Doctors
Christopher Jones and Louis Keith are both experts in the field of medical
tourism. Dr Christopher Jones DPhil is founder and managing director of
Patients Without Borders. Dr Louis Keith MD PhDis chairman of
Medical and Scientific Affairs, Patients Without Borders LLC and Emeritus
professor of Obstetrics & Gynecology at
Northwestern University Medical School in Chicago.
IMTJ
asked Dr Jones and Dr Keith for their opinions on a number of important issues
facing the medical travel industry.
What
is the biggest challenge facing the medical travel industry in 2007-08?
There is no simple answer to this question
because the challenges are multiple rather than singular. Speaking from the
perspective of the American health traveller, at least five issues of concern
come to mind. Obviously, the order of the issues differs depending on the
patient, the condition to be treated, and whether the travel is for elective or
obligatory treatment. First, safety is always a major issue. Unfortunately, the
word safety is used differently by different individuals. For one traveller, it
is the safety of the procedures and cleanliness in the medical facility or
hospital. For another, it is the safety of the water used to prepare the food
served to the patients and his or her family. Regardless, safety like beauty,
is defined by the patient who wants a level of comfort to be available upon
arrival and to be discernable during the process of choosing a medical facility
or destination.
A second concern relates to quality control.
Here also this can mean quality control of the sterilization processes during
an operation or quality control of the credentials of the physicians and
ancillary staff. Depending on the sophistication of the patient, expectations
for quality control may vary greatly and this variance may embrace both
internal and external methods of quality assurance.
Third is accreditation. Here the
expectation is that an external body will have inspected the physical facility
and the processes used within the facility to ensure that safety is always a
foremost consideration. In the United
States, accreditation is usually provided by
the Joint Commission International (JCI). It is of interest and a sign of the
growing importance of accreditation on an international basis that some
destination hospitals advertise that they have been accredited by JCI as a
means of attracting patients and ensuring their maintenance of high standards.
A fourth consideration is the provision for
follow-up care. Obviously, this will vary greatly with the treatment given and
can be expected to be more efficient if the patient’s referring physician is
brought back into the loop, full and complete records are provided and detailed
post-care instructions are sent. Failing this, the least that can be expected
is that the destination health care facility will assist the patient in finding
a home medical care facility to follow-up all aspects of treatment.
The final concern relates to the resolution
of complications. This is necessary because the success of medical therapy
cannot be guaranteed regardless of where it is
obtained. Nor can practitioners ensure that the treatments and procedures used
will be completely devoid of risks. A good destination facility will have
thought this issue through completely and provided the patients with printed
copies of their policies and procedures should this eventuality come to pass.
Should
countries focus on their own populations rather than seeking to attract paying
clientele from overseas destinations?
The
obvious answer to this question is,
quite simply, yes, but this is far too simplistic an answer and
probably
represents a Western medicine bias. What do we mean by this? If the
respondent
to the question lives or has trained in a Western or so-called
developed country, it would be hard to answer anything but ‘yes’
because
that question is a matter of the public consciousness. Further, these
Western
or developed countries, have a much better physician distribution than
many of
the destination countries. This means that the likelihood of the poor
being
totally disenfranchised is far less than might be the case in a
destination
country, especially where the poor live in isolated areas with little
or no
connecting transportation to places where medical care can be obtained.
If one were to answer the same question,
having been trained as a physician or having lived in an urban area in a
medical travel destination country, the response might be totally different and
go something like this: “The poor have always had to fend for themselves in the
country and have never had good access to the cities with medical care. Why
should those who live in the cities and have developed good destination medical
centers which are attractive to foreigners, halt our efforts because of the
existence of the poor in the country, since we are not responsible for their
being poor or living in the country.”
The middle ground here, working with rather
than against existing price differentials, is a business model to provide safe
voluntary opportunities for medical tourists who may wish to give back to the
country in which they are being treated. To us, this appears to be a rather
good way of benefiting both parties. For example, a married American father of
three may elect to have his heart valve repaired in India. If integrated measures are
in place, those family members who choose to accompany him on the medical trip
might find the opportunity to provide some social or community intervention, to
express thanks at being able to take advantage of the price differentials.
