Trusted by over 1.2 Million Global Healthcare Seekers
Destination Spotlight

Destination U.S.A.- Knowing the Right Questions to Ask

Destination Spotlight

What we today call medical tourism can be traced back thousands of years. It was chronicled among the Egyptians, Romans and Japanese. But the true roots of today’s practice of seeking medical interventions in another country other than one’s own started in Egypt. The Egyptians practiced advanced forms of medicine, and in 1248 the Mansuri Hospital opened in Cairo. At the time, it was the most advanced hospital ever built, and it served everyone regardless of race, religion or financial status.  Travelers came from all over the world to seek medical treatment at Mansuri because it offered the best, and sometimes the only care available.

Medical tourism today was coined to describe the rapidly-growing practice of travelling across international borders to obtain health care. Ever since several of the larger insurance companies such as Aetna, Blue Cross Blue Shield, WellPoint, Swiss Re and others started pilot programs to determine the quality and cost of covering surgeries offered in other countries, medical tourism has become one of the fastest growing niches in the health care industry. In fact, over 50 countries have identified medical tourism as a national industry.

Although many people do not realize it, the U.S.A. is one of the prime destinations for the medical tourist. A McKinsey and Co. report from 2008 found that a plurality of an estimated 60,000 to 85,000 medical tourists were traveling to the U.S.A.  for the purpose of receiving in-patient medical care.ii

The availability of advanced medical technology and sophisticated training of physicians are cited as driving motivators for growth in foreigners traveling to the U.S. for medical care, whereas the low costs for hospital stays and major/complex procedures at Western-accredited medical facilities abroad are cited as major motivators for American travelers.

However, selecting an appropriate medical destination is not simply a matter of looking at attractive hospital buildings and deluxe accommodations, and it certainly is not an issue determined only by the prices charged. How does an agency get quality information? It requires less effort than one might think if the United States is the destination in question.

Transparency has become a mantra, and what used to be impossible can now be located with a little effort. Perhaps the easiest way to start is to determine whether or not a hospital is accredited. A little time trolling around the internet will yield a lot of information, if you know what you are looking for.

You can visit Hospital Compare (visit www.hospitalcompare. to find comparable information about key hospital metrics. To make reliable information about physician quality available to the public, the government started Physician Quality Report in 2006 and has been collecting data ever since.

You can visit to find information on thousands of physicians measured on over 70 different quality metrics. If you are interested in how consumers rate hospitals, rehabilitation facilities and so forth, your can find this information, too. Hospital Care Quality Information from the Consumer Perspective (HCAHPs), can be accessed at

Among the many reasons for improved patient outcomes, which lowers the risk associated with the care, are 1) careful selection of patients, 2) experienced, educated and certified nursing and rehabilitative staff, and 3) expert and experienced medical supervision. So, medical tourism companies may want to ask for specific information from patients as well as institutions.

How Safe is This Patient for Travel?

Carefully screening “tourists” helps you make wise decisions. Medical patients need to be assessed thoroughly, and their medical and nursing needs ascertained precisely before embarking on a trip – or returning home. For safe outcomes, patients need not only expert physicians but also expert clinical care pre-intra-and post-surgery, as well as expert rehabilitation, preferably on site as long plane trips increase the likelihood of complications.

How Many of This Kind of Medical Procedure has the Medical Facility and Respective Medical Team Performed in the Last Year?

Careful analysis of almost 1 million elective orthopedic surgeries shows that high-volume centers, which have extensive orthopedic surgical experience, have better outcomes than lower volume hospitals.iii

How Do You Measure the Quality of Nursing Care?

Without doubt, nurses are chief among those who deliver care to patients, and their expertise is essential to positive patient outcomes. Registered nurses (RNs) typically specialize according to a particular work setting, a specific type of treatment, a specific health condition, organ or body system type, or population type.

Some RNs may also choose to become advanced practice nurses, who work independently or in collaboration with physicians and may provide primary care services.iv, v Clinical nurse specialists provide direct patient care and expert consultations in one of many nursing specialties.

