Last week as I was seeing off yet another satisfied customer back home to relay the amazing experience to his friends, family and generally anyone who will listen, I thought back over our patient experiences to the common theme that “wows” each and every one of them… The Medical Tourism Care Factor.

While much is out there on Medical Tourism accreditation, quality outcomes, medical training etc, the importance of ‘care’ seems somewhat swept under the carpet. Don’t get me wrong, quality assurance markers are extremely important; but in my experience, in patient testimonials, they are not saying “Wow, the hospital is internationally accredited” or “The surgeon has one of the lowest post-op infection rates out”. However, it is pretty common to hear “the surgeon made me feel so comfortable”,  “I felt like I was more than a number” or “The nurses were so attentive and caring”.

My suspicion as to why the care factor is not broadcast more widely is that it is beyond most Medical Tourists imagination. Remembering, that in many cases the starting point to seek treatment abroad is the disillusionment that they have experienced trying to access affordable care within their own health system. To tell someone in this situation that, not only will they receive excellent medical treatment at a lower cost, but they will also feel important and cared for while they are doing so, is like trying to explain Filet Mignon to someone who has only ever had burgers. While they know it is special, they can only really know the difference by experiencing it themselves.

This ‘Care Factor’ goes beyond one person to the whole experience; the call and guidance their facilitator gives them while they are deciding, the pre-operative experience with the surgeon, the hospital and nursing care, recuperative care, right through to the follow up once they return home. Get it right, and it is a recipe for health care success.

Related posts:

1. The Great Unknown – Is leaving home for healthcare really that scary?

Much has been written about the ebb and flow of opportunities around Medical Tourism as an attractive option for Americans seeking cheaper health care outside their own borders. From predictions of stellar growth by Deloitte in its 2008 report on the Medical Tourism market in the US, to significant downward revisions of forecasts due to the economic environment; authored by Deloitte in the 2009 installment.

Opinion generally around the fortunes of Medical Tourism are polarized, ranging from examples like; USA Today picking medical tourism in the USA to be one of the top 10 trends during 2010, to an article by Keith Pollard “Treatment Abroad” that points to medical tourism remaining in the margins for the foreseeable future. http://www.imtjonline.com/articles/2010/the-outlook-for-medical-tourism-30034/

Apart from feeling the need to reach for a bottle of Prozac and a stiff Gin after reading parts of Keith Pollard’s article, the issue I have with his opinion, is that it implies that Medical Tourism was originally prophesied as a Holy Grail, mainstream, overnight solution to the current issues facing the US health care landscape. In reality, Medical Tourism is a channel option within the business mix and will always be so. As such, being in the margins is probably a sound footing from which to continue to build on a beachhead industry, moving it towards a longer term goal of wider understanding and acceptance within the US health care landscape. As trite as it may sound, Rome wasn’t built in a day, or for that matter, a year.

Of greater interest, and proving that a week can be a long time in politics, was the election of Republican candidate Scott Brown to the US Senate. In doing so ending the 47 year stronghold by the Democrats in Massachusetts by the late Senator Kennedy, and preventing the Democrats from passing major reforms through the Senate unimpeded. A key reform Health care now appears stalled as the Republicans, with new found power, push back in response to, what appears to be, resounding public opinion. Watch this space, as it now appears that the already watered down health care reforms will be further watered down and in the process perhaps further opening the way for opportunities in Medical Tourism… watch this space.

Related posts:

1. Boutique Medicine – American style or New Zealand?

Apart from the cost one of the major differences between the majority of US healthcare and medical tourism destinations appears to be the personalized service one receives.

For example, the private healthcare offered in places such as New Zealand is the boutique option. You can choose your hospital, doctor and the day of treatment but you have to pay. In contrast, the public healthcare system in New Zealand is government funded and hence there is no charge for its use by individuals. Indeed the same doctors work in both systems. The real difference is in the waiting time, and choice of doctors.

