There's much discussion and hype around the medical tourism world about “quality”. Every hospital, clinic, healthcare destination and medical tourism web site claims to offer the “highest quality healthcare”, often matched with a claim of low cost treatment. Some healthcare providers invest vast sums of money in accreditation programs such as JCI in the hope that this “guarantees” quality to the patient and will assist in their marketing efforts. This is the first of three articles on quality in medical tourism written by Keith Pollard, Managing Director of Intuition Communication, the publishers of IMTJ and Treatment Abroad.
How can a patient make an informed decision about their choice of overseas healthcare provider based on quality? (In a later article, we’ll look at what quality in medical tourism actually means).
The role of medical tourism facilitators
One option for the patient is to use the services of a medical tourism facilitator. Many patients select a healthcare provider based on the recommendation of one of the growing band of “medical tourism facilitators”. But should they trust the judgement of a facilitator or third party agency? It raises some questions:
How many facilitation agencies have medically qualified staff who can carry out a proper assessment of the quality of care and clinical standards within a healthcare facility?
How does the facilitation agency compare the quality of healthcare providers in different countries or even in the same country?
Is their recommendation based on a “familiarisation visit” which essentially consists of a hospital tour and no assessment of clinical quality or facilities?
Is their recommendation based on the nature of the financial arrangement between the facilitator and the healthcare provider?
To demonstrate the problem, let's take a typical medical tourism facilitation company as an example. It doesn’t really matter who they are, and I’m not saying whether they are good or bad at what they do. In fact, this company is probably one of the better and more respected facilitators. But it serves as an example and demonstrates the problem faced by the patient, the facilitator and by the industry.
Here are some of the words used by the company to market their services to patients:
“Access to high quality medical care at world-class hospitals......... treatment from qualified, proven physicians.....Providers to whom we refer have a history of delivering quality service in a risk managed environment...... (we) personally visit our affiliated providers on a regular basis to further ensure high quality standards”
But the difficulty for this medical tourism agency is the same as for the patient. How do they define high quality and world class? How do they measure quality service? How do they ensure quality standards? And how do they compare the quality of different healthcare providers?
The facilitation company has no medical director and no medically qualified staff. The background of their staff is typical of many facilitators; their experience is in areas such as travel, marketing, business development and sales. So how do they assess clinical standards and quality in a healthcare environment? The simple answer is that they can’t. It’s a problem faced by all facilitators. All facilitators provide cost comparisons between destinations and healthcare providers, but you’ll struggle to find one that provides comparisons on criteria such as:
The number of operations undertaken of a specific type (on the basis that practice makes perfect... and if you need a hip replacement, you’re probably running a lower risk if you somewhere that does hundreds of these).
Clinical outcomes for specific operations.
Post operative complication rates
Post operative infection rates.
Incidence of MRSA and clostridium difficile
Pressure ulcer incidence
Can patients make an informed choice?
A second option for the patient is to research the options him/herself and to select the provider on the information that he/she can locate, usually on the web.
Some may select a healthcare provider because it is “JCI accredited” or has some other form of accreditation. But for many patients, JCI accredited may mean little. Knowledge of accreditation systems amongst patients varies widely. Mamy patients have no idea what JCI accredited means, and may have never heard of JCI.
So, what does JCI accredited actually mean to a patient? JCI accreditation is not a guarantee of quality; it tells a patient little about the real quality of healthcare that they may receive or the quality of treatment outcome that they may expect. The JCI program helps hospitals to implement processes that will improve the quality of care they deliver to patients which is a good thing. but some hospitals invest in JCI accreditation as a marketing ploy (albeit expensive) to ensure that payors such as insurance companies and assistance programs will provide patients
The other problem is that there's no guarantee for patient or facilitatator that quality standards are maintained between one JCI inspection and the next.
What's the answer?
There isn't one! Patients and facilitators are having to make uninformed choices But it would be a move in the right direction if we could encourage providers of services to international patients to publish clinical and quality data. It may not be comparable, it may raise questions about validity of data but it would be a step in the right direction. Let's here less about "we've got the highest quality facilities" and see some evidence from those providing services in the medical tourism business.