When most people think of “medical tourism”, they think of U.S. or European patients seeking health care services in Asia or Latin America where these services are often dramatically less expensive. According to Deloitte LLP, approximately 750,000 Americans traveled abroad in 2007 for medical care. It is estimated this number will grow to six million by 2010.
The high cost of U.S. medical care and the low rate of insurance coverage are driving many Americans to look abroad for treatment. Despite the current debate over health care reform in Congress, many are skeptical that health care costs will come down in the near future.
As a result, the demand for overseas medical care is expected to remain strong. In fact, the American Medical Association (AMA) issued guidelines in June 2009 to help employers, insurance companies and other entities that facilitate medical care outside the United States mitigate risk to patients.
Medical Tourism to the US ~ Not About the Cost
But while many Americans are choosing to leave the United States to receive less expensive medical care, more than 400,000 non-U.S. residents came to America seeking high quality care last year. Nearly $5 billion was spent by non-residents on U.S. health care services in 2008, according to a report from the Deloitte Center for Health Solutions entitled “Medical Tourism: Consumers in Search of Value.” These figures represent approximately two percent of the users of U.S. hospital services annually. Deloitte says that medical tourists to the U.S. do not seek U.S. medical care as a less expensive option. Instead, they are willing to pay higher costs because they believe U.S.-based medical care offers higher quality and shorter waiting times for key procedures.
Nine leading U.S. medical centers are the major providers of services to inbound medical tourists in the United States: Johns Hopkins Hospital, Cleveland Clinic, Mayo Clinic, Duke University School of Medicine and Memorial Sloan-Kettering Cancer Center. Many of these facilities have members and partners overseas, which aids in attracting international patients. For example, Johns Hopkins has ties with institutes in Japan, Singapore, India, United Arab Emirates and seven other countries.
What to Look For ~ Accreditation
As the number of medical tourists entering the United States continues to increase, there are several factors that foreign patients should evaluate when selecting a U.S. medical care provider, similar to the process Americans should use when choosing an overseas provider. Consumers should inquire about the health care providers’ credentials, the facilities’ accreditation status and, most importantly, whether a case manager will assist them to effectively coordinate their care.
Perhaps the most important criteria are accreditations held and the care coordination program offerings the facility holds. Accreditation by an independent, third-party organization, such as the Joint Commission, CARF and URAC, is important in helping assure quality health care services. Accreditation can range from an evaluation of an entire organization, such as Hospital Accreditation by the Joint Commission, to a specific function, which URAC’s Case Management Accreditation and Health Provider Credentialing programs offer.
Accreditation offers significant benefits for both consumers and organizations. Accredited organizations often find that after completing a comprehensive accreditation program they have improved management efficiency and program effectiveness. This leads to better quality of care at lower costs. The quality standards that are part of accreditation programs provide guidance on best practices and ensure that an organization’s processes have been thoroughly reviewed and vetted.
URAC’s Case Management Accreditation looks at 24 different operational areas, including quality management, organizational structure, case management staff qualifications, collaboration with the consumer, assessment of the consumer’s needs for the development identification of a consumer specific multidisciplinary plan of care and onsite case management services. URAC’s Case Management Accreditation is designed for organizations that use case management to better meet patients’ needs and improve their treatment outcomes by coordinating the full continuum of care.
The accreditation also requires reporting by organizations on case management measures of the case management process. These measures include prompt contact for enrollment into case management services, readmission to acute care within 72 hours of discharge, complaint resolution timeliness and reporting of consumers who decline case management services and the overall consumer satisfaction with case management services.
Consumers who select accredited organizations can be assured their health care provider has met the standards of a third-party organization. Often these standards include consumer protection policies and a definition of consumer rights.
Accredited health care organizations are often evaluated for key factors that are important for consumers considering medical care in the U.S. These include:
What is the provider’s consumer privacy protection and consumer rights policies? Because of the strict HIPAA regulations in the U.S., foreign visitors often have much more privacy and security protection in the United States than they would in their home countries. However, it is important to ask about training for employees on HIPAA compliance, rights of individuals and authorization procedures.
How much transparency of services and disclosure of coverage does the facility ensure? What information do patients receive prior to the procedures? Are all of the costs clearly outlined? The Obama Administration’s push for health care reform has made transparency a focal point in its plans.
Safety issues have also pushed transparency to the forefront; medication errors, infection rates and death rates are factors that weigh into consumer decisions about which hospital to go to for service. It is imperative that patients understand before they leave home the full extent of the procedures and related costs – and what they will be required to pay.
What are the policies and procedures in place to help ensure continuity of care? Will the facility provide a case manager to assist the consumer in navigating necessary follow-up care? One of the biggest challenges with medical tourism is ensuring proper follow-up care after the treatment, especially once the patient has returned home. It is vital that clear instructions are provided and the patient understands the next steps.
The patient’s primary care physician and specialists in his or her home country should provide the patient’s medical records and should receive contact information for the health care provider in the United States. Doctors in the United States and the patient’s home country should be introduced prior to the procedure, so that everyone involved in the patient’s care will have established clear communication in advance.
How transparent is the health website of the hospitals care and providers? According to a recent survey by the Medical Tourism Association (MTA), 49 percent of patients find out about medical tourism via the Internet and 73 percent rely on the Internet to research country destinations and hospitals.
It is important that these websites have been evaluated on key criteria including accuracy of information provided to consumers, privacy and security, disclosure of financial relationships to content providers and the process for responding to consumer complaints.
Qualifications of the Health Care Provider
How can consumers find out about the specific qualifications of the physician – and does the hospital monitor the provider to ensure quality care is rendered? Most importantly, does the hospital monitor the credentials of physicians and take action in the event of a serious patient safety issue which may have lead to a temporary suspension, or revocation of a license to practice?
Credentialing is a process whereby the hospital or health system verifies the physician’s qualifications, or those of another provider (i.e., physician assistant, nurse practitioner, and psychologist). Education, licensure status, liability claims, practice history and training are all evaluated and verified. Credentialing occurs at least every three years and directly prior to being granted privileges to admit and treat patients in a hospital.
Like consumers, international hospitals attempting to contract with U.S. health networks or case management companies should also look for accreditation when selecting partner organizations. Working with an accredited company provides the international hospital an assurance of enhanced consumer transparency for the services provided, which means that these hospitals can provide their patients the information they need. This clear communication benefits everyone – the consumers and the provider organizations.
Traveling to the United States for medical services is often a costly and complicated process for non-residents. Selecting an accredited health care provider is one way to ensure that consumers receive the high quality care they are expecting.
Working with accredited U.S. organizations gives international hospitals the accountability and responsibility they need to meet their consumers’ expectations. Additional information on the practice of case management may be found by contacting Case Management Society of America at www.cmsa.org
Christine G. Leyden, RN, MSN is Chief Accreditation Officer and Senior Vice President for URAC, the leading health care accreditation and education organization. For more information on URAC HIPAA accreditation, or to contact Ms. Leyden, visit www.urac.org.