Contrasting this with the US health system where a recent article cites an example of the same medical clinic having two entrances: one for the insured clients and one for the self- pay. The self pay got the boutique service; to see a doctor and the higher charge. The insured patient got the diagnostic test but very little more and their insurance paid (a reduced rate).

It appears more and more Americans are walking away from insurance and wanting to make their own decisions with added benefits that feel to them that they are receiving fair value for their own non-insured, self pay health dollar. In this environment of consumer driven healthcare, medical travel must be an option.

Americans now have a boutique option of medical care in their own country where increasingly the customer not the insurer pays. Since the customer can not negotiate substantial discounts, (like the insurers) they pay … a lot.

Hence to travel overseas for easy access to the same level of service, a single invoice (if not more personalized), for 25% the cost of the boutique service in the US, with no bureaucratic minefield or unexpected bills starts to sound attractive.

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1. Defensive Medicine – Why Americans Pay More

This recent article in the New York Times clearly highlights the disconnect between consumers and the US health system. These individual stories not only highlight the personal issues that these people face, but the economic concern that these people should be recognized as presenting to the US economy. These are stories about people in their economic prime who instead of being able live life and focus the contributions they can make to their families, communities and the wider economy through their work, worry more about the risks and complications of  living with or without Health Insurance, knowing that they are probably quite literally one medical incident away from potential financial disaster.

The New York Times introduces the story as follows and I quote.

“Much of the debate about health care reform focuses on people who don’t have insurance. But as Karen Barrow explores during the latest Patient Voices series, even people with insurance coverage are struggling with bills, confusing policies and red tape.

Six men and women share their experiences with health coverage and insurance issues. You’ll meet Tasha Huebner, 41, who found dealing with the insurance company worse than dealing with breast cancer. “With insurance, it was always a big surprise, what are they going to deny next?” she says.

Once she called her insurance company to find out why a $5,000 surgery bill had been denied. She was told it was because she had one too many nurses in the operating room during her surgery. “At that point I hung up on my insurance representative that I was talking to,” she says. “I didn’t even know what to do with that.”

Zoraida Reyes, 46, is a small business owner who was forced to cut health insurance, including her own. “I work six days a week, and I can’t afford insurance,” she says. “You can imagine the people who have a lot less than me, they’re probably worse off.”

And there’s Carl Arrington, 58, who lost his health insurance after his Internet company closed. Instead of paying for health insurance, he decided to invest in his health, changing his diet and exercising more. “If you’re in your 50s or 60s and you don’t have medical insurance and you don’t get it through your employer, it’s going to cost you two or three thousand dollars a month. With that kind of money I could see a doctor every week.”

Adrienne Schroeder, 31, has high-deductible health insurance through her husband’s job but is saddled with medical debt as a result of four pregnancies in six years, including two that ended in miscarriages. “Since we have insurance we should not be worried about having a baby or having a miscarriage and be stressed about how long it takes to pay it off,” she says. “Our daughter is near 18 months, and we’re nowhere near paying off these hospital bills.

The majority of the people in this story are representative of a Medical Traveler demographic that are coming to New Zealand in gradually increasing numbers for non-urgent or elective medical procedures as an alternative to the high cost of care in the US.

When considering travelling abroad for medical care a fundamental question is why is the destination I am travelling to able to provide healthcare at significantly less cost than America? The answer is two fold.

Firstly from a historical perspective most of the destinations offered in the past have been third world countries which have built hospitals not to service their own population , who in many cases can not afford them. but to cater for the local wealthy and overseas patients, yet leverage a local economy offering cheaper labour and materials.

However with the advent of first world countries like New Zealand, Belgium, Ireland and Germany offering their themselves as destinations one asks how can they provide such high quality care at significantly less cost than the US system? How can cardiac surgery in New Zealand cost 25% of the same surgery in the USA, even though both sets of surgeons are US trained?

