Measuring performance and quality in medical travel
BY STEVEN TUCKER, President, International Medical Travel Association
In
today’s complex and international world, it is harder and harder to
answer simple medical questions. For example, how would you answer
“Doctor, which is better: a bypass or angioplasty; conservative back
treatment or a lumbar discectomy; robotic video-assisted prostatectomy
or radioactive seed-implantation?” Historically, this field of research
has been called outcomes research and it is becoming increasingly
important today.
One of the most quoted and oldest “outcomes”
studies was conducted by Florence Nightingale in 1854. When she
arrived at the hospital in Scutari (in what is now Istanbul), Florence
was shocked by the unsanitary conditions and the high mortality rates
of the ill and wounded soldiers. She and her team of nurses reversed
the existing conditions by applying strict sanitary programmes across
the hospital and keeping exact records of the mortality rates of the
hospital patients.
Following these changes, the mortality rates
fell from 40 percent to two percent. Her outcomes-based approach, with
its emphasis on uniformity and comparability of the results, is
recognised as one of the earliest examples of what is now called
outcomes management.
Today, 154 years later, it appears that the
tipping point for going from elective “medical tourism” to medically
necessary “medical travel” may be dictated by a similar process.
Growth in medical travel is in the hands of large multinational
third-party insurers. These insurers, mainly from North America and
Europe, are now looking at Asia, South America, and India as reasonable
destinations for advanced medical care.
One of the key issues
for insurers, as well as government health service managers, is to
avoid the mistakes which have led to spiraling costs in the United
States. Today’s buzz words in healthcare circles are “pay for
performance” and “quality outcomes”. Despite the universal lack of
agreement on what to measure, or how we rate performance or even define
quality these ideas can, will, and must move forward in the global
healthcare arena.
Although understanding of these concepts is
still, for some, in its infancy, they are important carriers of the
weight of proven measures. For example, “pay for performance” is the
concept where doctors are rewarded for meeting pre-established goals
for delivery of healthcare services. This model rewards physicians,
hospitals, medical groups, and other healthcare providers for meeting
specific performance measures for quality and efficiency. The high
cost of Western style healthcare has pushed this idea to the top of
healthcare debate and is even featured in US presidential elections.
Despite
enthusiasm from administrators and purchasers of medical care, the
field is young and has yet to show real-world savings. Professional
medical associations and many influential physicians have also voiced
concern over the validity of simplistic quality indicators.
Processes
such as these are going to become more prominent in the evaluation of
medical travel and medical tourism. And, of course, we should never
forget that many individuals also travel at their own expense in order
to receive what they consider to be appropriate treatment.
The
International Medical Travel Association is dedicated to improving
healthcare for global patients and securing the medical infrastructure
for doctors and hospitals. Throughout this year, we will explore,
debate, and define evolving medical and public health concepts as they
relate to medical travel. We plan on reviewing:
- Evidence-based practice
- Outcomes and effectiveness
- Effective healthcare
- Technology assessment
- Preventive services
- Clinical practice guidelines
Since
you are reading this journal, you know that, along with all of us at
the forefront of medical travel, medical travel will only get bigger as
the world around us continues to get smaller – or, as some would say,
“flatter”!
