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Globalization and Medical Travel: Emerging Challenges of Quality and Safety

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

Maintaining high quality and safety for patients globally, beyond accreditation, requires identifying suitable measures of quality and safety for patients, and promulgating these measures across borders. This will help in identifying gaps in quality and assist health care organizations to "raise the bar." We know in the U.S. that there are more than 98,000 preventable deaths in hospitals due to medical errors; 50% of these errors are medication errors and most errors are unreported. We also know that infection rates in Massachusetts alone costs $473 million annually and that deaths in the U.S. are typically from infections related to surgical sites, central venous catheters, poor hand hygiene and ventilator associated pneumonias.

Raising the quality bar and closing the gaps globally requires efforts to achieve the following:

  • Sharing best practices across borders
  • Identifying and sharing common quality measures and outcomes
  • Collaborating in the development of evidence based metrics
  • Promoting international competition among healthcare organizations on quality and safety
  • Establishing guidelines for developing global centers of excellence in specialty care across borders.

There are hundreds of quality measures available, however—it remains challenging to select and agree on a universally-appropriate set that is meaningful to patients and will encourage organizations to identify these measures and compare data across hospitals and across international borders. Quality is neither a matter of opinion, nor is it the latest in fancy technology. Quality and safety are a property of systems and processes that are intentionally designed and measured. From the point of view of the delivery of care, I refer to the Institute of Medicine's framework: safe, timely, effective, patient centered, efficient, and equitable.

Quality and Safety: Looking Ahead
Medical travel (or ‘medical tourism’) is projected to be a $60 billion global business, with an estimated 750,000 Americans who have traveled outside the US for medical care in 2007. A 2008 Deloitte study projects the number of medical travel to increase to 6 million by 2010. More than 30 countries worldwide offer a range of medical services to medical travelers: executive check-ups, joint replacement surgery, cardiac surgery, spinal surgery, dentistry, and plastic surgery makeovers. Medical Travel remains an unregulated but attractive source of revenue for foreign hospitals, clinics and travel companies.

Competition for the medical traveler continues to focus on affordability; however. As this industry begins to sort itself out, there will emerge a select few that will become Centers of Excellence for specific types of care/procedures. These Centers of Excellence will provide transparency in the processes and outcomes of care that are measurable, reliable, and important to patients who choose to travel.


Sharon S. Kleefield, MA, PhD, is currently on the faculty of Harvard Medical School. She is developing International Health Care Education and Training programs with physicians at HMS and Harvard Medical Faculty Physicians at the Beth Israel Deaconess Medical Center. She may be reached at skleefield@hms.harvard.edu.
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