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. ©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. ©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. ©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. ©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. ©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. ©JointCommissionInternational
Impact of the Drivers
 Source of patients
 Marketing and promotion
 National Policy

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. ©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. ©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. ©JointCommissionInternational
Two Examples

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. ©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. ©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. ©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. ©JointCommissionInternational
Oversight

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. ©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. ©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. ©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. ©JointCommissionInternational

22. ©JointCommissionInternational

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. ©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. ©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. ©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. ©JointCommissionInternational
Resource
 OECD Report by Neil Lunt and others (2011)
– “Medical Tourism: Treatments, Markets, and Health
System Implications: A scoping review

28. ©JointCommissionInternational
AARP Bulletin, September 2007

29. ©JointCommissionInternational
Grazie.Grazie.
Xie XieXie Xie
Do jeh
Arigato
Shukra
Shukra
nn
Komawoyo
Tak
tesekkür
ederim