Globalization and Medical Travel: Emerging Challenges of Quality and Safety

Sharon S. Kleefield, for HealthLeaders Media, June 16, 2009

Editor's Note: This is the second 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.

Tracking medical travel since 2006, there has been a rapid growth and change from dental and cosmetic services to more advanced surgeries. Price sensitivity is one reason, as there are nearly 50 million uninsured patients in the United States. Furthermore, employers cannot afford the rising costs of healthcare for their employees. Finally, self-insured firms are offering voluntary medical travel options for employees. The epidemiology of U.S. patients is changing, as baby boomers are aging and requiring "parts replacements" such as knee and hip replacements. Many patients simply cannot afford healthcare in the U.S.

Finding "parts replacements" outside of the U.S. has become necessary for many American patients, especially those who are unable to work and are disabled from continuous pain and lack of mobility from orthopedic problems. Data on costs for procedures outside the U.S. are readily available, including complete travel packages for the medical traveler.

However, while price and affordability for patients is a primary issue for medical travel, few would support the growth of medical travel if the cost savings came at the expense of quality and patient safety. Adapting the more traditional and evidence based measures of quality to a newly global practice environment has become an emerging challenge for providers and patients. While the healthcare system in the U.S. is heavily regulated by several sets of quality and safety measures, the global environment presents local/cultural differences that may be unfamiliar, unmeasured, and most certainly unregulated.

Assessing Quality
Assessing healthcare quality can include:

  • The credentials and performance of healthcare providers
  • The performance of hospitals
  • Care provided to particular groups of patients
  • Care received by caseloads of patients stratified by procedure or diagnosis.

To provide an assessment from a more global perspective, quality can be measured internally by a hospital, or externally by an accrediting agency. For example, a hospital that is focused on maintaining and improving quality and safety will have systems and measures (or metrics) in place to support peer review, credentialing, complications from procedures and treatments, nosocomial infection rates, and patient feedback on their experience by a healthcare team, to name a few.

From an external view, accreditation and certification from a truly international organization appraises and rates a healthcare organization against a set of vetted international standards that are healthcare specific, patient focused, and reflective of an organization’s focus on continuous improvement towards the best possible outcomes.

For example, accreditation by the Joint Commission International (JCI) has provided this external validation/accreditation for more than 200 hospitals worldwide. Specific Patient Safety Goals are required as part of a JCI review: proper patient identification throughout the treatment process; surgical ‘time outs’ by the Operating Room team before starting surgery for a patient to ensure the correct patient, for the correct procedure on the correct body part; specific communication requirements for treatment orders; specific "high alert" medications removed from patient care units; appropriate hand hygiene to prevent infections; and effective strategies to reduce patient falls. These JCI goals are based upon evidence from both U.S. and international hospitals and are minimum goals for maintaining acceptable quality and safety for patients and staff.

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