How can patients judge quality in medical tourism?

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

• Etc, etc.....

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.

Medical Tourism: Everybody's Guide to Affordable World-Class Medical Travel

Last year, more than 180,000 Americans packed their bags and headed overseas for nearly every imaginable type of medical treatment: tummy tucks in Brazil, heart valve replacements in Thailand, hip resurfacing surgeries in India, addiction recovery in Antigua, fertility diagnosis and treatments in South Africa, thalassotherapy in Hungary, or restorative dentistry in Mexico.

Currently, at least 28 countries on four continents cater to the international health traveler, with more than 2 million patients visiting hospitals and clinics each year in countries other than their own. The roster of treatments is as varied as the travelers. If the notion of complex medical procedures in far-flung lands seems intimidating to you, don't feel alone. That's why I wrote the book Patients Beyond Borders, drawing from the varied experiences of hundreds of patients who, for dozens of reasons, have beaten a well-worn path to successful treatments abroad.

It all started when my father, who was 72 at the time, announced he was heading off to Mexico for extensive dental work. I well remember my first reaction upon hearing his plans: a mixture of bewilderment and fear, then resignation, knowing that despite my protestations, he was going anyway. In spite of my concerns—some of them quite real—I'm pleased to report a happy ending. Dad and his wife, Alinda, selected a U.S.-trained dentist in Puerto Vallarta and spent around $11,000—which included two weeks noodling around the Pacific Coast. They returned tanned and smiling, Dad with new pearly whites and Alinda with an impromptu skin resurfacing. The same procedures would have cost them $24,000 in the United States.

After his treatment, when I told the story of my father's trip, most friends responded with the same shock and disbelief that I had felt initially. Then, when I explained the quality of care and the savings, more often than not, those same folks followed me out the door, asking for Dad's E-mail address. I even had an airport customs agent abandon his post and follow me to the boarding gate, seeking additional information for his son, who he had just learned required heart surgery.

Not long afterward, I developed an infected root canal and found myself following my father's example. My research led me abroad for extraction and implant work. While pleasantly surprised at the quality of care, the prices, and the all-around-good experience of the trip, I nonetheless made a number of mistakes and created unnecessary difficulties and discomforts for myself. Had I done some simple things differently, my trip would have been more successful and more economical.

In seeking additional data on medical travel, I found no reliable source of information. Everybody had something to sell or a political ax to grind. Books, magazine articles, and newspaper reports seemed more like tourists' brochures than health travel references. Thus the idea for Patients Beyond Borders was born: a well-researched guide, written in plain English, that would offer an impartial look at contemporary medical travel while helping prospective patients ask the right questions and make informed choices.

As we contemplate our options in an overpriced, overburdened U.S. healthcare environment, nearly all of us will eventually find ourselves seeking alternatives to costly treatments—either for ourselves or for our loved ones. Americans are in the midst of a global shift in healthcare service: In a few short years, big government investment, corporate partnerships, and increased media attention have spawned a new industry—medical tourism—bringing with it a host of encouraging new choices, ranging from dental care and cosmetic surgery to some of the more costly procedures, such as hip replacement and heart surgery. Those patients who take the time to become informed about our changing healthcare world will be pleasantly surprised by a smorgasbord of affordable, high-quality, American-accredited medical options abroad. Those who do not may find themselves grappling with an ungainly, prohibitively expensive healthcare system and a rising absence of choice.

There is no single type of health traveler. In researching and writing Patients Beyond Borders, I talked with wealthy women from Beverly Hills who, despite their affluence, prefer the quality of treatment and attention they receive in Brazil or South Africa to medical care California style. I met a hardworking couple from Wisconsin who, facing the prospect of refinancing their home for a $65,000 hip operation here in the United States, headed to India instead. I interviewed a Vietnam vet who wearied of long waits and red tape. He said "bon voyage" to this country's ever deteriorating healthcare system and headed overseas for treatment.

From these patients' experiences and many more like them, you'll learn when and how health travel abroad might meet your medical and financial needs. And you'll become a more informed healthcare consumer—both here and abroad.