©JointCommissionInternational
Considerations in Entering
the
Medical Travel Industry
Paul vanOstenberg, Vice President Int...
©JointCommissionInternational
Medical Travel (Tourism)
 Act of traveling with the primary intent to seek medical,
dental,...
©JointCommissionInternational
Number of Medical Tourists
 Estimates lie on a continuum between statistics published by th...
©JointCommissionInternational
Why are patients willing to travel for
medical care?
 To foreign countries,
 Where they do...
©JointCommissionInternational
Drivers
 Low cost care
 High quality
 High technology
 Well trained medical staff
 “Exp...
©JointCommissionInternational
Cost Comparisons
 DELSA/HEA/WD/HWP(2011)3 12 Table 1: Medical tourism prices (in selected c...
©JointCommissionInternational
Impact of the Drivers
 Source of patients
 Marketing and promotion
 National Policy
©JointCommissionInternational
Examples of National Strategies
 Singapore – highly organized multi-agency,
public-private ...
©JointCommissionInternational
Fortis Healthcare’s Rajan Dhall
Hospital New Delhi, India
“We are a hotel delivering clinica...
©JointCommissionInternational
Risks and Challenges
 Quality and safety
 Language and cultural considerations
 Confident...
©JointCommissionInternational
Two Examples
©JointCommissionInternational
Japan
 Slow to develop
– Low number of trained doctors
– High cost of treatment
– Most trav...
©JointCommissionInternational
Bumrungrad Hospital
SOME FACTS:
 Located in Bangkok, Thailand
 1st
JCI accredited hospital...
©JointCommissionInternational
Bumrungrad Hospital
RISE WAS COMPLICATED:
 1997 when new hospital opened the Asia
financial...
©JointCommissionInternational
Bumrungrad Hospital
 Successful actions
– Web sites in different languages
– Extensive mark...
©JointCommissionInternational
Oversight
©JointCommissionInternational
 To improve the safety and quality of
care in the international community
through the provi...
©JointCommissionInternational
Bermuda
Brazil
Mexico
Chile
Costa Rica
Pakistan
India
Thailand
Singapore
Philippines
China
T...
©JointCommissionInternational
JCI Today
 Global knowledge disseminator of quality improvement
and patient safety
 Non-pr...
©JointCommissionInternational
• A government or non-government agency
grants recognition to health care institutions
which...
©JointCommissionInternational
©JointCommissionInternational
©JointCommissionInternational
Beware of Ratings
 Medical Travel Quality Alliance published the
“World’s Best Hospitals fo...
©JointCommissionInternational
“Singapore has the
biggest number of JCI-
accredited institutions
worldwide outside of
the U...
©JointCommissionInternational
Increasing Requests for Ensuring
Quality and Safety for Medical Travel
• International Medic...
©JointCommissionInternational
JCI Standards Address Key Issues
Relevant to Medical Travel
 Truth in admission policies
 ...
©JointCommissionInternational
Resource
 OECD Report by Neil Lunt and others (2011)
– “Medical Tourism: Treatments, Market...
©JointCommissionInternational
AARP Bulletin, September 2007
©JointCommissionInternational
Grazie.Grazie.
Xie XieXie Xie
Do jeh
Arigato
Shukra
Shukra
nn
Komawoyo
Tak
tesekkür
ederim
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2013 cambridge considerations in entering the medical travel industryl paul van-ostenberg,vp accreditation and standards