Nurse anesthetists provide anesthesia and related care before and after surgical, therapeutic, diagnostic and obstetrical procedures. Nurse midwives provide primary care to women, including gynecological exams, family planning advice, prenatal care, assistance in labor and delivery, and neonatal care. Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing and health care services to patients and families.

Does this Destination Provide Access to Nurse Experts?

If the facility’s nursing staff does not compare favorably with comparable national data, you may want to direct your medical consumers elsewhere. According to the Health Resources and Services Administration, there were 3,063,162 RNs in the United States in 2008. In this study HRSA found that:

  • Half (50 percent) of RNs have achieved a baccalaureate or higher degree in nursing or a nursing-related field in 2008, this is compared to 27.5 percent in 1980
  • The number of RNs with master’s or doctorate degrees rose to 404,163 in 2008, an increase of 46.9 percent from 2004, and up from 85,860 in 1980
  • The average age of all licensed RNs increased to 47.0 years in 2008 from 46.8 in 2004;
  • An estimated 444,668 RNs received their first U.S. license over the period from 2004 to 2008.

About 16% of the U.S. registered nurse workforce is comprised of foreign educated nursesvi (FENs) vetted by CGFNS International to ensure that their education, knowledge and experience is comparable to their counterparts in the U.S. CGFNS International, established in 1977, has reviewed and/ or certified the credentials of over 500,000 foreign educated nurses and other health care professionals for U.S. licensure and immigration. vii

Section 343 of the U.S. Illegal Immigration Reform and Immigrant Responsibility Act (the IIRIRA) of 1996 requires specific non U.S. citizen health care professionals complete a screening program before they can receive either a permanent or temporary occupational visa, including Trade NAFTA status.

CGFNS International was originally named in the law and continues to be the only authorized provider of this service for all health care professions affected: Registered nurses, licensed practical or vocational nurses, physical therapists, occupational therapists, physician assistants, clinical laboratory technicians (medical technicians), clinical laboratory scientists (medical laboratory technologists), speech language pathologists, and audiologists.

Are There Any Foreign Educated Nurses in the Facility, Which Demonstrates Cultural Competence and Commitment to Diversity?

Culturally competent care is essential for high quality patient care, and the FEN has contributed much to the delivery of health care in the U.S. The FEN also has done much to increase cultural competence and understanding of diversity among members of the nursing workforce in the United States by bringing new ways of thinking and serving a multicultural patient population.viii

There can be no doubt that their presence in the workforce will help make foreign born medical consumers more comfortable by assuring that the care they receive is culturally appropriate.

What is the Skill Mix of the Medical Team? How is Their Competency Assessed? Is the Medical Facility Committed to Continuing Education? What is the Tenure of the Facility’s Leadership and Personnel?

The answers to these four questions say a lot about the quality of care that patients will receive as a result of the commitment to service, leadership, and learning.

Is this a Magnet Facility?

In addition to accreditation, other important variables medical tourism companies should consider as they differentiate their package include becoming fully informed about the medical centers that have achieved Certification as a Magnet Recognized Facility.

What is the Nurse-Patient Ratio?

Medical tourism companies should know some other important national and state specific metrics — for example, a facility’s nurse patient ratio — especially in states like California. Other forms of recognition, such as listed among the nation’s top 100 hospitals, will also add considerably to helping to assure clients of safe, quality care.

Is On-Going Follow-Up Possible?

The continuum of care from point of entry to closure needs to be monitored. Families need to be included in the discharge planning and need to know what resources are available in the event that complications arise.

Hospitals that are committed to technology in terms of an electronic medical record (an important tool that enhances a provider’s ability to follow the patient after discharge), online communication with physicians (, and telenursing offer access and care over the internet – and this is important, especially for those who may live very far indeed from their care providers. Medical transport services also need to be factored into the equation.

