Chile: MSF Assessing the Situation in Areas Most Affected by the Earthquake

As the Chilean authorities manage the response to the disaster, MSF is concentrating its efforts in the areas that are most difficult to access.

March 2, 2010
Several teams from Doctors Without Borders/Médecins San Frontières (MSF) are assessing the needs in the Maule and Bio Bio regions of Chile, both of which were hard hit by the 8.8-magnitude earthquake that struck last Saturday.

The earthquake's impact zone covers nearly 1,000 kilometers along Chile's coastal regions; many areas there have yet to be evaluated. Our teams are in contact with the Chilean government, which is managing the response to the disaster. MSF will focus its efforts in the more isolated areas that rescue workers have not yet reached.

An MSF team in the Concepción region is planning to travel today with Chilean authorities to assess the situation in the coastal area north of the city. Two other teams are covering the coast in the Maule region, both north and south of the town of Constitución. The MSF teams have also visited hospitals in Curicó and Chillán, both of which have received people wounded during the earthquake. MSF will support the hospitals.

In its assessments, MSF workers observed significant damage in several areas, especially along the coast, which was hit both by the earthquake and the large waves it caused. But the damage does not seem to be as widespread, and the roads are in good condition. In some villages, people are sleeping in the streets, either because they lost their homes or because the daily aftershocks have made them afraid to be inside

MSF is also preparing a team of psychologists to provide care to the population, as our workers have witnessed many people traumatized by the earthquake and subsequent tremors.

MSF already has 14 staff on the ground: a team consisting of doctors, nurses, logisticians and a coordinator from Argentina, Bolivia, Panama, Mexico and also Chile.


You can also get all of the latest updates, including podcasts and videos, at www.doctorswithoutborders.org

The Association for Healthcare Philanthropy, established in 1967, is a not-for-profit organization whose more than 4,700 members direct philanthropic programs in 2,000 of North America's not-for-profit health care providers. AHP's members include fund raising professionals, development staff, public relations professionals, trustees, marketing professionals, administrators, and executives interested in health care fund raising. In 2003, AHP launched its Performance Benchmarking Service, which establishes standard metrics and industry best practices for fund raising success.

It was only a matter of time. First it was American manufacturing jobs that went over seas. A Chinese worker making $120 per month working 12 hours per day, 360 days per week, turns out hundreds of widgets at a fraction of the cost of an American made widget. A sign on a factory wall in China reminded the workers, "If you do not work hard today, you will have to work hard tomorrow to find a job."

White collar service jobs seemed immune to outsourcing until call centers with English speaking workers began offering customer service options to American companies. With today's virtual world and sophisticated communications systems, anything that can be done in a "back office" can now be done in a third world urban service center and transported by satellite to the computer screens of American managers.

So it should come as no surprise that the major American insurance companies are beginning to experiment with medical tourism, establishing networks of surgeons and dentists in places like India, Costa Rica and Thailand, where costs can be as much as 75% less than in the United States. Although the $5.1 billion spent on Medial Tourism in 2007 is less than 1% of the $2.3 trillion spent on healthcare in the U.S., it is a concept that the American medical community would be wise to monitor.

In the past, for the most part, Americans traveling abroad for medical care were comprised of the wealthy and the uninsured. And unlike American manufacturing jobs and admin jobs, the motivation of those visiting a foreign medical campus were not just cost. Some of the finest surgical centers in the world can be found outside the U.S. And the quality extends from the clinical to the non-clinical. High levels of service, the finest cuisine and luxury accommodation can make the entire process hard to duplicate in over-crowded U.S. hospitals staffed by over-worked physicians.

Until recently American insurance companies have turned their backs on the concept. But now the largest insurers, covering millions of policy holders are beginning to take a harder look. Pilot programs are either already underway or are pending.

There are still many hurdles to overcome before Medial Tourism can play a major role in addressing the relentless rise of costs in the U.S. Consumers with a policy with low deductibles and co-pays have little motivation to travel. But as costs for employers continue to escalate, employees will be shouldering an increasing percentage of the load. As high deductible policies become the norm, medical tourism will become a more attractive option.

Already, in dental procedures, where high deductibles are common and where many patients with health insurance have no dental coverage at all, medical tourism can mean the difference between a $10,000 out of pocket price tag and a price tag of less than $5,000 including travel and lodging. Throw in some frequent flyer points and people are beginning to sit up and take notice.

Quality concerns are another factor that will have to be addressed. It is difficult for people to grasp the fact that hospitals in Costa Rica can be as good or better than their local community facility. And there are no easy ways to compare facilities overseas. But as insurers become involved, they will help raise the bar and set standards for the facilities that they cover.

