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Emergency assistance for international risks.

There are the significant expenses associated with international travel by company executives, and the tremendous costs of maintaining expatriate employees, which are often three to four times higher than those for a home-based employee. And in a world where international markets are worth billions of dollars in revenue, U.S. corporations will spend millions training their executives in language courses, cross-cultural communication and international business etiquette in order to prepare them for a successful overseas assignment. As a result, companies want to ensure that they do everything possible to protect this investment.

Risk managers must therefore ensure that their companies have strategies in place that protect their overseas employees. However, in many cases risk managers will discover that their firms do not have the resources or expertise needed to provide assistance to these employees in times of emergency. Whether the situation is a sick or injured employee in a remote country who needs expert medical treatment, or a group of workers trapped in a war-torn nation, or an executive traveling overseas who loses all his money, many corporations are ill-equipped to provide aid to these personnel.

Procuring the services of an international assistance company is one way that risk managers can ensure their firms will be able to come to the aid of employees in crisis situations. Assistance companies typically have offices and agents located throughout the world, and are ready to offer assistance to their clients, whether in Beijing, Istanbul, Moscow or Bogota, and at any time of the day or night. Offered as an employee benefit, an assistance company with a strong international network can provide cost containment benefits for health care-related costs; repatriation benefits in emergency situations; expertise in dealing with local authorities and the customs departments of foreign countries; and a link between employees and their dependents. However, assistance services are needed not only during emergencies, but also in other situations, such as when it is essential to relay an urgent message, send an employee a cash advance or help him or her make emergency travel arrangements.

MEDICAL CRISES

Assistance companies can be of great help in the case of medical emergencies. Health care costs are a major expense for U.S. corporations and are presently growing every year by 20 to 25 percent. Although the emergence of managed care programs such as preferred provider organizations (PPOs) and health maintenance organizations (HMOs) has helped U.S. corporations control and reduce their domestic health care expenses, these types of cost control are not as fully developed on an international scale due to the differing characteristics of each country's health care system. Therefore, when an employee has a medical emergency while outside the United States, costs not covered by insurance can spiral out of control. Compounding the problem is the fact that health care standards and medical resources vary widely among foreign locales; in areas where new markets are opening, such as Eastern Europe, the former Soviet Union and certain countries in Asia, these standards are often seriously deficient.

The lack of quality medical services can pose significant problems for companies whose employees work in potentially hazardous settings. For example, oil companies operating in Asia or Africa on offshore platforms know the tremendous liability they face in case of an accident to one of their employees, and the costs of evacuating those injured to a competent medical facility able to properly treat accident and burn vlchms.

However, solutions to these problems do exist. In many cases, an international assistance company can make arrangements to transport a sick or injured employee to a hospital where more appropriate care is available or to a hospital covered by the corporation's PPO or HMO plan. In cases where it is necessary to expedite the treatment, some assistance companies can advance payment of the medical expenses.

An example of a successful medical evacuation involved a student affiliated with a U.S.-based international organization who was in a serious car accident while studying in Buenos Aires, Argentina. The young woman received numerous injuries, including a broken back, and was left in critical condition. After trying for four days to provide assistance through its own local staff, its risk manager, the American Embassy and the student's family, the international organization realized that it did not have the resources to provide the woman with quality medical treatment.

After receiving a quote for $150,000 to bring the student back home by air ambulance, the international organization also realized that it could not pay this amount, and needed help. The organization then contacted an assistance company, which immediately conducted an investigation to determine the condition of the student and the possibilihes for returning her home.

The assistance company took complete control of the case and began to monitor the woman's condition. Within a week, the company was able to make all arrangements for an air ambulance transport with physician, nurse and respiratory therapist escorts from Buenos Aires to San Diego, California. This transport service cost the international organization a total of $79,153. By obtaining the services of an assistance company, the organization was therefore able to safely fly the student back home while saving $70,847 on transport costs.

In many emergencies, an assistance company will have to monitor the situation for an extended period of time before the case can be resolved. For example, an employee of an American firm traveling in Romania became hospitalized in Bucharest, with what was either a stroke or a heart attack. After the assistance company was notified by the employee's daughter, it immediately initiated an investigation into the case by contacting the local assistance representative who learned from the attending physician that the employee had actually suffered a stroke.

Due to the poor quality of local medical facilities and the severity of the employee's condition, the assistance company recommended that the employee be evacuated by air ambulance to the nearest capable medical institution. Bids were requested from air ambulance companies and, according to company policy, the assistance company engaged the lowest bidder at $9,600 to take the employee to Munich, Germany. Within 72 hours of notification, the assistance company had successfully completed the transport and the employee was in Munich, receiving proper care.

