2013 cambridge considerations in entering the medical travel industryl paul van-ostenberg,vp accreditation and standards

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Considerations in Entering the

Medical Travel IndustryPaul vanOstenberg, Vice President International Accreditation and Standards

Joint Commission International

World Bank MENA Conference Cambridge, England

21 June 2013

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Medical Travel (Tourism)

Act of traveling with the primary intent to seek medical, dental, or surgical care

Includes leisure traveler who has need for health care while on vacation

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Number of Medical Tourists

Estimates lie on a continuum between statistics published by the Deloitte management consultancy at one end of the spectrum and a more conservative estimate by McKinsey and Company at the other.

Figures that are regularly reproduced in the literature (Johnson and Garman, 2010, Whittaker, 2010) draw on data collected and projections made by Deloitte, which put the number of US citizens leaving the country in search of treatment at 750,000 in 2007 (Keckley and Underwood, 2008). This number, Keckley insists, would reach somewhere between 3 and 5 million by 2010 (Keckley and Underwood, 2008, Keckley and Eselius, 2009).

US tourists represent roughly 10% of the global number of medical tourists (Ehrbeck et al., 2008), this would suggest that total worldwide figures would lie somewhere between 30 and 50 million medical tourists travelling for treatment each year.

The frequent citation of medical tourism as a $60bn industry can be traced back to Deloitte‘s report (MacReady, 2007, Crone, 2008, Keckley and Underwood, 2008).

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Why are patients willing to travel for medical care?

To foreign countries, Where they don’t understand the language, Have never been before, and may never go again, Don’t know anyone, May have to convince family, friends and their regular

doctors that they are doing the right thing

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Drivers

Low cost care High quality High technology Well trained medical staff “Experimental” procedures Cultural heritage/connections Recreation for family or convalescent period

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Cost Comparisons

DELSA/HEA/WD/HWP(2011)3 12 Table 1: Medical tourism prices (in selected countries) Procedure US India Thailand Singapore Malaysia Mexico

Heart bypass -CABG 113 000 10 000 13 000 20 000 9 000 3 250 Heart Valve replace 150 000 9 500 11 000 13 000 9 000 18 000 Angioplasty 47 000 11 000 10 000 13 000 11 000 15 000 Hip replacement 47 000 9 000 12 000 11 000 10 000 17 300 Knee replacement 48 000 8 500 10 000 13 000 8 000 14 650 Gastric bypass 35 000 11 000 15 000 20 000 13 000 8 000 Hip resurfacing 47 000 8 250 10 000 12 000 12 500 12 500 Spinal fusion 43 000 5 500 7 000 9 000 15 000 Mastectomy 17 000 7 500 9 000 12 400 7 500 Rhinoplasty 4 500 2 000 2 500 4 375 2 083 3 200 Tummy Tuck 6 400 2 900 3 500 6 250 3 903 3 000

Breast reduction 5 200 2 500 3 750 8 000 3 343 3 000 Breast implants 6 000 2 200 2 600 8 000 3 308 2 500 Crown 385 180 243 400 250 300 Tooth whitening 289 100 100 400 350 174 Dental implants 1 188 1 100 1 429 1 500 2 636 950

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Impact of the Drivers

Source of patients Marketing and promotion National Policy

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Examples of National Strategies

Singapore – highly organized multi-agency, public-private approach. Tourism and economic development approach

India – changed policies on Visas for target countries – special Visa category

Malaysia – created a national committee in MOH for promotion

Philippines – Created a body to “certify” certain providers as “destinations”

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Fortis Healthcare’s Rajan Dhall Hospital New Delhi, India

“We are a hotel delivering clinical medical excellence.”