You see, the whole world is going ‘green’
but flexi-fuel cars were not initially invented to save the planet. They were
invented quite simply to satisfy a growing demand for cars, particularly in India and China. Regardless of the original
intentions, marketing these cars to families mindful of their carbon-footprint
has been hugely successful.
By the same token, we cannot expect
hospitals in foreign destinations to offer voluntary services as an act of
contrition, even though many medical tourists are socially minded and middle-aged with families or friends accompanying them.
The same people who request donations to charity rather than tangible wedding
gifts would sooner choose a clinic that promotes the local economy than a
clinic that feigns to be an oasis in locations well known to have poverty and
health disparities.
Presumably, an arrangement would be made
between the private hospital and local charities. There may even be special
government or tax incentives for such an initiative. Ideally, the medical
travel hospital would participate in these voluntary opportunities to pull-up
the livelihoods of the wider population. This opportunity may be totally unique
and in all likelihood would never be available in countries such as the United States.
If a portion of the cost of treatment went
as a donation to the local project, a positive externality could result in a
wider recognition of the problems, as well as wider recognition of the programs
to deal with the problems. In our experience, patients want transparency and
such a program would greatly enhance a receiving hospital’s transparency in the
eyes of patients seeking its services from far away.
You
started a new company - Patients Without Borders LLC - which has an
Investigative Health Division. What do you do and how is this company different
to other medical tourism firms?
Firstly, we do not connect patients
directly with providers so that is how we are different from medical tourism
firms, or so-called ‘medical middlemen’. Patients Without Borders LLC was
established as a full service consultancy to provide objective and often
academic policy insights into the $60 billion medical tourism and clinical
outsourcing marketplace. That estimate is widely quoted by most medical travel
experts and we came up with it in 2006.
We have a special division called
Investigative Health because in many instances we are called in at the last
minute to investigate the value (for example, cost-effectiveness) of a product,
hospital or entire marketplace. Here we can send a team of specialists to
liaise with local health ministries to ensure that ethical, legal and policy
protocols are met. Whereas other vendors may not wish to work in foreign or
remote settings, members of our team are not shy of travel. Our specialists
have experience working in a hospital setting as top-100 doctors, in the
laboratory as pharmaceutical leaders and on the ground as academics in leading
institutions.
Here is a recent example of the types of
services we provide. A Middle Eastern Health Ministry contacted us to provide a
feasibility analysis of the outsourcing marketplace for clinical trials in
their country. Not only did we determine that capturing the ability to manage
outsourced clinical trials would bring in an estimated $50 million in
additional revenue the first year, we showed that carefully guiding this market
with trained project managers would ensure safety and ethical provision of care
which would benefit the trial participants – the patients themselves. The
hospital, owned by the government, was concerned about legal recourse and a
lack of cultural sensitivity for trials conducted in their country. We
recommended a strategy of hiring and training local project managers that
worked within the cultural context. The client was sufficiently pleased that
they decided to retain us for a longer term project, ahead of other vendors.
Our reasonable prices were one thing, but they were confident in our
transparency and respect for local ethics.
In this case we relied on our exceptional cast of knowledge leaders who
advised on a sensitive situation before it became a problem.
Our motto is quite simply “our center is
not our perimeter”. We are based in the USA but can have a team of experts
on the ground in another country the next day if they require high-end policy
analysis. And we leave no stone unturned. Where possible, we liaise with local
thought leaders so that we do not miss anything important. The larger
consulting firms are often unable to be this thorough because they run a volume
business. Our business is building long-term relationships with the primary
goal of safety, and secondary goal of profitability. We protect the client from
going down the wrong path and leverage their core competencies so they can participate in the medical travel and
outsourcing industries as leaders. Further information on our firm can be found
at www.investigativehealth.com.
