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Healthcare standards and certification with a regional flavor...do we need them?

Accreditation check list

In his Second Opinion column, Dr Constantine Constantinides from healthCare cybernetics questions the need for and motivation behind the development of regional standards, certification, and accreditation and wants to see more “evidence-based” support for some areas of health tourism.

I am a frequent participator at medical tourism conferences (which by the way, is not what I consider to be my business activity). Not infrequently, I have to sit through one more presentation about one more new “Standard”, Certification” or “Accreditation” scheme. Some of the proposed schemes are “region specific”.

I strongly believe that the driver for this proliferation of “region-specific” (e.g. African, European, Asian, and American) standards and certification schemes is not necessarily about primarily improving service quality and patent safety. My cynical side tells me that the business and professional motives of those who promote these schemes have to be considered.

Such initiatives may be dressed in the mantle of a “Non Governmental Organization”, a “Not for Profit” and may be clouded by the requisite .org website address. Self-appointed consumer advocates and activists may raise concerns about protecting the safety of the “regional” consumer.

So the question arises...are individual consumers asking for and demanding the establishment of region-specific standards to protect their health? Or are  “international” standards not good enough?

From integration…back to fragmentation

When we are struggling so hard to create an integrated world, why go back on the path to fragmentation? In whose interests and benefit would this be?

Is there a place and a value for “region-specific” standards and certification? In my view….possibly, but only for “appropriate technology”, in third world countries, where the concept and practice of “appropriate technology” has taken root and tends to keep people technologically behind the times.

(By the way, I like “appropriate technology” provided it is seen and applied as a “stop-gap” – whilst parallel efforts are made to elevate things, and people, to contemporary world standards.)

Standards, certification...and protectionism

Protectionism is something which I abhor. I see the introduction and imposition of “region-specific” standards and certification as a form of regional protectionism. Consider the obligation (and complexity) of US medical doctors (physicians), lawyers and other professionals having to register separately in each US state that they want to work in.

What purpose does this serve? Is this aimed at protecting the consumer?

The concept and issue of “evidence-based”

And as for standards and certification for health services which are (as yet, at least) not “evidence-based” (e.g., spa services, some wellness services, homeopathy and osteopathy), well, what can I say?

I am repeatedly riled by unsubstantiated claims and assertions of efficacy and effectiveness of products and services in the context of health. I will support and even champion health-related products and services, once I am presented with...evidence.

And how is evidence acquired and demonstrated?

  • Double blind (and controlled) studies
  • Results which can be duplicated /reproduced by unrelated and independent others

And a final comment...on accreditation schemes

Not infrequently, I am asked for (free) advice on which accreditation scheme a hospital should go for.  My standard answer is this.

  • Ask your clients /customers.
  • Ask the payer / cost bearer  - statutory insurance organization, health insurance scheme, national health system.
  • And check how deep your pockets are before you decide.

By the way, expect during 2011 to hear of a European JCI-like Accreditation Scheme - or JCI “lite”.


Profile of Dr Constantine Constantinides

Constantine Constantinides

Dr Constantine Constantinides runs healthCare cybernetics, a “think and do tank” with a recognized competency in Health Tourism Integration and Development. His home base is on the island of Samos in Greece.

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