Providing health care to a mass of heterogeneous population is critical to an extent as lots of sensitive issues might be tagging along. To provide healthcare globally, the healthcare providers need to give importance to social and cultural differences among medical tourists. The difference in nutritional habits, religious practices and customs must be known, understood and well addressed. Apart from this, the healthcare providers should also take care of the gender requirements; this will help in better communication with the patients and maintain a long-lasting relationship.

Cultural Issues

Catholics: Few catholic patients and their relative might wish to have a priest and conduct a prayer service or other religious ceremonies.

Addressing this need, many western hospitals provide chapel and pastoral services. A practice called Eucharistic adoration (Holy Communion) is also provided.

Islam:  During the month of Ramzan the health care providers should be aware of the fasting requirements of the patient. They might prefer to have a non-pork or vegetarian meal. Few may expect the meat to be halal (prepared in a customary way).

Keeping this in mind, some health care providers have separate kitchen and menu where food is prepared keeping their customs and belief in mind.

Language

Language is a great barrier in medical tourism, as communication is very important in providing the right treatment. Therefore, many countries encouraging medical tourism have made it a point that the health care providers know either the patients language or English.

Many healthcare centers arrange for round-the-clock translators.

Therefore, health and disease dealt along with cultural and religious issues aids in better understanding of the patient and treat him better.

People consider that their health information is highly sensitive and it deserves to be highly protected. Assessing the medical records of a patient will be bound by strict legal and ethical issues which prohibit any disclosure of the information, and ensuring that no unauthorized person has access to the reports. Every healthcare center and physician has the utmost duty of respecting the privacy of treatment of a patient. The American Code of Medical Ethics states that – any information disclosed to the physician by the patient during their conversation or later after diagnosis should be maintained confidential. The patient will be able to disclose his condition frankly, only when he is completely confident that the physician and the hospital management will respect his privacy. This enables the physician to diagnose the condition and treat the patient appropriately. However, there are few exceptions to this rule, where the physician is allowed to share the information, with the consent of the patient, to another physician for a second opinion or in case where the patient threatens to harm himself or others.

Care must be taken by the physician while handling patient’s information in computers and fax, physician must avoid discussing the result with patient or superiors in an open public area. Patients information must be used only for the purpose it was given. It should always be taken care that the patients are treated with same level of care and support, regardless of the patient’s health report.

It is not only the responsibility of the organization to maintain privacy, patients should also be careful while handling and discussing their reports. Few very important points to remember are

• Medical identity theft: This is when someone else uses the name and identity and makes use of all medical insurance facilities of that person. Therefore, it is very important to protect and safeguard one’s identity.
• Avoid sharing Personal information with strangers.
• Always keep a track of health information and health insurance card

Legal issues concerning medical tourism is very rare, but sometimes the patient might be subjected to unfamiliar legal issues, if the procedure goes wrong. Dealing issues like medical malpractice or negligence in a foreign country might be a tougher job. Few hospitals may not be able to pay back in case the patient has won the suit. Most of the insurance company does not cover the procedure that has taken place out of the country. Complications arising long after return to home may for sure add more fuel to the fire. Some countries in order to attract medical tourists announce some form of legal remedies for malpractices which is not so appealing to medical tourists.

Process of Accreditation

Initially lots of questions were raised over How to provide the best environment for the clinicians to work? How to provide standard quality treatment for the patients? How to ensure people that the hospital follows quality diagnosis, treatment and hygienic environment? These questions subsequently ended in a standard process called “Accreditation”. If a healthcare facility wants to provide quality medical care to its patient or it wishes to attract medical tourists, depending up on their interest, they choose for national or international accreditation.