The German physicians discovered that the employee was suffering from left side paralysis and possible brain damage. They recommended that the patient be hospitalized for a two-week period, followed by commercial airline transport back home. After careful consideration of the situation, the assistance company1s physicians and the attending doctors in Munich reached an agreement to transport the employee home via stretcher on a commercial flight at the end of seven days. By doing so, the employee's company would be able to realize substantial savings in hospital expenses.

The assistance company began immediate arrangements for the transport. However, as in many emergencies, situations change constantly. The day before the employee was to be flown home, he suffered a heart attack. The employee was then diagnosed with severe coronary artery disease, and the attending physicians in Munich said he could not travel for at least another seven days. Bypass surgery was recommended.

The assistance firm was informed that there was a four to six month waiting list for bypass surgery in Munich. Again, the assistance company investigated all available options. After the seventh day had passed and the employee could be transported by air ambulance back home, the assistance company took bids for the transport. The lowest bid received was for $73,451.

The employee's, company met with the assistance firm and decided to wait at least another seven days to see if the -- patient's condition improved. With close monitoring, it was determined that the employee could be transported after another 10 days of hospitalization on a commercial stretcher with a physician and nurse escort. The cost estimate supplied to the company was for $33,824, which covered commercial stretcher transport, hospitalization expenses and physician fees. By choosing this option, the assistance company was able to help the company select the best strategy and save the company over $50,000.

Assistance companies can also be of help in less serious cases. For example, if an employee who is overseas on a work assignment develops a minor yet incapacitating illness, the company can provide the employee with financial assistance, message forwarding, escort services for the employee's children or help in making new travel arrangements. Other services include providing pretrip information and recommendations to business travelers and helping an employee replace lost or stolen items.

Other Emergencies

Risk managers should be ready to assist traveling or expatriate employees in other types of emergencies as well. Examples of these situations include removing employees from nations where war breaks out, helping an employee who needs legal assistance in a foreign country, or arranging for the repatriation of a deceased employee's remains. Although many U.S. corporations provide crisis training for executives who travel or relocate overseas, this training is often insufficient in emergency situations. When an emergency strikes, the company has to spend many hours and much extra expense to handle the unprepared-for situation. And because this assistance is unplanned and therefore provided at a moment's notice, it will often not produce the desired results.

Therefore, unless an emergency system is already in place, it is often far more difficult for companies to provide effective assistance. And although teleconferencing and telefaxes have dramatically improved international communications, time differences between the United States and a foreign country often make it difficult for the home country to provide immediate assistance. For example, if an emergency occurs at a company branch in Paris at 9:00 a.m., it will be 3:00 a.m. at the company's home office in New York, and no one will be there to take the call.

However, assistance companies are available to service their clients during emergencies 24 hours a day, 365 days a year, providing a vital human link for traveling executives or expatriates. A good emergency assistance firm has the ability to respond quickly to the crisis, to assist the corporation in obtaining a quick assessment of the seriousness of the situation and to help make arrangements to deal with the problem.

An example of such a crisis situation involved a large U.S. defense contractor that had a number of employees working in Riyadh, Saudi Arabia, during the height of the Persian Gulf Crisis. Despite their connections with both the U.S. and Saudi governments, the firm was unsuccessful in securing a method to repatriate their employees. The firm then hired an assistance company, which contacted its local representative to see what could be done about the situation. Within 48 hours of notification, the assistance company had secured the equivalent of a DC-10 aircraft, received air clearance and organized ground transportation to evacuate the company's employees and their dependents to a safe location.

Help for Dependents

In many cases it is not only the employee that requires the assistance company's services, but also his or her dependents. When an executive is traveling abroad on company business, family members will also be able to access assistance services in the event of an emergency. In the case of expatriate employees, overseas assignments sometimes fail because the spouses do not receive the support they need. Giving the spouses access to a service provider with personnel who can speak their language and understand their needs offers them a valuable support system while living abroad.

Expertise and a strong international network are the backbone of a good assistance company. The firm must have the experience needed to provide valuable information to their clients so they can determine, for example, whether it is medically necessary or possible to transport a patient from one facility to another, what equipment will be needed to accomplish this and if medical personnel should accompany the patient. This expertise will also allow the assistance firm to calculate the costs of certain procedures, such as the case of the young woman with a broken back who was evacuated from South America to California. Finally, the assistance company must have a strong international network so it can provide assistance to its clients on a worldwide basis.
COPYRIGHT 1993 Risk Management Society Publishing, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

Article Details
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Author:Balbinot, Sergio
Publication:Risk Management
Date:Jun 1, 1993
Words:2030
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