According to the National Coalition on Health Care approximately half a million Americans travelled internationally to seek surgical treatment in 2006. This trend looks set to continue increasing with the population aging and the prospect of lower healthcare cost in America nowhere in sight. There are 4 Ds one should consider in selecting a medical travel destination which have been described by Dr Rome Jutabha of UCLA: Domain Doctors Data and Disaster. Lets deal with each one in turn but before that a few words about the importance of the country of destination.


Being left hanging high and dry is the last thing you would want while you are convalescing. Thus it is important to assess if the country that you would be visiting is generally safe and has an adequate regulatory framework to protect you the consumer. Good sources of information include the US State Departments regular travel advisory for US citizens and a recent World Bank publication  Governance Matters 2007: Worldwide Governance Indicators 1996-2006.

The latter ranks countries in terms of their political stability government effectiveness regulatory quality and rule of law and control of corruption.Another important consideration would be on who the main driver of medical tourism in the country is. If it were driven primarily or regulated strongly by the government then there would be greater assurance that the international consumer would be adequately protected because the countrys reputation would be at stake.

Lastly as most blood banks are run by national or regional governments it would be prudent to check the quality of the blood supply and the rigor with which blood is tested for infectious diseases such as HIV and hepatitis.


Domain. What is the hospitals clinical focus? Is the hospital really a specialist in the procedure you are undergoing? There is little point travelling thousands of miles if the attending physician is not an expert.Doctors and Hospitals. The qualifications of the doctors are important but as U.S. board certification requires specialist training to be undertaken in the U.S. and not anywhere else there would be relatively few doctors in the world having American board certified qualifications compared to the number of overall physicians.

Membership and fellowship of the Royal Colleges in the United Kingdom are the main specialist qualifications for much of the Commonwealth countries in the world such as Singapore which is a major medical travel destination. Accreditation with Joint Commission International (the international arm of the Joint Commission) is the usual mark of quality for hospitals outside the United States but there are many other accrediting bodies such as Trent Accreditation Scheme in the United Kingdom.

Experience is probably more relevant given the diversity of medical qualifications and accrediting bodies globally. The doctors treating you should have a good track record in the procedure and be able to tell you their own personal results as well as that of the hospital. While scientific publications and conference presentations are not essential to clinical expertise they are a useful measure of peer recognition and the standing of your attending physician in his or her medical specialty.

The number of clinical trials the doctor or hospital is involved in can also be telling. Pharmaceutical and medical devices companies will only work with doctors and hospitals that meet their stringent standards to be trial sites and you can capitalize on the background checks done by them to double-check the standards of the hospital you are about to enter. For example www.clinicaltrials.gov (a website hosted by the National Institutes of Health documenting clinical trials worldwide) records that the Singapore National Eye Centre is currently involved in 18 clinical trials (Site accessed on Sept 12 2007).

Data- Nothing beats knowing the doctors and hospitals results are publicly available. However while many hospitals publish online their own results it is often unclear how the data is collected and whether the data has been subject to external audit for accuracy. It would be much more reassuring if an independent body such as the government centrally collates and publishes this information and this is already happening.

In New York City the New York City Health and Hospitals Corporation has begun to put online the outcomes of certain diseases such as pneumonia and heart attack including complications such as infections while in Singapore the Ministry of Health regularly publishes not only the clinical outcomes of procedure e.g. Lasik and cataract surgery but also the price patients pay for them.

Another measure of reliability of data is the publication of results in peer reviewed publications such as the New England Journal of Medicine and the Lancet.Disaster- Despite the best efforts of everyone disasters can and do happen in healthcare and you want to know you will receive the best possible care if something unfortunate occurs. As mentioned above check that the blood supply is safe. If you are seeking treatment at a hospital that adopts a focused factory approach i.e. it only manages heart diseases or orthopedic conditions then make sure that the hospital has ready access to all the specialists you might need in a medical disaster e.g. nephrologists in case of post-operative kidney failure requiring dialysis infectious disease physicians for post-operative wound infection etc.

Traveling outside the United States is something Americans are seriously considering in ever-increasing numbers. Like any other overseas venture there will always be uncertainty but the savvy patient can minimize risk by carrying simple checks and asking the right questions before leaving the U.S.Darren Tan. MHS (Mgt) BSc (Biology) leads the Outcomes Research team at the SingHealth Centre for Health Services Research.

He and his team works extensively on evaluating clinical interventions which forms the bridge linking the endpoints of practices and interventions with their effectiveness.Dr Jeremy Lim. MBBS MPH MRCS (Edin) MMed (Surg) a surgeon by training Jeremy leads the SingHealth Centre for Health Services Research. He has written and lectured widely on health policy and maintains a personal and professional interest in public healthcare quality and accessibility for all especially the poorest segments of society.

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