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.

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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.

Why is Medical Tourism a Solution for the United States, Canada, and the United Kingdom?

At this moment the healthcare crisis in the U.S can be likened to a pressure cooker that is about to blow its top. The number of uninsured or underinsured Americans is close to Fifty million, and shows little sign of diminishing. According to the U.S. Census Bureau, the elderly make up twenty-three percent of the major costs of U.S healthcare spending and each year more people are entering these age brackets as the baby boomers mature and get older.It is projected that:
The number of Americans aged 65 or over will double by 2050
The number of people age 85 or over will quadruple by 2050
By 2030 over half of U.S. adults will be over age 50
The over 65 population will nearly triple as a result of the aging Boomers.
More than six of every 10 Boomers will be managing more than one chronic condition.
Although Canada has an admirable healthcare system in many respects, many residents admit that there is a serious crisis brewing. Poor government funding has led to a notable lack of physicians, nurses, and state-of-the-art medical equipment. This, in addition to the long waiting times for many surgical procedures, has created unrest and an urgent call for healthcare reform. According to a 2007 article in the Christian Science Monitor, Britain's Department of Health reported that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.In each of these cases the government has failed to adequately meet the basic healthcare needs of many of its citizens. As baby boomers age and the current healthcare system is stretched to the breaking point, expect individuals and businesses to look at new ways of regaining control of their healthcare. The medical tourism phenomenon is a natural outgrowth of these conditions – an outlet if you will, for people trapped by an unwieldy system that offers little hope for a better tomorrow. Long wait times for certain procedures is also a big factor for residents of Canada and other countries with socialized medicine, and is effectively forcing people to look for other options, including medical tourism. Wait times of a year or more are quite common in Canada and England. Contrast this with “wait times” of weeks or even days at many medical tourism destinations.

Twelve Natural Health Tips for Smart Travel

(NaturalNews) Traveling can be hard on your health. Increased stress, changing time zones and difficulty finding healthy food can all negatively impact your health. And if you travel by air, you have the added problems of exposure to airborne pathogens, fragrance chemicals, and other pollutants brought into your air space by unhealthy people. On top of that, there's the additional difficulty of bringing all your health supplements, superfoods and appliances with you (a Vita-Mix is heavy!).So how can you protect yourself from sickness and environmental stress when traveling while still providing yourself with your most important health supplements and superfoods? Being an experienced traveler myself, I'll share with you my best tips for maximizing your health when traveling on planes, trains or automobiles.
Tip #1: Boost your immune system before you goDon't dare walk into an airport, train station or other public place without protecting your immune system first. How do you accomplish that? It's simple: For at least three days before your trip, start drinking lots of vegetable juice and taking immune-boosting herbal supplements. It's even better if you're drinking fresh juices every day as a regular habit, but if you're not, at least kick in the healthful juices before you travel.On the supplements side, I like to take Kyolic garlic supplements (www.Kyolic.com), medicinal mushrooms (www.MushroomScience.com), Echinacea, goldenseal, ginger and other similar immune herbs (www.BaselineNutritionals.com). It's also important to get plenty of zinc in your diet by eating pumpkin seeds or taking high-quality zinc supplements. Taking lots of vitamin C and vitamin D3 is also helpful, but be sure to get them from high-quality supplements (I don't recommend cheap multivitamins like the Centrum brand). The best sources for high-end individual supplements are www.WellnessResources.com and www.LivingFuel.com (check out their Super Essentials fish oils with astaxanthin.
Tip #2: Bring superfood powders for instant mealsHaving superfood powders with you at all times is a great travel strategy, even if you're just traveling to a relative's house for a few days (your relatives probably aren't as health conscious as you are, right?). Don't clobber your immune system by eating the junk in their refrigerator; bring your own superfoods and amaze (or annoy) your friends and relatives with your own astonishing commitment to a truly healthful diet!Which superfood products should you bring? There are a lot of them I recommend, including Living Fuel (www.LivingFuel.com), Boku Superfood (www.BokuSuperfood.com), Healthforce Nutritionals (www.HealthForce.com), HempShake (www.Nutiva.com), Emerald Balance (www.SGNnutrition.com) and Delicious Greens (www.Greens8000.com). There's even a new product I just saw at Whole Foods called Amazing Meal (www.AmazingGrass.com). I haven't tried it yet, but I know their Amazing Grass product is high quality, and I intend on reviewing their Amazing Meal product soon.

How safe is surgery abroad?

