Comparing quality in medical tourism

To keep things simple, this blog has moved to the IMTJ web site. You can find the Health Tourism Blog here in future. Here's an extract of the latest blog post on Comparing quality in medical tourism.

How does a medical tourist make a valid comparison of a doctor, hospital or clinic in one country with a doctor, hospital or clinic in another? The simple answer is that he or she can’t. And the truth is that it may never be the case (well not in my lifetime).

In the hypothetical world, we talk about patients making informed choices about treatment....about how we can provide them with the information that they need to compare healthcare providers and make valid decisions about which one is the “best”, the “safest”, the “highest quality”. But even if someone is only interested in treatment within one country, this may be impossible. In a country such as the UK where there is a national publicly funded health system it becomes more of a possibility. In the UK, there are quality indicators, performance measures, and outcome data that are collected in the same way and analysed in the same way across all healthcare providers (whether they are public or private hospitals). So, patients can make reasonably valid comparisons of healthcare providers.

However, in many countries which are promoting themselves as medical tourism destinations, there may be no strategy or system for collecting data on quality, performance and outcomes on a national basis. So, making an “informed choice” even within that country becomes a virtual impossibility.

.........Read the full article at IMTJ: Go to Comparing quality in medical tourism.

Patient choice in medical tourism...Let's hear the patient's voice

The recent Medical Tourism Climate Survey conducted by IMTJ for the European Medical Travel Conference 2010 provided an interesting insight into the current state of the industry and how people in the industry are thinking about medical tourism. The survey analysed the views of over 250 people involved in medical tourism from 55 countries. One particular question that drew my attention was one that asked people in the industry about the factors that influence patient choice. The question was this:

“What factors do you think are important to medical tourists when they choose a healthcare facility or treatment provider abroad?”

Expertise and qualifications of the doctor/dentist ranked first. Comments and ratings by other patients ranked second.

It’s the high ranking of “patient opinion” that surprised me, given the industry’s apparent reluctance to “buy in” to the concept of patient ratings and reviews. Hospitals worldwide are investing large sums of money in accreditation and quality standards, sometimes as a marketing tool to attract patients and referrers. But very few patients have any idea what JCI accreditation means, or how this can help them to compare quality at different hospitals.

So, how are patients comparing competing destinations and healthcare providers?

As patients evolve into healthcare consumers, they are considering the purchase of healthcare in much the same way that they consider the purchase of any consumer good or service. And medical tourists are no different.

Let’s consider the tourism or travel element of medical tourism and medical travel. When consumers are booking a holiday or a hotel, what do they do and where do they go to gather information that will guide their choice. To determine price and availability they visit travel and holiday portals online. Sites such as Lastminute.com and Expedia attract massive volumes of traffic. And where do these consumers go to gather “opinion” about quality and services at their destination or hotel. Travel consumers want to hear from “people like me” before they buy.... which is why TripAdvisor has become one of the busiest web sites in the travel sector.

So, what are the options for medical tourists who want to hear from “people like me” before they buy? Many patients whether they are travelling patients or “stay at home” patients make extensive use of patient forums before they make a decision on treatment at home or abroad. Infertility treatment abroad is a good example. Take a look at the Fertility Treatment Abroad section of the FertilityZone web site, and some of the discussions that take place around the services provided by various IVF and infertility clinics abroad:

• Clinic Fiv Madrid, Spain - 620 comments and 22,219 page views.


• IVF in Norway -- 122 comments and 12,431 page views.

If you were a patient seeking infertility treatment abroad what would influence your decision more....

• The accreditation status of the clinic?



• The qualifications of the doctor?



• The views of other patients?

I’m willing to bet that the views of other patients....“consumer opinion” would be the major influence on your decision. (Obviously, for IVF treatment, patients would also be looking at outcome data/fertilisation rates published by the clinic). This seems to be the conclusion reached by the respondents in the IMTJ Medical Tourism Climate Survey.

So...why hasn’t the medical tourism sector bought into patient ratings and reviews?

At Treatment Abroad, we were the first to enable medical tourists to rate and review overseas hospitals and clinics. At Medical Tourism Ratings and Reviews, patients can score these clinics and post their comments about the service and treatment received. To enable this, we invest heavily in Bazaarvoice, the world leaders in online rating systems to manage our new service. They make sure that only valid reviews make it on to our medical tourism reviews site. The moderators are well educated, trained and tested to ensure only appropriate user-generated content gets posted. Nevertheless, we are disappointed in the adoption of this reviews system by our clients.