Jason Grewal

Fortis, VP of Operations

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Risks and Challenges

Quality and safety Language and cultural considerations Confidentiality and security of health information Continuity of Care – both before and after

hospitalization or procedure Initial referral and admission processes Follow-up after patient returns to home country Coordination and information-sharing among various

practitioners Handling and tracking of complications

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Two Examples

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Japan

Slow to develop– Low number of trained doctors– High cost of treatment– Most travelers were outbound

More recently– Coordination by Ministry of Economy, Trade and

Industry– Emphasis on high end treatments = high cost– Focus on skills intensive prpocedures

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Bumrungrad Hospital

SOME FACTS: Located in Bangkok, Thailand 1st JCI accredited hospital in Asia Pacific(2002) 1997 New larger facility (554 beds) and they

entered the travel market Close to 500,000 travel patients – in-patients

– 50% actually came from USA – others are expats

72% of travel patients are self pay

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Bumrungrad Hospital

RISE WAS COMPLICATED: 1997 when new hospital opened the Asia

financial crisis hit and demand dried up The Baht’s devaluation made care low cost for

those paying in USD Upper income from neighboring countries

flooded in After Sept. 11 those from Middle East had

trouble entering USA so shifted to Asia

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Bumrungrad Hospital

Successful actions– Web sites in different languages– Extensive marketing– Attend/speak/exhibit at conferences– Work with travel brokers– Work with insurance companies– Get to know provider groups– Connect with the local hospitality industry– Joined multiple medical travel associations– Build a new wing for Middle East patients

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Oversight

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To improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services

Mission of Joint Commission International

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Bermuda

Brazil

Mexico

Chile

Costa Rica

Pakistan

India

Thailand

Singapore

Philippines

China

Taiwan

S. Korea

Indonesia

Turkey

Egypt

Ethiopia

Saudi Arabia

Qatar

UAE

JordanLebanon

Spain

Ireland

Denmark

GermanyCz. Rep.

AustriaJCI HeadqartersChicago, USA

JCI European OfficeFerney-Voltaire, France

JCI Middle East OfficeDubai, UAE

JCI Asia-Pacific OfficeSingapore

UKNetherlands

Switz.

Slovakia

Poland

Ukraine

Italy

Russia

Romania

Croatia

Albania

Hungary

Bulgaria

Bahrain

Syria

Israel

Kuwait

Argentina

Venezuela

Japan

Fiji

Kazakhstan

KyrgyzstanTurkmenistan

Belize

Guatemala

Colombia

Nicaragua

Ecuador

Bahamas

Trinidad and Tobago

Dominican Republic Chad

South Africa

Eritrea

Gabon

Nigeria

Uganda

Zambia

Portugal

Angola

Malaysia

Panama

Oman

Vietnam

Belgium

Joint Commission International

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JCI Today

Global knowledge disseminator of quality improvement and patient safety

Non-profit affiliate of the Joint Commission 529 accredited or certified organizations in 52

countries Commitment to partnering with NGOs, HCOs, etc. ISQua-accredited program and standards

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• A government or non-government agency grants recognition to health care institutions which meet certain standards that require continuous improvement in structures, processes, and outcomes

• Usually a voluntary process

Accreditation – A Definition

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Beware of Ratings

Medical Travel Quality Alliance published the “World’s Best Hospitals for Medical Tourists”.– Countries represented in top 10

• Malaysia

• Germany

• Lebanon

• India

• South Korea

• Thailand x2

• Turkey

• Singapore

• India

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“Singapore has the

biggest number of

JCI-accredited

institutions

worldwide outside

of the

US…..Americans

trust American

credentials” Josef Woodman

Author of Patients Beyond Borders

28 February 2007, The Straits Times

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Increasing Requests for Ensuring Quality and Safety for Medical Travel

• International Medical Travel Association issued position paper advocating that international health care organizations be held to high standards set by recognized accreditation authorities

• American Medical Association adopted guiding principles on medical tourism

– Outline steps for care abroad for consideration by patients, employers, insurers, and third parties

– Require patients to be made aware of their legal rights and have access to physician licensing and facility accreditation

• Increasing exposure in international trade journals highlighting the need to research quality when considering medical travel

• Deloitte study mentions JCI in particular in reference to patients’ increasing concerns about quality in international hospitals

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JCI Standards Address Key IssuesRelevant to Medical Travel

Truth in admission policies Communication in Language and Manner that

is understood Rights as Patients-Respected Continuity of Care After Discharge Professional Competence Evidence of Quality-Valid Data Complaints Acted on in Timely Manner

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Resource

OECD Report by Neil Lunt and others (2011)– “Medical Tourism: Treatments, Markets, and Health

System Implications: A scoping review

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AARP Bulletin, September 2007

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Grazie.Grazie.

Xie Xie Xie Xie

Do jeh

Arigato

ShukraShukra

nn

Komawoyo

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