About 100,000 Brits paid for private dental and medical work abroad last year. But how big are the risks? Your Life investigates..
A growing number of Britons are flying overseas looking for cheaper, and often faster, medical treatment. And they are not just after breast implants and tummy tucks...
The latest trend is for dental work. This is not surprising as, according to the Citizens' Advice Bureau, seven million British adults don't have access to a dentist.
The problem became worse in 2006 when new dental contracts were introduced and 1,000 dentists left the NHS.
"With high treatment costs and a shortage of NHS dentists, it's no wonder people are going abroad," says Keith Pollard, managing director of Treatment Abroad, a medical tourism information provider.
"In Hungary - the top spot for dental tourism - a root canal costs £104 compared to the average UK price of £220." According to Treatment Abroad, last year 43 per cent of medical tourists from the UK had dental treatment, 29 per cent cosmetic surgery, 18 per cent for other operations such as hip replacements, and 10 per cent for fertility treatment.
Why do it?
"People are going private because of the problems around affordable dental treatment, NHS waiting times," says Mr Pollard.
"Treatment is also cheaper abroad - even including travel and accommodation costs."
Research carried out by the official International Passenger Survey, which questions UK citizens leaving all airports and ports, shows that in 2004, 25,000 Brits travelled abroad for private health care.
In 2007, this figure had jumped to 100,000.
How risky is it?
"Of 650 people who took part in our Medical Tourist Survey 2007, 97 per cent said they would pay for surgery abroad again and 20 per cent believed they'd saved around £10,000," says Keith.
But what about the rest? "There are no statistics for the numbers of operations that go wrong," says Dr Anthony Halperin, chairman of the national charity The Patients' Association.
"As a dentist, I've done repair work on people who've had botched treatment abroad and it's not uncommon. I've also heard of people who have had other surgery, which has gone horribly wrong."
Dr Lorraine Ishak, clinical director of a leading UK cosmetic surgery group, adds: "We're increasingly seeing more patients who've had a bad experience abroad. Across the industry, 33 per cent of surgeons have seen 'much more' repair work over the past five years, due to cosmetic surgery abroad.
A total of 92 per cent of surgeons surveyed by the British Association Of Aesthetic Plastic Surgeons (BAAPS) said they're most concerned with the lack of aftercare provided."
Dr Halperin adds: "This lack of aftercare is one of the many reasons why the Patients' Association advises people to think carefully before booking treatment abroad.
You need to consider that often the first time you meet your surgeon is the day of your treatment. There may be a language barrier and minimal access in the event of an emergency.
"The British Medical Association has also highlighted the dangers of flying too soon after major surgery."
Dr Ishak, of Transform Cosmetic Surgery, adds: "We offer a 24-hour telephone support line, as well as a doctor and surgeon on call at all times. Overseas providers aren't able to offer patients this level of care. Standards are often less stringent abroad than in the UK. You need to be able to trust the facilities and your surgeon's skill and qualifications."
What if it goes wrong?
"You have no rights, only the right to legal redress - which means you would have to sue the foreign surgeon or clinic. This is complicated in the UK, let alone abroad," explains Dr Halperin.
"Guarantees often aren't worth the paper they're written on. Usually the small print states that it's void unless you have regular check-ups afterwards.
Most people don't fly back for these routine appointments. Also, no firm will insure you against something going wrong due to the high risks involved."
A spokesperson from the Department of Health adds: "We strongly advise people having surgery abroad to do their research and make sure they're clear about prices, procedures, recovery times and aftercare."
Before you pay up..
If you do want to go abroad, Dr Halperin says...
Check the clinic has a phone number and address, not just a website . Organisations should make it easy for you to contact them.
Check that the surgeon speaks good English.
Ask about recovery times and what happens if there are complications either straight after surgery or after you return to the UK.
Ask for a copy of the surgeon's and the clinic's insurance certificates in English.
Check the clinic is registered with the medical statutory body of that country. For instance, in the UK it's the General Medical Council.

SOUTH KOREA: JCI and Korean Hospital Association work together

Joint Commission International (JCI) and the Korean Hospital Association (KHA) have agreed to establish programmes focused on improving the quality and safety of health care services in South Korea.

JCI has worked with health care organizations, ministries of health, and global organizations in more than 80 countries. It focuses on improving the safety of patient care through the provision of accreditation and certification services as well as through advisory and educational services aimed at helping organizations implement practical and sustainable solutions. JCI is accredited by the International Society for Quality in Health Care (ISQua).

