Lessons from the front line

 

I am fascinated by the idea of a patient packing a suitcase and travelling to another country to perform a medical procedure that is not available, not accessible, or too expensive in his or her own country. 

Although ‘medical tourism’ seems to be the most common terminology to describe this practice, I think that it misrepresents the industry. I tend to use ‘medical travel’ instead, mainly because the value of medical travel goes beyond cosmetic and aesthetic interventions, the type of treatments implied by the term medical tourism. 

My interest in medical travel started when I was a medical student in Syria, a country that used to be a major destination for dental and cosmetic treatments. Later, studying International Health in the UK, I explored the idea of medical tourism in the Rhodes Incubator and was supported by the Entrepreneur First (EF) Business Incubator to develop a healthcare delivery business model in the UK, in which we integrated medical travel within the process of care.

My business startup focused on medical travel from countries like the UK and Europe to countries like India, Thailand, Turkey, and others. This direction of medical travel is exciting and is based on providing access to affordable and quality healthcare services (although I also think the opposite direction of medical travel to the UK is also very lucrative).

Our business model aimed to make the local physicians a part of the medical travel process, to improve the quality and continuity of care. I spoke extensively to patients, medical providers, and experts in the UK healthcare industry about the medical travel market.  We got to the point where we had over 40 ‘early adopter’ physicians in the UK to recommend our platform to their patients, and we had one procedure booked.

We did not proceed with the business as we did not receive investment. However, the experience has led me to reflect on the challenges of setting up a medical travel business in the UK, namely:

  • Medical travel patients are not financially or medically protected against malpractice and medical errors. 

     There is no comprehensive insurance protection for medical travelers. Patients are usually not reimbursed against any complications of treatment or medical errors that arise after they return to their home country. One insurance product that aims to fill this gap is Medical Travel Shield®. However, their insurance benefits are small (they provide only £2,000 coverage for complications of treatment abroad and they do not reimburse for any medical errors or malpractice).

  • Medical travel lacks a holistic approach to patient care.

    Medical travel is not integrated within the local UK healthcare services. Patients usually decide to travel for care individually without the involvement of their local physicians or GPs, who usually do not have oversight over the patient’s treatment. Additionally, patients are not being screened for fitness to travel before traveling for care and are not being followed up by a local physician after returning from travel. Moreover, detailed records of the interventions and treatments that the patients undergo abroad are generally not available, are sometimes of poor quality, or are in a foreign language. In that sense, continuity of care is absent, and medical travel is ‘siloed’ from the official care pathway. 

  • Medical services are targeted directly to patients in a highly commercialised way.

    For example, advertisers market packages of weight loss surgery to the patients through Google ads, social media ads, and social media marketing groups. This issue raises ethical challenges as patients are not usually medically qualified to make the such critical decisions about their healthcare. 

  • There is a lack of trust in the medical travel industry – but is this overrated?

    Medical providers usually lack trust in the medical travel industry and the medical providers and systems of other countries, especially the less-developed ones. Moreover, they are usually not familiar with the clinical care standards and education systems of foreign countries. The fact that international providers are considered competitors to the local providers in a business sense makes it complicated. Therefore, the local providers do not have the trust or the financial incentive to encourage medical travel. 

    On the other hand, patients themselves lack trust in the medical travel because medical travel frequently entails travelling to a foreign country to undergo a procedure at a facility by a medical provider that they meet for the first time. This idea can be scary for many. The fact that there are individual cases in which treatment abroad resulted in complications adds to this trust barrier. However, these complications are not medical travel specific. Any medical treatment may result in complications, which can happen even in the best healthcare facility with the highest quality standards. In my opinion, these individual cases do not discount medical travel as a treatment option, but highlight the need for more quality assurance and better continuity of care in the medical travel industry. 

    Overall, I believe that the trust barrier and the lack of trust are overrated. One group of patients that demonstrates this is the diaspora. The diaspora patients in the UK and US frequently travel back to their home countries for care. In fact, diaspora patients constitute a significant proportion of medical travel volume globally. This may be explained by the fact that they are familiar with the care standards and healthcare services in their own countries and that in many cases they prefer using these services over the healthcare services in the countries where they live. 

  • Regulatory barriers challenge this industry.

    There are regulatory challenges in the medical travel industry. Different countries have different accreditation schemes around the world. Most of these accreditation schemes are country-specific, and not known by other providers in other countries. These accreditation schemes work on a local scale but are of minimal effect on an international scale because providers across countries are not aware of the local standards of accreditation. There are international accreditation schemes like the JCI, Trent, Accreditation Canada, that are addressing this problem by accrediting facilities to the same standards across different countries. However, in my experience, most medical providers in the UK do not know about these accreditation schemes. 

    The training process for medical students and the training process for doctors is very different between countries. Similarly, standards of care are different among countries. In some countries, formal standards of care are underdeveloped, and it remains up to the individual health centres and providers to keep high standards of care. Other countries like the UK have highly developed formal standards of care that help to maintain quality across providers and centres. That providers from one country do not necessarily know the standards of care in another also challenges the development of medical travel. 

  • There is a lack of transparency in the medical travel industry.

    Many healthcare facilities do not share or publish statistics about their performance, quality, and rate of complications for variety of reasons. This makes it hard to assure quality and standards. 

    An interesting example of a hospital group that does, is Apollo Hospitals in India. This group has been measuring and benchmarking their quality indicators and sharing them with the public. Sharing audited and accurate quality-metrics enables patients to have evidence-based quality indicators from the destination they want to go to. Moreover, it enables insurers to get into the business of medical tourism with more certainty because they would know the outcomes and the complication rates. I believe that this should be the direction of the future. 

About the Author

Alex Youssef is a global citizen, a doctor, and the first Syrian Rhodes Scholar. He is an Oxford-trained international health specialist pursuing an Engineering D.Phil. (Oxon) in Artificial Intelligence in Oxford. A healthcare entrepreneur, he has co-founded a hearing aids import and distribution business in Ukraine, recently completed an Entrepreneur First business incubator in London and been awarded an Exceptional Talent entrepreneurship UK visa. Alex writes about healthcare and entrepreneurship, and is looking to build a new health-focused venture.

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