As medical tourism industry is blossoming every day, the hotel industries soon began to sense the growing market because of medical tourists. The hotel industry also gained edge by holding the often held conferences and meetings. A medical tourist and his family requires accommodation, therefore, depending upon the treatment and the number of days required to stay, hotel accommodation can be booked in advance. Hotel reservations can be done online or through phone. Looking and searching for hotels on the day of arrival after a long, tired jet-lagged journey in a completely unfamiliar country is confusing and time-consuming. Many hotels, in order to attract medical tourists and also to be little out of medicine, offer many facilities like – spa offerings, Ayurvedic treatments, herbal massages, acupuncture, yoga, meditation, gym etc. Many hotels also offer after care facilities. The hotel management takes additional responsibility of training their staffs for better interpersonal communication and basic do’s and don’ts after surgery. They may also arrange for a dietician, physiotherapist and a round the clock care taker.

Ground Transfer Arrangements

There are several options for ground transportation from the airport to the hospital or hotel. Available ground transportations are buses, train, rental cars, limousine, and executive car or taxi cabs. Online booking of the ground transfer is also available; if the tourist has not booked earlier he may find a ground transportation help desk in the airport. Each of the industry providing these services are color coded. This will help the medical tourist to navigate their way through once they have arrived. The name and color of most industries are displayed above their location for convenience of the medical tourists. Special and exclusive ground transportation service is also available, on request, for elderly and seriously unwell people.

Counseling Clients about Trip Interruptions and Lost Baggage

Trip interruptions

A long pre-planned trip can be cancelled or interrupted due to personal reasons or due to weather or technical problems. While arranging for a long medical trip, a person spends money in areas like ticket booking where it is non-refundable. Having a trip cancellation or interruption insurance will help the person to gain back around 50-60% of the money.

Many insurance policies cover only for medical treatment procedures; therefore, it is always advisable to check with the insurer whether trip cancellation/interruption is also been covered.

Trip cancellation or interruption travel policy covers the cancellation under the following situations

• Illness or sudden death of family member
• Change of mind
• Sudden emergency health condition
• Sudden business conflicts
• Terrorist attack, hijacking
• Bad weather or natural disaster
• Medical quarantine
• Accident
• Staff and officials going out of service
• Unexpected delay in Visa or passport processing
• Stolen passport and Visa

After deciding a trip for medical tourism, a person might have a list of arrangements to be made but the main focus will be on travel arrangements. First and foremost the person has to book a ticket to the chosen destination. Identify the flight for the destination; ticket booking can be done online or through phone. Before booking the tickets the traveler must make sure to compare the pricelist of different airline services. To avoid these confusions many people opt for the option of going for a medical tourism facilitator, who takes care of every arrangements from the start of choosing hospital, taking care of travel and till the return to home. A journey to abroad may require things like:

Passport

A passport is an internationally identified document that is issued by the national government which recognizes the purpose of international travel and identifies a person’s name and nationality. If a person doesn’t have a passport, begin the process immediately as it might take 6-8 weeks. And if he already owns a passport, checking the validity of the passport before starting the journey is important.

Requirements for Passport application:

• Residential proof
• Passport size photos
• Photo identity proof
• Birth certificate/proof of age
• Passport fee
• Marriage certificate
• Fully filled certificate

Travel Retailing and Logistics

Planning and implementing medical travel for the first time might be really multifaceted; the tourist must take care of many aspects, where much focus is on planning and implementing the travel and cost of the trip. To avoid all these confusions many people opt for a medical tourism facilitator – who takes care of all the necessary arrangements from the time of decision making, choosing the best destination and hospital, till the return to home.

The journey starts with many questions, the person might have doubt whether he has taken the right decision, or chosen the perfect hospital and physician, the quality of treatment provided etc. The checklist before starting the trip includes…

•  Previous medical reports, X-rays etc
• Brief communication with the doctor regarding the treatment procedure and the cost of the treatment.
• Insurance policy papers
• A detailed (approximate) schedule about the trip is always useful – like number of appointments needed, number of days the patient need to stay, recovery time etc.
• Passport, Visa (if required), ATM/Credit cards
• Travel documents/tickets
• Contact address and number of the doctor and hospital
• Identification card

With the amazingly rapid growth of medical tourism, many national and international health care centers are promoting health care travel regulations. These regulations work towards promoting a significant medical regulatory system that aims at providing the fastest health care services, advanced technologies and medical delivery procedures in the world. The US Federation of State Medical Board (FSMB) along with International Association of Medical Regulatory Authorities (IAMRA) is working toward these standards. Many countries like India, Malaysia, Thailand and Philippines follow their own local regulatory act. But till now there is no international regulation for medical tourism.