As the demand for medical tourism, or as I prefer to say, medical consumerism, continues to grow the most important factor ensuring success will be patient outcomes. Thus the successful medical tourism company, and the most successful medical tourism destinations will do all possible to ensure their clients’ safety by carefully selecting the client and carefully matching him/her to the best providers of the particular services they need.

The medical tourism industry would be well served by researching and initiating the development of desired patient outcomes in order to form a baseline for the measurement of the practice.


i. Africa and the Middle East: Israel, Jordan and United Arab Emirates. The Americas: Brazil, Canada, Costa Rica, Cuba, Mexico, Panama, United States, and Uruguay. Asia/Pacific: Brunai, China , Hong Kong, India, South Korea, Malaysia, New Zealand, Pakistan, Philippines, Singapore, Taiwan and Thailand. Europe: Czech Republic, Cyprus, Estonia , France, Germany, Hungary, Lithuania, Poland, Romania and Turkey

ii. Allison Van Dusen, 2008 U.S. Hospitals Worth the Trip. Forbes May 29, 2008 ing08_0529healthoutsourcing.html accessed 9/4/11

iii. Annals of Internal Medicine. 18 January 2011 annals/tipsheets/ 18jan 11.htm; Surgical-edge-goes-to-regional-hospitals/UPI-82731298265260/#ixzz1X1E3xjpK accessed September 3, 2011;Ko CY, Chang JT, Chaudhry S., Kominskey G 2002 Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection? Surgery132:2 pp 268 – 73

iv. Stanton, Mark W Hospital Nurse Staffing and Quality of Care. Research in Action. Issue 14 accessed September 6, 2011

v. Bureau of Labor Statistics.

vi. HRSA Study Finds Nursing Workforce is Growing and More Diverse. March 17, 2010. finds_nursing_workforce_is_growing_and_more_diverse.html

vii. accessed September 6, 2011

viii. Davis CR (2001)

Foreign-Educated Nurses and the Changing U.S. Nursing Workforce. Nursing Administration Quarterly, Vol. 26, No. 2, Winter 2001. Lippincott Williams & Wilkins

About the Author

Franklin A. Shaffer, EdD, RN, FAAN, CEO, CGFNS International, represents the professional and global community as an expert on, leader in, and resource for health professional mobility, regulation, credentialing, certification, and health policy. He serves as a leading voice on issues regarding the global migration of the health professions and provides strategic leadership for the development of the enterprise’s programs that are designed to protect the health care consumer through credentials evaluation and standards development.

He was previously executive vice president of Cross Country Healthcare and chief nursing officer for Cross Country Staffing where he worked closely with over 3,000 hospitals in the U.S. and the world. He was appointed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO or the Joint Commission) to serve on their Nursing Advisory Council. He was also the former deputy director for the National League for Nursing. Dr. Shaffer holds a doctorate of education in nursing administration from Columbia University. He was inducted into the American Academy of Nursing in 2002.`

CGFNS International is an immigration-neutral, nonprofit organization globally recognized as a credentials evaluation and assessment authority on education, registration and licensure of nurses, health care and other professionals worldwide. For more information, go to

Learn about how you can become a Certified Medical Tourism Professional→
Disclaimer: The content provided in Medical Tourism Magazine ( is for informational purposes only and should not be considered as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. We do not endorse or recommend any specific healthcare providers, facilities, treatments, or procedures mentioned in our articles. The views and opinions expressed by authors, contributors, or advertisers within the magazine are their own and do not necessarily reflect the views of our company. While we strive to provide accurate and up-to-date information, We make no representations or warranties of any kind, express or implied, regarding the completeness, accuracy, reliability, suitability, or availability of the information contained in Medical Tourism Magazine ( or the linked websites. Any reliance you place on such information is strictly at your own risk. We strongly advise readers to conduct their own research and consult with healthcare professionals before making any decisions related to medical tourism, healthcare providers, or medical procedures.
Free Webinar: Building Trust, Driving Growth: A Success Story in Medical Travel Through Exceptional Patient Experiences