Method of assessment

1. Hospital requests for a survey application.
2. Self-assessment about performance is done and the form is submitted.
3. Desk review is done after self-assessment.
4. Now a complimentary copy of “Comprehensive Accreditation Manual for Hospitals (CAMH)” is received by the hospital.
5. Surveyors inspect the premises, documents etc, interview the staff, and observe processes, reviews their records.
6. A brief initial feedback by the surveyor to the management is given at the end of the day, to ensure no surprises in accreditation reports.
7. Quality assurance of the surveyors finding is given.
8. A formal notification which includes feedback regarding standards met and deficiencies is given.
9. The surveyor evaluates the standards and quality followed by the hospital on a score of five. The score for each area is initially summarized. These scores are later consolidated into a single performance area score.
10. Detailed accreditation result is notified.
11. The applicant’s performance regarding fulfillment and of requirements is monitored.
12. Periodic re-accreditation is done.
13. Regular self-assessment must be done by the hospital to enjoy continuous accreditation. After accrediting a hospital, the accrediting organization continuously monitors the health care providers.

2.2.   List of Accredited Hospitals

Thailand

1. Bumrungrad International
2. Bangkok Hospital group
3. Bangkok Hospital Phuket
4. BNH hospital
5. Samitivej Hospital group – Samitivej Srinakarin
6. Samitivej Sriracha
7. Samitivej Sukhumvit hospital

Mexico

1. The American British Cowdray Medical Center IAP – Observatorio Campus
2. The American British Cowdray medical center IAP – Santa Fe Campus
3. Christus Muguerza Alta Especialidad
4. Clinica Cumbres Chihuahua
5. Hospital CIMA Hermosillo
6. Hospital CIMA Monterrey
7. Hospital San Jose Tec de Monterrey
8. Hospital Y Clinica OCA

India

1. Apollo Hospital- Chennai & Hyderabad
2. Asian Heart Institute
3. Krishna Heart and Super Speciality Institute
4. Ojas Laser Eye Surgery Center
5. Al Shifa Hospital
6. Ruby General Hospital
7. Shroff eye Hospital
8. Apollo Gleneagles Hospital
9. Wockhardt Hospitals
10. Fortis Hospital
11. Indraprastha Apollo Hospital
12. Satguru Pratap Singh Apollo Hospital

Singapore

1. Alexandra Hospital
2. National University Hospital
3. The Parkway Group of Hospitals (East Shore Hospital, Gleneagles Hospital, Mount Elizabeth Hospital)
4. Raffles hospital
5. Singapore General Hospital
6. Institute of Mental health/Woodbridge Hospital
7. KK Women’s and Children’s Hospital
8. National Heart Center Singapore
9. National Dental Center
10. Tan Tock Seng Hospital
11. Changi General Hospital
12. Mount Alvernia Hospital

Costa Rica

1. Hospital CIMA
2. Hospital Clinica Bibilica
3. Hospital La Catolica

Philippines

1. St. Luke’s Medical Center
2. Manila Doctor’s Hospital
3. Beverly Hills Medical Group
4. World Citi Med
5. San Juan de Dios Educational Foundation

Turkey

1. Istanbul Memorial Hospital
2. Anadolu Medical Center
3. Acibadem HealthCare Group (Acibadem Bakirkoy Hospital, Acibadem Bursa Hospital, Acibadem Kocaeli Hospital, Acibadem Kadikoy Hospital, Acibadem Kozyatagi Hospital)
4. Medical Park Health Care Groups (MPHG Antalya Hospital, MPHG Bahcelievler Hospital, MPHG Bursa Hospital, MPHG Goztepe Hospital)
5. Florence Nightingale Hospital Group (Sisli FN Hospital, Gayrettepe FN Hospital, Kadikoy FN Hospital)
6. Dunya Eye Hospital
7. Yeditepe University Hospital

Israel

1. Tel Aviv Sourasky Medical Center
2. Rabin Medical Center
3. Assaf Harofeh Medical Center

Panama

Hospital Punta Pacifica

Malaysia

1. Penang Adventist Hospital
2. Prince Court Medical Center
3. International Specialist Eye Center (ISEC)
4. Damai Service Hospital
5. Ampang Puteri Hospital
6. Gleneagles Medical Center Penang
7. Sunway Medical Center
8. Damansara Specialist HospitaL
9. Gleneagles Intan Medical Center

Germany

1. University Medical Center Freiburg
2. DRK Kliniken Berlin
3. Klinikum Chemnitz gGmbH

Poland

1. The Clinical Hospital No.10 and Polyclinic
2. Damian Medical Cente

Brazil

Albert Einstein Jewish Hospital.

