This week saw the publication of the “Top 10 World’s Best Hospitals ™ for medical tourists” by the Medical Travel Quality Alliance (MTQA). This list of medical tourism hospitals has raised some eyebrows in medical tourism circles and questions about the basis of selection and the motive for the initiative.
IMTJ’s Ian Youngman talked to MTQUA founder Julie Munro about the background to the list and how it came about.
What audits and checks were carried out to establish the rankings? Were they carried out by site visit, questionnaire, or tele-interview? Did a professional market research company or members of the MTQUA do the research?
We are not a research company so there was no thought of conducting a rigorous statistical review and comparing empirical data in determining the Top 10 World’s Best Hospitals for medical tourists. We did not do a survey, nor are we pretending to have done one. Rather we focused on the surrounds that make up the elements of a successful medical journey in medical and personal terms for the traveling patient.
How many hospitals were assessed in total?
We considered probably most of the hospitals that are promoting themselves as destinations for medical tourists. How many were seriously considered? A much smaller number, about 40 to 50.
American and UK hospitals were not included, as I believe that these destinations have traditionally been the medical choice for travelling patients with significant means and or special or unique cases. Our intention was to select international hospitals that offer services to the vast majority of people seeking care in a foreign country, whether uninsured Americans who need/want affordable care, Britons, Canadians and others who can’t afford to wait for care, or others who simply don’t have the care available at home.
What criteria were used to evaluate hospital performance and why?
In making our selection for the top ten, we carefully weighed a number of factors that we believe are the most important in a patient’s medical journey. It is not a perfect list, and even the number one hospital is not perfect but we feel these ten represent the best for a medical traveller based on our years of experience working with medical tourists from all parts of the world, patients’ comments, site visits, discussions with and recommendations from established medical travel agents, interviews with industry leaders, and information from the hospitals themselves.
We have identified critical components of care and management of the medical tourist, and not in any order of priority:
Value for services
International patient marketing
International patient management
Patient safety and security
Attention to the unique needs of the medical traveler
Regarding location or value for services (cost), hospitals have little if any power to affect changes or improvements in location or foreign exchange rates. They are subject to geopolitical and economic factors beyond the hospital's control.
In recent years, nearly all emphasis within the medical tourism industry has been on medical quality and on international patient marketing. Hospitals have been learning about and concentrating on medical quality and improving delivery and outcomes. They have also been learning how to market their services and how to drive patients to their facilities.
But a medical tourist’s needs go beyond medical quality, cost and location. MTQUA believes the industry needs to also consider four additional key ingredients of the patient’s medical journey. These can be controlled, improved, changed, influenced and managed by the hospital, clinic or agent, yet we as an industry have spent very little time discussing them.
Can a hospital on its own create the perfect journey for medical travellers? In our experience... no. I have seen hospitals try and fail. It takes a partnership, a network of all those who work with the patient: hospital, doctor, agent, home-based doctor, travel and hospitality staff, to create and manage the medical traveller's care environment. MTQUA is encouraging people and companies to identify and build networks of providers and service companies to work together in the best interests of medical travelers.
How was the judgment made on medical quality and outcomes?
As to outcomes, some hospitals on this list excel in outcomes and some are making commendable strides toward improving outcomes and making outcomes data available. But there is still a lot of work to be done in this area.
Most but not all of the hospitals are JCI accredited, meeting a specific internationally recognized standard. Those that are not JCI accredited, meet other standards such as their own country accreditation standard and recognition by their peers on an international level as having achieved excellence.
What are the international patient management criteria?
International patient management refers in part to protocols hospitals may or may not have in place for handling the needs of international patients including, in part, emotional issues, communication issues, family and home doctor contacts, legal obligations, unexpected events or situations. It also refers to the care management protocols that take the patient from initial inquiry to admission, discharge and follow up care.
Why did the press release only mention American medical tourists?
The American medical tourist is a good representation on a global level because more Americans tend to look for and travel far and wide around the globe for good healthcare, whereas other nationalities tend to travel regionally. We realize that what is good for these Americans is also good for everyone else.
There were some unusual names in the list.
You mean Schoen-Kliniken in Germany and Shoultice Hospital in Canada. The former regularly welcomes patients from the Middle East, and the latter being very popular with patients from the US.
You say that problems of terrorism downgraded Thailand hospitals, but not India.
The UK’s Foreign and Commonwealth Office advice to travelers to India includes,
“ There is a high general threat from terrorism throughout India. Recent attacks in Mumbai, Delhi, Ahmedabad and Bangalore have targeted public places, including luxury hotels and railway stations. Future attacks may target public places frequented by Westerners including in the major metropolitan centres (Delhi, Kolkata, Chennai, Mumbai).”
And on Thailand it says,
“ There is a high threat from terrorism throughout Thailand. Attacks could be indiscriminate, including in places frequented by foreign travellers.”
The point is not that Bangkok, or Monterrey, or Bangalore may be dangerous, if they were, they would not be on our list. Patients need to feel secure, and to be secure. Patients need to know their surgery and/or recovery will not be disrupted for external reasons. Disruptions can damage their health or create significant additional costs for them. They already have enough other health-related problems to worry about.
When the Bangkok airport closed, patients flying in for possibly life-saving treatment had to be rerouted, and herded into buses for an uncomfortable and possibly health-threatening drive to reach their destination. Patients ready to return home who had made arrangements for caregivers to meet them at their destination were faced with additional unexpected complications or expenses. Reports of political instability must be taken seriously. In our experience, these may not directly affect the physical safety of the patient but the call should be made by someone on the ground who represents the patient and who will act in the patient’s best interest. This can be a family member, friend or a professional medical travel agency. In our view, a hospital’s assurances are simply not good enough.
Turning to the MTQUA, how big is it?
We are a small organization with a small budget and modest staff. Support for the moment comes from my company InterMed Global. We have just taken on a full-time intern to help us in the coming months as we transition from a new business to a larger entity that I hope will find a way to generate some income. If anyone has ideas of how we can earn some money and grow revenues without compromising our mission, we want to hear from them.
All participants and advisors are listed on the website. Membership is growing slowly but steadily-35 are currently listed. All members of our advisory panel were asked for their support, and every single one has agreed to help our cause. We continue to add advisory panel members on a regular basis, people who believe in our mission and who are representative of the medical travel and health tourism industry.
Who votes on who runs MTQUA?
MTQUA is not an association, is not intended to be one, and does not pretend to be one. Hence no votes and no officers. It is our hope that MTQUA will become a home to networks of individuals, hospitals, and service providers in the medical tourism industry who want to promote medical quality and excellence for medical travelers.
I chose this route (non-association) partly because of my experience with industry associations, present and past. I am dismayed and disappointed when I hear so many people speak on behalf of the industry yet lack understanding or experience in what it takes to successfully provide for the medical traveller, because this is what it is all about.
The mission of the MTQUA is to advance patient safety and medical excellence for travelling patients by encouraging, developing and promoting professionalism in medical travel and health tourism. We are committed to raising industry' standards, to put quality first and to truly partner with hospitals and other providers as equals in the care of the medical traveler.
We’d like to hear what others in the industry have to say on this issue. The MTQUA’s rankings could be seen as one group's view of the ten best hospitals. Other medical tourism professionals might choose ten completely different hospitals. It depends on the criteria that you use and what exactly you are able to compare. For example, in the USA, Avery Comarow’s America’s Best Hospitals comes up with a very different set of rankings to HealthGrades because they are looking at different things. The difficulty in medical tourism and in comparing international hospitals is that no one has agreed the criteria for comparison; let alone how to collect the data to make these comparisons worthwhile!