IMTA's open letter to the industry to better measure quality in medical travel


One of the most quoted and oldest “outcomes” studies was conducted by Florence Nightingale in 1854.  When she arrived at the hospital in Scutari (in what is now Istanbul), Florence was shocked by the unsanitary conditions and the high mortality rates of the ill and wounded soldiers.  She and her team of nurses reversed the existing conditions by applying strict sanitary programmes across the hospital and keeping exact records of the mortality rates of the hospital patients.  

Following these changes, the mortality rates fell from 40 percent to two percent.  Her outcomes-based approach, with its emphasis on uniformity and comparability of the results, is recognised as one of the earliest examples of what is now called outcomes management.

Today, 154 years later, it appears that the tipping point for going from elective “medical tourism” to medically necessary “medical travel” may be dictated by a similar process.  Growth in medical travel is in the hands of large multinational third-party insurers.  These insurers, mainly from North America and Europe, are now looking at Asia, South America, and India as reasonable destinations for advanced medical care.  

One of the key issues for insurers, as well as government health service managers, is to avoid the mistakes which have led to spiraling costs in the United States.  Today’s buzz words in healthcare circles are “pay for performance” and “quality outcomes”. Despite the universal lack of agreement on what to measure, or how we rate performance or even define quality these ideas can, will, and must move forward in the global healthcare arena.

Although understanding of these concepts is still, for some, in its infancy, they are important carriers of the weight of proven measures.   For example, “pay for performance” is the concept where doctors are rewarded for meeting pre-established goals for delivery of healthcare services.  This model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting specific performance measures for quality and efficiency.  The high cost of Western style healthcare has pushed this idea to the top of healthcare debate and is even featured in US presidential elections.

Despite enthusiasm from administrators and purchasers of medical care, the field is young and has yet to show real-world savings.  Professional medical associations and many influential physicians have also voiced concern over the validity of simplistic quality indicators.

Processes such as these are going to become more prominent in the evaluation of medical travel and medical tourism.  And, of course, we should never forget that many individuals also travel at their own expense in order to receive what they consider to be appropriate treatment.  

The International Medical Travel Association is dedicated to improving healthcare for global patients and securing the medical infrastructure for doctors and hospitals.  Throughout this year, we will explore, debate, and define evolving medical and public health concepts as they relate to medical travel.  We plan on reviewing:

  •     Evidence-based practice
  •     Outcomes and effectiveness
  •     Effective healthcare
  •     Technology assessment
  •     Preventive services
  •     Clinical practice guidelines

Since you are reading this journal, you know that, along with all of us at the forefront of medical travel, medical travel will only get bigger as the world around us continues to get smaller – or, as some would say, “flatter”!


IMTA Column

Articles, 01 July, 2009

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