Jason Yap argues the industry needs to find commonly accepted standards

 

It’s a boom time in medical travel, so many people say around the world. Country after country, city after city announce national programmes and the estimated numbers of people travelling around the world for healthcare increase with every report. It is, however, still a very fragmented industry and the market is still evolving.

In the excitement of the heady first days of what seems to be a treasure trove for the proactive entrepreneur, it is easy to forget who is at the centre of the industry – the patient. Historically, healthcare seekers stayed mostly within their own cities and countries, but as international barriers are reduced, patients now have more options than ever before – hence, the exciting new industry we find ourselves in.

We have to remember that patients come first, and that our mission is to make appropriate and affordable healthcare available to people who otherwise cannot find the healthcare they need or want. Do we really understand what is happening around the world when the available information are from media reports which are based on other reports, often without references or based on bald guesstimates from vested interests? Many numbers are being bandied around and they are not all comparable with one another.

Confusion

There are so many ways of counting the volume of medical travellers. Some countries and healthcare providers count all patients with international passports, whether or not they are expatriates, transient workers or actual medical travellers. Some count visitors specifically or primarily for healthcare, while others count all international travellers consuming healthcare services even if they came primarily for other reasons like leisure or business.

Some count individual persons (irrespective of the number of visits to the country), some count visitors (hence double-counting patients who come on more than one occasion), some count visits to the facilities (which are actually healthcare episodes rather than patients), and some even count the number of individual service points within one facility. Not surprising then, when healthcare facilities and country announce their patient volumes, the numbers are usually correct but the units may be unclear.

When it comes to the revenue earned from medical travel, there is also confusion. Some report the total medical bills paid by the international patient (however that is defined, which of course varies), while others report the total earnings from the travelling patient. The spending of the travel companions may also be rightly considered a contribution to the medical travel industry and may be included. 

Clarity

Here are some definitions for the various measures awash in the industry. Frequently, the numbers seen are accurate, but the measures are fudged or simply unclear.

  • Patients are people. The numbers of patients reported should be the number of individual identities in the hospital registers, preferably avoiding double-counting of patients who go to more than one facility in the country. Time and again, what are presented as numbers of “patients” visiting a country or facility are actually one of the measures mentioned below.
  • Visitors are people crossing borders. Patients who visit a country more than once (in, say, a year) may be multiply counted. These numbers tend to be produced by national tourism organisations who obtain their data from disembarkation/embarkation cards. More often than not, these numbers cannot be related well to patient numbers or actual visits to facilities.
  • Facility episodes or encounters are inpatient, outpatient or day surgery visits to the healthcare facilities by the patients. Naturally, there may be more than one episode or encounter in the course of the patient’s visit to the country. Many countries seem to be reporting numbers of episodes of care collected from their various healthcare facilities and simply added together, irrespective of potential double-counting. The terms “episodes” and “encounters” are borrowed from the healthcare industry and perhaps not readily understood by the tourism industry. One wonders if part of the confusion arises because healthcare providers are providing healthcare statistics to tourism people.
  • Service points are locations within the healthcare facilities that sequentially look after the patient. An outpatient episode (or encounter) can consist of a consultation with the doctor, an X-ray and a visit to the pharmacy – three service points within one facility episode. Again, this could be the source of much misinterpretation if the data is interpreted as “We saw x patients”, when what the data really means is “We saw patient x times”.
  • Lastly, there should also be clarity on the kind of medical travellers they are, as they may be travelling primarily for healthcare or just seeing a medical spa while on a business trip. While these are all healthcare encounters, they are different in nature and have different implications for the medical travel industry. 

Transparency

In the interests of the patient, transparency and clarity are important. There are several reasons:

  • The first and foremost reason, of course, is simple business integrity. It may sound strange to have to actually say it out, but it is important to tell the truth and not deceive. Even telling absolutely true facts but allowing erroneous conclusions to be reached is not acceptable.
  • Secondly, patients choose their healthcare providers based on a whole range of clinical and other criteria, including volumes of patients seen. While it makes marketing sense to show as large numbers as possible, misrepresentation is not ethical.
  • Thirdly, it is simple good business sense. When patients discover that the marketing numbers do not stand up to scrutiny, they will doubt everything else as well, even the truth. It would be a sad day when patients choose not to go to good healthcare facilities with excellent services because the marketing spiel produced a negative halo effect. 

So what can we do to become more transparent?

  • Firstly, there must be the will to be transparent, a corporate resolution to provide good, clear information to our patients. Marketing is marketing, but ethics are ethics. We should have the good character, good grace and the good sense to tell the truth.
  • Secondly, speak clearly. When reporting numbers, make sure that the full truth is reported, including the units of measurement. When we are reporting numbers of “visitors to the country” or “episodes of care at the facility”, let’s not call them “patients” because they are not.
  • Thirdly, think of the message received – that is, what the recipient of the information hears and understands. It is not good to make totally factual statements if the less-informed patient understands something else by it, still less to deliberately present information in misleading ways.

The International Medical Travel Association supports truth in reporting and marketing and encourages its members and other medical travel players to be clear and transparent in information they release. Besides thinking of patients first, it is only good sense because, when patients find they cannot trust us to tell the truth about our patient volumes and revenues, they will not trust us for anything.

To join the IMTA, contact [email protected].

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