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  • * Costs of surgeries around the world. Costs given in US$ ** The price comparisons for surgery take into account hospital and doctor charges, but do not include the costs of flights and hotel bills for the expected length of stay. Source: Authors, March 2011, compiled from medical tourism providers and brokers online.
  • As you know, the mission of JCI is to improve the quality and safety of health care around the globe. We meet this mission in three ways: Individual organization accreditation Country-level efforts to assist Ministries of Health and Governmental Agencies to strengthen the role of quality oversight at the country level International level as a consensus builder and vehicle for sharing new knowledge on quality and safety in health care JCI includes international members on its Board and has representatives from Asia, Middle East and Europe.
  • This is a traditional definition of accreditation Voluntary – although come countries it is mandatory. Includes recognition given to health care organizations who meet the standards. Public recognition via certification/announcement, financial or requirement that one is accredited. In order to do something else, have a nursing or medical school, insurance discount. Philosophy commonly includes improvement – continuous improvement over time – not a one time effort. Not any one “right” definition. Accreditation must be relevant to unique characteristics of each county’s heath care system, financial reimbursement/payment scheme, culture, level of care provided.
  • 12. Accreditation: IMTA issues position paper. International Medical Travel Journal . Sept. 2008. 13. AMA provides first ever guidance on medical tourism (press release). June 12, 2008. 14. International Herald Tribune (Sept. 25, 2008), US News & World Report (May 1, 2008). 15. Keckley P.H., Underwood H.R.: Medical tourism: Consumers in search of value. Deloitte Center for Health Solutions, 2008.
  • 2013 cambridge considerations in entering the medical travel industryl paul van-ostenberg,vp accreditation and standards

    1. 1. ©JointCommissionInternational Considerations in Entering the Medical Travel Industry Paul vanOstenberg, Vice President International Accreditation and Standards Joint Commission International World Bank MENA Conference Cambridge, England 21 June 2013
    2. 2. ©JointCommissionInternational 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
    3. 3. ©JointCommissionInternational 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).
    4. 4. ©JointCommissionInternational 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
    5. 5. ©JointCommissionInternational Drivers  Low cost care  High quality  High technology  Well trained medical staff  “Experimental” procedures  Cultural heritage/connections  Recreation for family or convalescent period
    6. 6. ©JointCommissionInternational 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
    7. 7. ©JointCommissionInternational Impact of the Drivers  Source of patients  Marketing and promotion  National Policy
    8. 8. ©JointCommissionInternational 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”
    9. 9. ©JointCommissionInternational Fortis Healthcare’s Rajan Dhall Hospital New Delhi, India “We are a hotel delivering clinical medical excellence.” Jason Grewal Fortis, VP of Operations
    10. 10. ©JointCommissionInternational 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
    11. 11. ©JointCommissionInternational Two Examples
    12. 12. ©JointCommissionInternational 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
    13. 13. ©JointCommissionInternational 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
    14. 14. ©JointCommissionInternational 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
    15. 15. ©JointCommissionInternational 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
    16. 16. ©JointCommissionInternational Oversight
    17. 17. ©JointCommissionInternational  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
    18. 18. ©JointCommissionInternational Bermuda Brazil Mexico Chile Costa Rica Pakistan India Thailand Singapore Philippines China Taiwan S. Korea Indonesia Turkey Egypt Ethiopia Saudi Arabia Qatar UAE Jordan Lebanon Spain Ireland Denmark Germany Cz. Rep. Austria JCI Headqarters Chicago, USA JCI European Office Ferney-Voltaire, France JCI Middle East Office Dubai, UAE JCI Asia-Pacific Office Singapore UK Netherlands Switz. Slovakia Poland Ukraine Italy Russia Romania Croatia Albania Hungary Bulgaria Bahrain Syria Israel Kuwait Argentina Venezuela Japan Fiji Kazakhstan Kyrgyzstan Turkmenistan 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
    19. 19. ©JointCommissionInternational 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
    20. 20. ©JointCommissionInternational • 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
    21. 21. ©JointCommissionInternational
    22. 22. ©JointCommissionInternational
    23. 23. ©JointCommissionInternational 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
    24. 24. ©JointCommissionInternational “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
    25. 25. ©JointCommissionInternational 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
    26. 26. ©JointCommissionInternational JCI Standards Address Key Issues Relevant 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
    27. 27. ©JointCommissionInternational Resource  OECD Report by Neil Lunt and others (2011) – “Medical Tourism: Treatments, Markets, and Health System Implications: A scoping review
    28. 28. ©JointCommissionInternational AARP Bulletin, September 2007
    29. 29. ©JointCommissionInternational Grazie.Grazie. Xie XieXie Xie Do jeh Arigato Shukra Shukra nn Komawoyo Tak tesekkür ederim

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