And of course there is the liability issue. Employers are concerned that they may become the target of litigation if something goes wrong. Especially when one considers that the average malpractice recovery in Thailand is around $3,000 and the average in the U.S. is around $300,000. But again, as Medical Tourism matures there are solutions at hand. Some Medical Tourism companies are already beginning to offer employers insurance against overseas liability.

A measure of the power of competition on price can be found in a number of areas where local facilities have offered discounts on their posted prices when faced with the loss of business to facilities off shore. According to a recent USA story by Tom Murphy, "Shortly after Hartford, Conn.-based Aetna Inc. and the Maine-based grocery chain Hannaford Bros. Co. launched a program to send patients to Singapore for hip and knee replacements, some New England hospitals countered with their own deals."

American doctors are not yet faced with head to head competition with medical "sweat shops" in the third world. And a Democratic congress searching for healthcare reform ideas are unlikely to embrace sending American healthcare jobs over seas. But the outsourcing of American healthcare is not as far fetched an idea as it once seemed.

For many, the funding of a Roth IRA has not been an option for saving for retirement. However, beginning on January 1, 2010, a new opportunity is available for those interested in a Roth IRA. New IRS rules are making it easier than ever to convert to a Roth IRA. All taxpayers are now eligible to convert a traditional IRA to a Roth IRA, regardless of income or filing status. In addition, individuals can convert some types of qualified retirement plans, including 401(k) plans, profit sharing plans, governmental 457(b) plans, and 403(b) plans. A Roth conversion allows individuals to convert future taxable income to future tax-free income.

Why convert to a Roth? A Roth IRA allows for more flexibility than a traditional IRA. For example, contributions and earnings on the contributions to a Roth IRA are not taxed when withdrawn upon retirement and the RMD law (Required Minimum Distribution at age 70 1 /2) does not apply to funds in a Roth IRA. In exchange for the future tax breaks afforded by a Roth IRA, the amount converted into a Roth IRA is typically taxed as ordinary income in the year of conversion. A short-lived plus is conversion to a Roth in 2010 which allows for the tax to be spread over two tax years-2011 and 2012. If conversion to a Roth takes place after 2010, all taxes must be paid in the conversion year.

Keep in mind that a Roth conversion might not be right for everyone. Look at the pros and cons of a conversion based upon your unique situation. Several factors need to be considered. If any one of the following applies to you, you might want to consider a Roth conversion:

1. Taxes. Consider whether or not your tax rate could be higher in retirement than it is today. We have no idea what future tax rates will be, but it is possible that tax rates across the board are currently low relative to where they might be in the future. If you don't have enough money to pay the taxes on the conversion of all of your tax-deferred assets, or if doing so would push you into a higher tax bracket, you might want to consider converting a portion of your assets.
2. Time. Consider how much time you have before you need to withdraw the money from your IRAs. Generally, the younger you are, the more beneficial a conversion will be because you will have more years to recover the tax bill. As mentioned earlier, Roth IRA savings are not subject to RMDs during your lifetime, giving you the opportunity to create a greater legacy for your loved ones.
3. Cost. Consider whether or not you can pay the taxes on the conversion from non-retirement assets. Using cash outside the IRA adds more leverage to the conversion, although you can still benefit from a Roth conversion by using IRA assets to pay the taxes.

The internet offers several Roth conversion calculators and other tools to assist investors in determining whether converting retirement assets to a Roth IRA makes sense. Be advised that these internet calculators may not be as accurate as those available to financial advisers. The calculators found in planning software developed specifically for financial advisers tend to be more sophisticated because they allow the adviser to make adjustments to individuals' tax rates and withdrawal rates in addition to assumed inflation rates. The basic calculator generally does not allow for these adjustments and may provide a very different answer from a calculation prepared by a professional financial adviser.

If you want to learn more about Roth IRAs and the Roth conversion changes for 2010, go to www.rothretirement.com. In addition, be sure to consult with your tax or financial advisor to determine if a Roth conversion is right for you.

Angel T. Marvin graduated from the University of South Carolina with a B.S. in Engineering in 1993 and a Master of Taxation in 2002. She is a Certified Public Accountant in both North and South Carolina. Her professional memberships include the American Institute of Certified Public Accountants and the South Carolina Association of Certified Public Accountants. Prior to joining Abacus, Angel was a tax manager in the Federal Business Tax Group at Grant Thornton, LLP, working with real estate development, health care, manufacturing and professional service companies. Phone: 803-933-0054 Fax: 803-753-9476

Although you don't see it in the headlines, and you don't hear it from the "talking heads" on the evening news and the politicians seem to be ignoring the issue, we have a growing shortage of primary care physicians that is reaching crisis levels. If healthcare reform succeeds in putting 41 million new souls into the system It doesn't take an Einstein to extrapolate...

