2013 cambridge considerations in entering the medical travel industryl paul van-ostenberg,vp...
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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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