KHA and JCI will assist hospitals in Korea as they strive to achieve a level of quality recognized worldwide. Together JCI and the KHA will:

* Establish an ongoing series of educational programs for KHA member hospitals.
* Translate and publish the Joint Commission International Accreditation Standards for Hospitals, Third Edition, into Korean.
* Establish a help desk for KHA members to answer their questions about JCI standards, accreditation and service.
* Distribute information on JCI standards for all accreditation programs via the KHA information network.
* Develop and promote the use of patient safety solutions for the benefit of South Korean patients and health professionals.

"Working with JCI will help the Korean Hospital Association raise the profile of health care in South Korea, and bring international recognition to the quality of care in South Korean hospitals. Improving the quality of health care and patient safety in South Korea is a strategic initiative of the KHA."
says Hoon Sang Chi of the Korean Hospital Association.

More than 246 public and private health care organizations in 36 countries have been accredited by JCI. Only one hospital in South Korea has achieved JCI accreditation-Severance Hospital, Yonsei University College of Medicine, Seoul. Others are working towards JCI accreditation.

With strong government support, South Korea is on the way to become a leading medical tourism destination in Asia. The South Korean government has introduced a new category of visa for tourists who visit the country for medical reasons. The foreign medical tourist visa, M, is adopted in a bid to boost the nation's medical tourism industry as local hospitals and medical institutes asked the government to simplify the visa issuance process. The new visa is issued in two forms, C3 (M), a 90-day visa for those with short-term treatment purposes, and G1 (M), a one-year visa for those who need long-term care.

A law change allowing Korean hospitals to market services to foreigners and team up with travel agents has major Seoul medical institutions offering packages to two million gyopo, ethnic Koreans living overseas, promising them faster and more affordable service

According to a new RNCOS research report, “Emerging Medical Tourism in South Korea”, government initiatives to promote the country as a medical tourism hub will fuel the growth in the South Korean medical tourism industry. Despite the gloomy outlook for the world economy, medical tourism industry in South Korea has witnessed an impressive growth of more than 55% in 2008 over the same period last year. Due to the global recession, South Korea is now 30% cheaper to visit than it was last year.

USA: US Surgeons association offers advice on medical tourism

The number of patients seeking medical and surgical care overseas has grown in recent years, prompting the American College of Surgeons (ACS) to study the issue and to develop an official “Statement on Medical and Surgical Tourism.” The ACS statement was developed with the patient’s interests in mind, and also offers guidelines for employers, agencies and insurers.

Doctor James Unti of the ACS Nora Institute for Surgical Patient Safety says, “It is important that individuals considering health care services outside the US become informed of the potential risks and complications as well as the medical, social, cultural, and legal implications of receiving such care.”

For those who chose to seek surgical care abroad, the ACS encourages patients to:

* Seek care of the highest quality.
* Select health care institutions that have met accreditation standards established by Joint Commission International, Trent International Accreditation Scheme, or a similar internationally recognized accrediting body. They should be aware that accreditation standards are not uniform and that standards set locally can vary from place to place around the world.
* Seek care from surgeons and anaesthesiologists certified in their respective specialties through a process equivalent to that recognized by the American Board of Medical Specialities in the United States.
* Prior to travel, make specific arrangements for continuity of care and follow-up care at home.
* Obtain a complete set of medical records prior to returning home so that the details of their care are immediately available to their physicians and surgeons in the U.S.
* Understand the special risks of combining long international flights and certain vacation activities with anaesthesia and surgical procedures.
* Consider the medical, social, cultural, and legal implications of seeking medical treatment abroad prior to deciding on a venue of care.

The ACS also
* Supports their rights to select their surgeons and health care institutions without restriction.
* Encourages its Fellows to assist all patients in reaching informed decisions concerning medical care, whether at home or abroad.
* In the event of proven medical liability for injury, viable means for the recovery of damages should be in place.
* Patients should be aware that many of the means for legal recourse available to citizens in the US are not universally accessible in other countries.
* Opposes the imposition of provisions for mandatory referral of patients by insurers to health care institutions outside the US
, unless such provisions are clearly and explicitly stated in the insurance contract and accepted by the subscriber.
* Opposes the addition of provisions for mandatory referral abroad for patients with insurance contracts already in force, unless there is a fully informed consent from the patient.
* Supports the view that employers or insurers referring patients for mandatory treatment abroad should be responsible for the coordination and reimbursement of follow-up care in the US, including the management of postoperative complications, readmissions, rehabilitation, and long-term care.

The American College of Surgeons is a scientific and educational organization of surgeons with more than 74,000 members and is the largest organization of surgeons in the world.