Here is a primer for our leaders in Washington:

· The American Academy of Family Physicians predicts that, if current trends continue, the shortage of family doctors will reach 40,000 in a little more than 10 years.
· The average wait to see a primary care physician can run up to 30 days in many cities.
· 50 years ago half of our physicians were primary care providers.
· By 2000 14 percent of U.S. medical school graduates were entering family medicine.
· By 2005 the figure was 8 percent.
· A recent survey of students interested in internal medicine showed that 98 percent wanted to become specialists.
· When Massachusetts added 340,000 citizens to their universal healthcare program the wait to see a primary care physician in Boston jumped to 61 days.
· The four categories of primary care, Family Medicine, Internal Medicine, OBGYN and Pediatrics are the lowest paid averaging about $175,000 while medical specialties such as cardiology demand salaries over $400,000.
· Medical education debt can run up to $200,000.
· Politically correct or not, within a few years over 50% of our medical students will be women and they are far more affected by lifestyle issues than their male colleagues.
· It takes from 8 to 10 years to build a doctor from scratch so there are no quick fixes.
· To the same degree that our general population is aging, our supply of practicing doctors is aging and approaching retirement. In fact the physician shortage would be far more severe if thousands of physicians had not delayed their retirement do to the recent economic calamity.

Here is a primer for American citizens:

· Don't get sick.
· Don't change doctors (you might not be able to find a new one).
· Don't lose your job.
· Don't relocate.
· Schedule a doctor visit for three months from now...you can always cancel it if you aren't sick or injured by then.
· If you plan to have an accident or heart attack in the immediate future, get in line at the emergency room now.
· If you have health insurance now, plan to pay more.
· If you don't have health insurance now, plan to pay more.
· If the government doesn't come up with a solution...plan to pay more.

Washington is the place where the concept of unintended consequences was invented. It's nice to see that the more things change, the more they stay the same.

Every year between 600,000 to 1,000,000 health care workers experience needlestick injuries in the United States; this does not account for the injuries that go unreported. Most needlestick injuries involve nursing staff but laboratory staff, physicians, housekeepers, and other health care workers are affected as well.

Needlestick injuries occur whenever a healthcare worker is exposed to a needle or other sharp device. Needlestick injuries depend on the type of design and the devices used and are typically related to certain work practices such as recapping, transferring a body fluid between containers, and failing to properly dispose of used needles in puncture-resistant sharps containers. These needlestick injuries expose healthcare workers to serious diseases and infections and can result in millions of dollars of expenses for the medical facility or hospital for both the physical and the emotional injuries. According to the American Hospital Association, one case of a serious infection by bloodborne pathogens can result in $1 million of employers costs related to testing, follow-up, lost time, and disability payments. The cost of a high-risk exposure is almost $3,000 per injury even when no infection occurs.

In order to address the issue and reduce the number of injuries that healthcare workers receive from needles and other sharp medical objects, OSHA created the bloodborne pathogens standard which has been in effect since 1992. This standard applies to all occupational exposures to blood or other potentially infectious materials. Some requirements include the following:

· A written exposure control plan designed to eliminate or minimize worker exposure to bloodborne pathogens
· Compliance with universal precautions (an infection control principle that treats all human blood and other potentially infectious materials as infectious)
· Engineering controls and work practices to eliminate or minimize worker exposure
· Personal protective equipment (if engineering controls and work practices do not eliminate occupational exposures)
· Prohibition of bending, recapping, or removing contaminated needles and other sharps unless such an act is required by a specific procedure or has no feasible alternative
· Prohibition of shearing or breaking contaminated needles (OSHA defines contaminated as the presence or the reasonably anticipated presence of blood or other potentially infectious materials on an item or surface)
· Free hepatitis B vaccinations offered to workers with occupational exposure to bloodborne pathogens
· Worker training in appropriate engineering controls and work practices
· Post-exposure evaluation and follow-up, including post-exposure prophylaxis when appropriate

Needlestick injuries are an important and continuing cause of exposure to serious and fatal diseases among health care workers. Greater collaborative efforts by all stakeholders are needed to prevent needlestick injuries and the tragic consequences that can result. While prevention is important it is also important to make sure that your organization is covered for the injuries that do occur. Talk with you insurance provider to make sure that your worker's compensation program covers the costs associated with needlestick and other sharps injuries to combat the expenses your organization incurs with the associated injuries.

* The information in this article was provided by the National Institute for Occupational Safety and Health (www.cdc.gov/niosh). If you have any questions about your coverage please contact J. Krug representative.

As the President and founder of J. Krug & Associates, Jeff has used his industry expertise in creating and maintaining unsurpassed insurance and risk management programs for all of his firm's clients. His desire has built J. Krug & Associates into a dynamic organization that has set new standards of service excellence within the insurance industry. Phone: 847-818-7502 Email: jkrug@jkrug.com

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