Continuity of Care and the International Patient

Editor's Note: This is the third of three contributed features submitted by members of the International Medical Travel Association's Board of Directors. The IMTA is a not-for-profit global organization of stakeholders in the international medical travel industry.

The time has come for leadership in the medical travel industry to focus on one of the most important issues facing all stakeholders: continuity of care. It is a major concern, and rightfully so. Everyone wants to know how patients will access follow-up care after they have undergone a procedure, surgery or other treatment outside of the United States.

Today, there are some major challenges, primarily centered on a lack of communication between caregivers, liability concerns, and sharing patient records.

Some physicians may reluctantly provide follow-up care to their patients who decided to access high quality, low cost surgery in a foreign country. These physicians may find it challenging to communicate with doctors outside the country as easily as they would with a U.S. colleague, the result of language barriers and time zones differences.

If the patient is uninsured or does not have a U.S. physician, it may be necessary for this patient to pay for copies of their medical records in the foreign country—including x-ray films. They will also need to transport these records back home in order to provide them to a new U.S.-based physician that is handling follow-up care. This is recommended, particularly when foreign providers do not have electronic medical records or the digital capabilities to transmit written records. Conversely, when patients need to send their medical records to a foreign physician, there are HIPAA challenges that must be addressed by the U.S. physician.

Additionally, there may be malpractice risks for U.S. physicians, a factor that has generated considerable attention. However, there is limited available evidence of any prevalence of malpractice regarding follow-up care, and few studies have been conducted.

While these challenges may be of concern, they can and should be overcome. The opportunity is to take the long view approach and understand that the globalization of healthcare will ultimately lead to more choice and options.

Defining the problem
While government officials and voters debate the politics of the U.S. healthcare system or the injustice of one of the wealthiest nations on Earth having nearly fifty million of its people uninsured or underinsured, thought leaders in medical travel must address the reasons why U.S.-based physicians are reluctant to treat individuals returning to this country following medical care or treatment outside U.S. borders.

Today, many studies show a growing number of highly-complex procedures being performed abroad, including neurology, orthopedics, bariatrics, and cardiology. The list of diagnoses and procedures for which U.S. citizens go elsewhere for care is growing. According to a 2008 Deloitte Study, most are elective procedures that require follow-up care for a period of weeks and involve a surgical intervention. Common medical tourism procedures that consumers choose are dental, cosmetic, orthopedic, and cardiovascular.

Furthermore, last year the AMA published a set of guidelines for medical tourism and stated that "coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the US."

Strategic partnerships and alliances to ensure continuity of care
As the quality of care and improved patient safety level the playing field between the United States and international providers, and as the size of the medical travel market increases, there will undoubtedly be a number of progressive physicians, large insurance providers and other healthcare businesses leading the way. It's not difficult to imagine that by working in partnership with leading accredited foreign hospitals, these U.S. providers will be able to offer a complete uninterrupted continuum of care for a reasonable price.