and try something else. At this age, you have nothing to prove and that's a blessing. Also, there's the compensation question. Retired workers re-entering the workforce generally have more considerations that just a salary amount. For instance, if your retirement plan is based on your income over the last few years of employment, and many are, don't put yourself back on a payroll. Such a move can affect how much pension money you get. Instead, negotiate an arrangement where you're a self-employed contractor. Since you'll be responsible for your tax payments, make sure you're paid enough to compensate for the employer's share of Social Security that you'll owe. Plus, older workers should be upfront about their compensation needs. If you need health benefits more than you need money, negotiate that. If you need a flexible schedule, make that clear. Another option for older workers who want to work but also want variety and new challenges is to consider temping, according to QuintCareers. Temporary agencies help place you with employers who need your particular skills. A wide range of temporary agencies is available, so find one that meets your criteria. If you want to continue working -- but in a new career field -- consider taking the time for self-assessment and career exploration. If you are unsure of your next career field, examine your likes and dislikes, strengths and weaknesses, and consider talking with a career
professional. And for the really adventurous, another option is starting your own business after retirement from your current job. While many have been successful starting their own businesses, it is certainly riskier later in life. For those who want to work, but are lucky enough not to need the income, volunteering is a wonderful option. Volunteering is a great way to stay active while also making a significant contribution to a worthy organization. Volunteering opportunities abound in every community. Senior Corps is one such organization, assisting local nonprofits, public agencies, and faith-based organizations in carrying out their missions by matching seniors with opportunities. But why should you work or volunteer if you don't have to? Experts suggest working helps older folks keep their minds and body active, provide social interaction and relationships, support their value system and work ethic, find meaning to life, and fight stereotypes that only the young are good workers. Finally, what about those retired folks who want to get more education? Contact the colleges in your area and see if they offer specific programs for your educational interests. For those who want to learn, but do not want a formal program, consider taking courses designed for seniors. Depending on your circumstances, retirement can be either a boon or a bust. The important consideration is if you have prepared. It may or may not be too late. However, retirement from work is only a change in geography. Retirement from life is more consequential. Remember not to confuse them. Your Golden Years should be just that - Golden.
ABOUT THE AUTHOR Mark Roberts’ professional sales background includes 30 years of sales and marketing in the tax, insurance, and investment markets. Mark is a licensed life, health and accident insurance agent in all 50 states and DC. He serves as Manager of National Accounts at Careington International (www.careington.com). You may contact Mark at: markr@careington.com or view his blog at www.yourbesthealthcare.blogspot.com. 41
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