When we promote the reviews system direct to patients and people who have enquired about treatment abroad, we get excellent take up. Patients are keen to share their experiences and benefit from other patients’ experiences. Similarly, some of our clients see the benefit of allowing patients to rate and review their services and actively encourage their past patients to visit the site and post a review. The system is free. It doesn’t cost the client a penny extra to participate. But many of our clients are less enthusiastic about patient reviews.

Why is there reluctance to encourage patient reviews for medical tourism?

The most common objection from clients is that they are worried about negative reviews. What happens if a patient actually says something that they don’t like?

Well, as all of the hotels and holiday providers on Trip Adviser know, a negative review may affect their business negatively. Or will it?

On Medical Tourism Ratings and Reviews, we publish negative patient reviews, as long as they are not profane or violate other rules of moderation, such as raising litigation or malpractice issues.

Negative patient reviews are valuable

Negative reviews are of value to the healthcare provider and to healthcare consumers. Negative reviews show credibility – if there are nothing but 5-star reviews for your services, healthcare consumers get suspicious about the authenticity of the content.

Negative reviews also give objective feedback and help healthcare providers uncover blind spots. Perhaps there was a breakdown in a process or poor communication with the patient, or some misinformation in the description of your services on your website. Direct feedback from your patients is the most transparent way to uncover these issues and get them solved quickly.

When we publish a negative review on Medical Tourism Ratings and Reviews, we give the client a chance to respond – to explain what went wrong and to say what they are doing to put things right. Negative reviews which we reject and do not publish (but we do pass to clients) are also incredibly valuable. When patients are upset with your service or their treatment, they sometimes get angry, which can cause them to violate the terms of our review system, use profanity, threaten legal action or go off on a tangent – all things that can lead us to reject a review.

Don't ignore negative patient reviews

It’s important for healthcare providers not to ignore this information, because if you can uncover and solve a legitimate problem, and complete the circle, it makes it less likely that the patient will spread their rancour to blogs, forums, and other places where you are unable to see, control or address their comments.It’s important for healthcare providers to review all negative content, so they can uncover service or system improvements to improve future patient interactions.

The message... it’s time for medical tourism providers to start actively encouraging patients to rate and review their services and to start listening to what patients have to say. Accept that sometimes things do go wrong, that patients will be unhappy and will want to tell the world.

You may learn more from getting something wrong than you do from getting something right.

Practice makes perfect...a message for medical tourism providers and patients

In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"

Now, what can we conclude from this?

Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.

So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.

One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.

Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.

Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.

Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.

So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.

And ask the guy "how many have you done this year?"

NHS Patient Choice - Lessons for medical tourism

In the UK, "patient choice" is one of the driving forces in healthcare. Since April 2008, patient choice has been extended in the UK. Patients can choose which hospital they are treated in....anywhere in the country. Patients can choose the time of their hospital appointment. In some cases, patients can choose the individual consultant they see. The NHS Choices website lists information about all NHS hospitals, such as their MRSA rates, facilities and ratings and reviews by patients which means that patients can make an informed choice.
The NHS Choose and Book web site enables people to make their choices.
In reality, the patient choice initiative has been a bit of a disappointment. One problem is that not enough patients are actually aware that they have a choice. The Report of the National Patient Choice Survey, England - December 2008 has analysed uptake of patient choice so far.
The key findings:

• The percentage of patients recalling being offered a choice of hospital for their first outpatient appointment was 46% in December 2008, the same as in September but up from 30% in the first survey (May/June 2006)
• 50% of patients were aware before they visited their GP that they had a choice of hospitals for their first appointment, up from 48% in September and 29% in the May/June 2006 survey.

The factors influencing choice

• Hospital cleanliness and low infection rates were given most often (by 74% of patients) as an important factor when choosing a hospital.
• The other five are quality of care (given by 64% of patients), waiting times (63%), the friendliness of staff (57%), the reputation of the hospital (55%) and location or transport considerations (54%).

So what can medical tourism businesses learn from this?

If UK patients can compare NHS hospitals on MRSA rates, post operative infection rates and outcomes, why can't they do this for overseas hospitals? Or perhaps, why is it difficult if not impossible to find a hospital treating medical tourists that publishs such data or makes it freely available on their web site?

Many people in the UK have the right under EU law to travel abroad for treatment. The EU Directive sets up a framework around this. but the basic right of free movement already exists. So, why aren't people taking advantage of this?

• They don't know they have the right.
• They don't "trust" overseas hospitals.
• They would rather wait for treatment on the NHS in their local area.

Awareness of overseas treatment options can be generated by the providers themselves. One of the best tools to consider is the use of patient stories to create local press coverage and thus raise awareness. See this story in the Scotsman. Let's see more of them!