Jordan

Speciality Hospital – Amman, Jordan

Accrediting Organizations

Medical institutions providing quality health care and maintaining high standards of treatment are accredited by the international accrediting organizations. There are two different organizations that provides accreditation

1. Organizations that accredit the healthcare centers such as The Joint Commission International (JCI), International Organization for standardization (ISO), Trent International Accreditation Scheme.
2. The umbrella organization “The International Society for Quality in health care (ISQua)” that certifies JCI, ISO, Trent organizations to accredit health care centers.

2.1.   Understanding approval

After a person has decided to undergo treatment in abroad the next thing he should focus on, is the quality of service, technological advancements and standards, qualification and experience of the physicians, the hospital norms for controlling spread of infections. To know all these information, a person need not surf the net and read through the entire check list of norms and standards followed by the medical providers. Just relax!  And check only for the term “accreditation”.

The term accreditation means the hospital fulfills all the basic standards and follows the list of norms for providing the best world-class care. Hospitals that are accredited subject themselves to a comprehensive evaluation and make an effort to improve the healthcare factors that may directly or indirectly involve the quality of the care and safety of the patients.

“The act of accrediting is granting of approval to a hospital by an

official review board after the hospital has met the specific code

of practice for medical tourism.”

Importance of Accreditation

Patient’s perspective

Entrusting life and health in the hands of a completely unknown physician in a far away country is really like inviting more troubles. Any patient entering a health care center deserves to know the quality of treatment provided, its facilities, maintenance of cleanliness, how well the physician and staff’s are trained, and what step they follow to minimize infection etc. It is always advisable to avoid non-accredited hospitals when opting for a medical trip. Accreditation assures the medical tourists that the hospital adheres to certain standards, medical code, professional ethics, and strives for excellence. It helps to weed out non-standard hospitals and unprofessional physicians. Also, many insurance companies refuse to pay back the cost of treatment that is undergone in a non-accredited hospital. Patients can always demand for accreditation information’s like – What type of accreditation the hospital has? When was it accredited? On what basis the accreditation was given? How the hospital maintains the standard of accreditation? Hospitals’ being transparent and honest to medical tourists about this fundamental information is very important.

Few important standards which the accreditating organization look for are – patients care, physicians credentials, medication management and use, and confidentiality of information.  Always before flying for Medical Tourism make sure to carefully research the facilities provided by the health care center, and choose the health care center that are accredited by national or international accrediting organization.

From the perspective of the healthcare center

By gaining accreditation, the healthcare centers notify the people that it is providing good services. It also ensures the patients that the quality is continuously monitored and the institution is working to improve its services. There is always an opportunity to correct and improve the work done by the organization. Accreditation gains the hospital a world-wide recognition. International accreditation attracts patients from all over and promotes medical tourism. Due to rapid development of medical tourism industry, good annual revenue is earned by the accredited hospitals. The quality of services provided by an accredited institution is high and the chance of complaints from patients and staffs will be reduced. Many funding agencies also look for accreditation of the hospital. It also contributes to good staff-management relationship and improves staff morale and culture in the organization. Feedback from the accrediting organization often helps to increase the standards of the hospitals.

From the perspective of funding agents

By funding an accredited hospital, the funding agents are confident about the return of investment compared to non-accredited service providers. In an accredited organization, regular auditing is not needed, an annual auditing is sufficient. Effectiveness, efficiency and client satisfaction are the key elements which a funding body always looks for and this is ensured to them in an accredited hospital.