Christopher Jones and Louis Keith speak on the biggest challenges facing medical tourism

 

IMTJ asked Dr Jones and Dr Keith for their opinions on a number of important issues facing the medical travel industry.

What is the biggest challenge facing the medical travel industry in 2007-08?
There is no simple answer to this question because the challenges are multiple rather than singular. Speaking from the perspective of the American health traveller, at least five issues of concern come to mind. Obviously, the order of the issues differs depending on the patient, the condition to be treated, and whether the travel is for elective or obligatory treatment. First, safety is always a major issue. Unfortunately, the word safety is used differently by different individuals. For one traveller, it is the safety of the procedures and cleanliness in the medical facility or hospital. For another, it is the safety of the water used to prepare the food served to the patients and his or her family. Regardless, safety like beauty, is defined by the patient who wants a level of comfort to be available upon arrival and to be discernable during the process of choosing a medical facility or destination.

A second concern relates to quality control. Here also this can mean quality control of the sterilization processes during an operation or quality control of the credentials of the physicians and ancillary staff. Depending on the sophistication of the patient, expectations for quality control may vary greatly and this variance may embrace both internal and external methods of quality assurance.

Third is accreditation. Here the expectation is that an external body will have inspected the physical facility and the processes used within the facility to ensure that safety is always a foremost consideration. In the United States, accreditation is usually provided by the Joint Commission International (JCI). It is of interest and a sign of the growing importance of accreditation on an international basis that some destination hospitals advertise that they have been accredited by JCI as a means of attracting patients and ensuring their maintenance of high standards.

A fourth consideration is the provision for follow-up care. Obviously, this will vary greatly with the treatment given and can be expected to be more efficient if the patient’s referring physician is brought back into the loop, full and complete records are provided and detailed post-care instructions are sent. Failing this, the least that can be expected is that the destination health care facility will assist the patient in finding a home medical care facility to follow-up all aspects of treatment.

The final concern relates to the resolution of complications. This is necessary because the success of medical therapy cannot be guaranteed regardless of where it is obtained. Nor can practitioners ensure that the treatments and procedures used will be completely devoid of risks. A good destination facility will have thought this issue through completely and provided the patients with printed copies of their policies and procedures should this eventuality come to pass.

Should countries focus on their own populations rather than seeking to attract paying clientele from overseas destinations?
The obvious answer to this question is, quite simply, yes, but this is far too simplistic an answer and probably represents a Western medicine bias. What do we mean by this? If the respondent to the question lives or has trained in a Western or so-called developed country, it would be hard to answer anything but ‘yes’ because that question is a matter of the public consciousness. Further, these Western or developed countries, have a much better physician distribution than many of the destination countries. This means that the likelihood of the poor being totally disenfranchised is far less than might be the case in a destination country, especially where the poor live in isolated areas with little or no connecting transportation to places where medical care can be obtained.

If one were to answer the same question, having been trained as a physician or having lived in an urban area in a medical travel destination country, the response might be totally different and go something like this: “The poor have always had to fend for themselves in the country and have never had good access to the cities with medical care. Why should those who live in the cities and have developed good destination medical centers which are attractive to foreigners, halt our efforts because of the existence of the poor in the country, since we are not responsible for their being poor or living in the country.”

The middle ground here, working with rather than against existing price differentials, is a business model to provide safe voluntary opportunities for medical tourists who may wish to give back to the country in which they are being treated. To us, this appears to be a rather good way of benefiting both parties. For example, a married American father of three may elect to have his heart valve repaired in India. If integrated measures are in place, those family members who choose to accompany him on the medical trip might find the opportunity to provide some social or community intervention, to express thanks at being able to take advantage of the price differentials.

You see, the whole world is going ‘green’ but flexi-fuel cars were not initially invented to save the planet. They were invented quite simply to satisfy a growing demand for cars, particularly in India and China. Regardless of the original intentions, marketing these cars to families mindful of their carbon-footprint has been hugely successful.

By the same token, we cannot expect hospitals in foreign destinations to offer voluntary services as an act of contrition, even though many medical tourists are socially minded and middle-aged with families or friends accompanying them. The same people who request donations to charity rather than tangible wedding gifts would sooner choose a clinic that promotes the local economy than a clinic that feigns to be an oasis in locations well known to have poverty and health disparities.

Presumably, an arrangement would be made between the private hospital and local charities. There may even be special government or tax incentives for such an initiative. Ideally, the medical travel hospital would participate in these voluntary opportunities to pull-up the livelihoods of the wider population. This opportunity may be totally unique and in all likelihood would never be available in countries such as the United States.

If a portion of the cost of treatment went as a donation to the local project, a positive externality could result in a wider recognition of the problems, as well as wider recognition of the programs to deal with the problems. In our experience, patients want transparency and such a program would greatly enhance a receiving hospital’s transparency in the eyes of patients seeking its services from far away.

You started a new company - Patients Without Borders LLC - which has an Investigative Health Division. What do you do and how is this company different to other medical tourism firms?
Firstly, we do not connect patients directly with providers so that is how we are different from medical tourism firms, or so-called ‘medical middlemen’. Patients Without Borders LLC was established as a full service consultancy to provide objective and often academic policy insights into the $60 billion medical tourism and clinical outsourcing marketplace. That estimate is widely quoted by most medical travel experts and we came up with it in 2006.

We have a special division called Investigative Health because in many instances we are called in at the last minute to investigate the value (for example, cost-effectiveness) of a product, hospital or entire marketplace. Here we can send a team of specialists to liaise with local health ministries to ensure that ethical, legal and policy protocols are met. Whereas other vendors may not wish to work in foreign or remote settings, members of our team are not shy of travel. Our specialists have experience working in a hospital setting as top-100 doctors, in the laboratory as pharmaceutical leaders and on the ground as academics in leading institutions.

Here is a recent example of the types of services we provide. A Middle Eastern Health Ministry contacted us to provide a feasibility analysis of the outsourcing marketplace for clinical trials in their country. Not only did we determine that capturing the ability to manage outsourced clinical trials would bring in an estimated $50 million in additional revenue the first year, we showed that carefully guiding this market with trained project managers would ensure safety and ethical provision of care which would benefit the trial participants – the patients themselves. The hospital, owned by the government, was concerned about legal recourse and a lack of cultural sensitivity for trials conducted in their country. We recommended a strategy of hiring and training local project managers that worked within the cultural context. The client was sufficiently pleased that they decided to retain us for a longer term project, ahead of other vendors. Our reasonable prices were one thing, but they were confident in our transparency and respect for local ethics.  In this case we relied on our exceptional cast of knowledge leaders who advised on a sensitive situation before it became a problem.

Our motto is quite simply “our center is not our perimeter”. We are based in the USA but can have a team of experts on the ground in another country the next day if they require high-end policy analysis. And we leave no stone unturned. Where possible, we liaise with local thought leaders so that we do not miss anything important. The larger consulting firms are often unable to be this thorough because they run a volume business. Our business is building long-term relationships with the primary goal of safety, and secondary goal of profitability. We protect the client from going down the wrong path and leverage their core competencies so they can participate in the medical travel and outsourcing industries as leaders. Further information on our firm can be found at www.investigativehealth.com.

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