India: The quality council of India has set up “Standards for the Quality and wellness industry”. This consists of a series of regulations that accredits the hospital providing medical tourism facility. These regulations will guarantee the medical tourist a dependable, quality conscious and service health care professionals. This regulatory act covers the wellness of service regarding

•  Technology
•  Skilled manpower
•  Infrastructure
• Consumer protection
• Procedures and controls

Regardless of the treatment a person wants to undergo, cost of the treatment has always been a major issue. Undergoing treatment in one’s own country where the cost is so high is not possible until the patient holds an insurance policy. In this case, if he wishes to go to abroad for treatment because of cost-effectiveness and less waiting time, he should clarify with the insurance provider whether his policy is applicable for overseas treatment as most of the insurance company does not provide an international coverage.

But as the popularity of medical tourism is increasing and people are aware of overseas treatment, many insurance companies have now come forward to provide Mediclaim for treatment undergone in foreign country. Few countries claim to offer insurance to the medical tourists, but as a foreign consumer the patient has very little right to get the money back. Most of the medical insurance companies look for JCI accreditation or any other international accreditation. Getting insured from an insurer who does not cover the regulations of the home country is riskier as the consumer protection law does not apply.

Insurance companies usually do not claim or repay the cost of treatment undergone in a cheaper medical center. Some insurance company along with paying back the money spent for treatment it also covers the expenses of travel, accommodation and other chargers of the tour for patient and an attendant. A recent report from McKinsey & Co. states that if insurance policy claims all these medical tourism expenses than annually around 500,000 – 700,000 Americans may travel overseas. Some insurance policies provided to medical tourists are:

Professional Liability Insurance for Medical Tourists

If a patient files a suit against the health care provider for negligence or unintentional misrepresentation of information, this policy covers legally the amount payable by the health care provider.

Personal Accident Insurance for Medical Tourists

This policy covers and pays a pre-agreed amount if the medical tourist is disabled permanently by accident or dies during the trip.

Trip Cancellation Insurance for Medical Tourists

The insurance company will reimburse the money for a prepaid non-refundable expenses like air-ticket, accommodations etc, if the journey is cancelled under emergency.

As known, medical tourism is emerging as extremely popular outsourcing industry world-wide. People travelling to far away land for treatment are always concerned about the quality of hospital, quality of treatment and the standards and norms followed by the hospital. Therefore, many laws are enforced by different countries which give the right to the patients to know why an organization is collecting all the details. How will they store the collected information? Will the information be shared with someone else? Does he have access to his own reports? This law also helps in filing a suit against the hospital if the concerned person feels that his privacy is not been protected and the reports are mis-handled.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) – US/India

The Health Insurance Portability and Accountability Act of 1996 ensures the protection of privacy of health information of an individual and the way the health care center handles, maintains and uses the health information. It is important to know that HIPAA protects only the individually identifiable health information. The Title-1 of HIPAA covers the insurance needs for patients, in case of change or loss of job. Title-2 (Administrative simplification) deals with preventing health care frauds and abuse. It points out the need for establishing national standards for electronic transactions of patient’s information and health insurance plan.

The Patient Safety and Quality Improvement Act of 2005 (PSQIA) - US 

PSQIA creates a voluntary organization called Patient Safety Organizations (PSOs). These organizations collect, aggregate and analyze confidential information reported by the health care providers. After analyzing, PSOs will identify the malfunction and suggest measures to eliminate patient safety risks and hazards.

Personal Information Protection and Electronic Document Act (PIPEDA) – Canada 

PIPEDA law was enforced to promote patients trust in computerized information. Apart from covering the information under HIPAA, PIPEDA covers other Personal information like education, marital status, religion, genetic and ethnic origin, income, purchase and spending details. The organizations under PIPEDA must obtain the patients consent while using or sharing any information. Security requirements like maintaining the records in locked cabinets or protection of electronic information by passwords are demanded by PIPEDA.

Personal Information Protection Act (PIPA) – British Columbia/Japan – 2004

This act protects the privacy of the patient’s information and suggests the health care providers to obtain consent before using or sharing of the medical information. This also provides rights to access and own their personal information and request for any changes or corrections if required.

European Union (EU) Law

The European Union law called the directive 95/46/EC, protects the privacy of individual data with regard to processing. Processing of data include – using, retrieving, disclosing, transmitting or other ways of using the data. The EU covers a broad spectrum of information including the medical information and personal data’s such as bank statement, credit card number, any criminal records, employment details and all other information relating to the individual. The EU data directive also states that only the authorized

controllers (individual or the government or private organization) only can process the data alone or in co-operation of other controllers. This law also prohibits the transfer of data out of EU unless the recipient country shows protection law similar to EU directive.

These above stated laws help medical tourists to have a successful journey and legally protect the privacy of their reports. Most of the Asian countries also follow these laws.

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.