One fundamental difference is the widespread practice of defensive medicine throughout the US system, illustrated in the recent article Costs of Defensive Medicine

A 2005 study of 824 doctors in Pennsylvania by Havard School of Public Health and Columbia Law School found 93% reported practicing defensive medicine

Driven by the financial need not to be wrong doctors in America it seems over treat and over diagnose. Operations it seems are performed that are both unnecessary and wasteful, let alone an unnecessary risk to the patient. Screeds of CTs and MRIs are done because the punishment of missing something is far greater than the satisfaction of having the confidence to say to the patient ”Even though we could do this test in my opinion you don’t need it”.

In other first world countries it is perceived that doing that unnecessary test is a risk to the patient. In America it is perceived that not doing the test is a significant risk to the doctor.

In Atul Gawande’s erudite commentary of the state of the US  healthCare system- The Cost Conundrum we hear that

Spending on doctors, hospitals, drugs and the like now consumes more than one of every six dollars we earn, The financial burden has damaged the global competitiveness of American businesses and banrupted millions of families, even those with insurance

Well to use a wellknown American saying ” Houston we have a problem….” and to an outside observer…it seems to be a big one.

The issue is that other first world healthcare sytems are not really cheap; its just that Americas healthcare system is really and truly massively expensive. The dramatically high prices American consumers are paying is for not higher quality procedures but for a wasteful system.

Other English speaking first world countries offer just as good quality healthcare as the USA; in some instances due to the co-ordination of aftercare, the access to the surgeon for the patient, they offer a better more personalized healthcare experience.

Its just at a cheaper price.

Related posts:

1. Boutique Medicine – American style or New Zealand?
2. The Great Unknown – Is leaving home for healthcare really that scary?

It is a story heard all too often in Medical Travel stories – The patient who needed surgery 5 years ago and has sacrificed quality of life because they can’t afford surgery. Desperation pushes them to seek out other options and that is when they pack their bags and head for foreign shores. The only regret when they are headed back home pain-free… waiting for so long to do it.

So why are people waiting? Three reasons I can think of:

1. Financial – Yes it is much cheaper, but what if it I still don’t have the cash?

2. Lack of knowledge – I didn’t even know that these options were available?

3. Fear – I have never been outside of the USA, I don’t know what to expect, it’s too hard.

The first 2 are easy. Financial assistance is available for medical care and some options will extend to offering assistance to medical travelers. One such option is mymedicalloans.com who offer assistance to New Zealand bound medical tourists.

The industry as a whole is doing a fine job at raising the profile of Medical Tourism and the PR surrounding it, means that the message is slowly but surely getting through. One of the most effective means of education is through word of mouth and the more happy patients going back to the USA, the more that seek out offshore options.

So coming back to fear – I certainly understand it. Medical treatment is scary and confusing enough on its own without adding the distance factor to it. But there are many ways that you can make your journey a whole lot less daunting with a few simple steps:

1. Research your destination

Find out all you can before you go about the country and customs you are going to so you know what to expect. Look at travel forums to get insider tips. Know how you are going to get from A to B.

Research the medical care at the hospital as well. Find out outcome information, number of surgeries the surgeon has performed. Nurse to patient ratio’s. Number of english speaking staff.

2. Talk to previous patients

Most good facilitators or international patient departments will be able to arrange for you to contact a patient who has agreed to talk to prospective patients. They will also be able to give you insider tips and reassurance of the quality and ease once you get there.

If you can’t talk to a patient then seek out credible testimonials. Good facilitators or treatment centres will have them readily available on their website.

3. Select an appropriate destination

There are so many Medical Travel destinations out there these days that you can pick and choose based on factors that are important to you. Do you want to choose a very safe destination? Is an English speaking destination important to you? Make a checklist of things you want in a destination and then start matching the available destinations to your wishlist.  If you are a fussy eater, you don’t want to go to somewhere that has food tastes vastly removed to what you are used to.

4. Find a facilitator you can trust

You should feel comfortable with the facilitator you are using. These are the people that you are entrusting with your healthcare, if you can’t trust them then find a new one! You should be able to ask them anything, if they don’t know the answer right off, then they should be finding out for you. Some patients actually find that traveling abroad for healthcare using a good facilitator is easier than staying at home, after all the facilitator knows the system inside out and takes care of everything for you. How many people can say that about using facilities at home?

5. Take a companion

Medical Travel is much easier with somebody to share the experience with you, but choose carefully. Someone who is off shopping or playing golf the entire time is not helpful. It is common to feel a little blue after surgery no matter where you have it and having someone on hand who can sympathize and help cheer you up is incredibly helpful. If you can’t take a companion then talk to your facilitator about home care assistants, it is amazing how much difference a friendly face makes when you are recovering.

There are many more tricks of the trade that make the medical travel experience a whole lot easier but the underlying factor is that a GOOD facilitator can make the process easy and familiar. Never underestimate how valuable being greeted by someone you trust and 24 hour assistance can make to the ease of your journey. Even at home haven’t you ever wished that someone would just figure it all out for you? That is the Medical Travel difference… They do!

Related posts:

1. 10 Handy Tips for Hip Replacement Surgery Overseas

As traveling overseas is becoming a more widely accepted way of receiving medical treatment, here are a few key questions to tick off your list when considering an overseas destination.

How far do I need to travel?, Is it a direct flight or multiple stop overs?

Where possible try to book direct international flights rather than flights with 1 or 2 stopovers. You might not notice it so much traveling to the destination, but returning home after surgery could prove to be far more taxing than it needs to be with lengthy stopovers included in your travel plans.

How easy is communication with the doctors and nursing staff of the destination Hospital?

When dealing with issues about your health it’s vital that you are not in the position of not being understood, or not understanding what the doctors and nurses are saying. For example if you are an English speaker, consider countries where English is spoken as the primary language first.

What is the total cost of the package

Most destinations advertise medical procedure costs only and compare them to similar US based medical procedure costs. This is meaningless as you need to factor in the cost of travel, accommodation, aftercare and transport costs within the destination country. Always compare the total package cost of the destination to the procedure cost in the US for a true savings comparison.

What are the Potential hidden costs in the packages?

You don’t want any surprise costs when you travel to the destination country. Never assume, always confirm what additional out of pocket expenses you can expect.

What happens after discharge from Hospital, does the destination country provide comprehensive aftercare?

This plays a critical part in aiding your recovery after a medical procedure. Some destinations provide daily physical therapy, excercise routines and nursing programs in your Hotel to aid in getting you back to full health as quickly as possible. Some destinations also provide domiciliary aids to help with shopping and even dressing if required. Not having comprehensive aftercare can impact on the success of your procedure and recovery time. Make sure you fully understand what you will be receiving in the way of aftercare post surgery.

How transparent is the medical destination?

Will the destination hospital share surgical outcome data concerning their hospital and the procedure that you are traveling for? How many operations has the surgeon you are seeing performed and what training has the surgeon undergone? Can you talk your procedure over with the surgeon prior to leaving home? Can you talk to other patients that have already been there? All important points to help build both your understanding and confidence in the overall process.

What happens when things go wrong?

In the majority of western hospitals, the risk of complications is minimal but never zero. Adverse events happen even to healthy people. Find out what contingencies the destination hospital has in place to ensure you are looked after if you have a complication, and what it will cost. Some Destinations include contingency insurance to protect you against additional costs incurred as a result of an adverse event. It’s an important point to check before you agree to travel.

Will you feel safe and comfortable traveling to the destination?

Traveling and having a medial procedure will make you feel considerably more vulnerable than usual, so you must feel you can trust the destination you have chosen to make you feel comfortable and safe. Complete culture shock can be avoided by selecting a safe and culturally similar destination to your own, consider destinations that are safe, friendly and conducive to aiding your recovery.

What is the main purpose of my travel?

While beautiful beaches and scenery might sound enticing, they shouldn’t outweigh the quality of care factor when deciding on the destination. The time you spend at the destination may involve some must see tourist sites and experiences before the operation. However, after the operation you are more likely to be solely interested in getting better and getting home, so plan carefully.

These are just a few things to consider when traveling for medical treatment. A professional well focused medical destination will have anticipated many of these issues and questions, making the process of traveling there is as simple and risk free as possible.