The
problem...
There
has been much discussion on forums recently about certification and accreditation
of hospitals, price versus quality and negative stories on medical tourism.
An
impossible solution...
One
solution is to create an international body accrediting, certifying and able to
expel for poor standards, "bad behaviour", hospitals, clinic, doctors and agencies promoting medical
tourism. This will never happen... although it will not stop people pursuing
the dream of 'global accreditation' in the medical tourism sector.
We
already have national and international accreditation of hospitals and clinics
but country pride stops there being on international body. If anything,
countries are moving to set up local alternatives to overseas accreditors.
Medical
quality and medical tourism quality are different beasts.
The
really big problem is that having medical accreditation does not mean a
hospital or clinic is fit to deal with medical tourists. What are the language
flue cues and cultural understanding of doctors and nurses? What about ethnic
foods and religion? What about pre-care, post-care, patient record systems, and
dealing with accommodation and family members travelling with the patient? The
list goes on.
A partial solution
There
is a partial solution that can work where a country has very tight government
control over local hospitals. This already happens in Malaysia and South Korea,
and is coming in Japan. It only works where the government effectively has
control over most medical tourism promotion. That solution is to only promote a
handful of specially selected hospitals and clinics by effectively giving them
medical tourism licences over and above normal medical ones. There seem to be
fewer problems of negligence and consumer problems in Malaysia, and to a lesser
extent in South Korea, compared to 'ease of entry' competitors such as India
and Thailand. It could work in China and Singapore too.
But, I
cannot see this being of any benefit in Europe, the Middle East or North
America; the numbers of potential hospitals and clinics is huge and government
control is far less tight.
Regulation by the medical tourism
industry
There
is an argument for self-regulation. But we have scores of organisations
offering a variety of accreditation and certification services, some of which
require nothing more than paying a fee. But there is no consistency between
providers and we have all seen what happens when you effectively allow bankers
to control banking regulation!
Regulating medical tourism agencies
Consumers
do not know if a medical tourism agency is working for them for a fee, working for
the hospital for a fee, or both. Some agencies seem to ignore all principles of
agency law and try to have it both ways.
My
proposed solution is that every single medical tourism agency should be
regulated and licensed by the country they are in. Those countries that only
allow travel agencies to trade would find it easy to adapt as they already have
different rules for travel agents, tour operators and airlines. Those countries
that allow anyone to act as a travel agent would find it harder, but at least
the consumer would know if an agency was or was not licensed.
Regulating hospitals and clinics
The
problem for many customers is that they do not know if a clinic is a world
leader attached to a teaching hospital, or an unlicensed shack in the middle of
nowhere where a beautician has a go at cosmetic surgery with no training.
Pretty pictures on websites can be faked easily, as property scammers have done
for years. It is relatively easy to know if somewhere is a world leader or is a
tiny one-man band. But the vast majority of hospitals and clinics are in
between.
Perhaps
we should stop re-inventing the wheel. When you plan a holiday or business trip
one of the first things you do is to see if the hotel is one or five star,
whether it is just bed and breakfast, or self-catering, or even a tent. The
type of accommodation gives you a good clue on how much you expect to pay and
the facilities. Some of the problems with medical tourism is that the customer
is sold a “ five-star hospital” when in reality it could be a “no star
boarding house” The customer has no way of comparing prices or value.
The
solution...
We
should talk to and learn from the specialist organisations that offer
international and national ratings for hotels and restaurants and adopt a star rating system for every hospital and
clinic in the world that seriously promotes medical tourism.
Perhaps
at the next medical tourism conference, instead of listening to the umpteenth
presentation from Borovia on why we should send people to its “ world class
hospitals, top doctors, great tourist attractions and lowest prices”, delegates should talk about one thing...
how the industry can establish such a system.
An
international system is never going to happen, but using ISQua principles- a sort
of international check list could be worked out, to be run by individual
countries. International standards on goods and services are developed in just
this way, and the system has worked well for decades for manufacturing. I
recall that there is even one health accreditor that is heavily involved in ISO
standards and can offer advice.
But,
you say, how can you enforce it. Slowly, slowly is the answer. For sake of
argument, let us call it the international standard of medical tourism... with
a rating system from 1 to 10. Medical tourism agencies could refuse to work
with anyone without an IMT rating. (Would they...?) Agencies of countries
promoting medical tourism could refuse to promote any hospital or clinic
without an IMT rating.
OK...
it could take a decade to make it happen. But as hospitals and clinics would
have to pay an annual fee and be subject to losing their IMT status, or having
it reduced, then it could also sort out the real players from the dabblers. And
making every medical tourism agency have a licence would put genuine
professionals on a par with other tourism service providers, and would help
keep out the less scrupulous operators.
The
real beneficiary would be patients and customers who could tailor the location
they use to the price they can afford. Everyone knows about star ratings for
hotels - so it is easy to explain.
Am I suggesting international medical
accreditation?
Absolutely
not. Controlling certification and accreditation of hospitals, clinics, doctors
and dentists must be left to the country where they operate. This is the only
way sanctions can apply. Also, medical tourism should stop being
"arrogant" and pretending to be above its marginal station, It must
accept local civil law and how medical negligence does or does not work in
another country.
Just
as hotel accreditors leave fire and building safety, food safety, planning and
other business basics to the country where the hotel is, then medical tourism
must leave the basics of the laws concerning running a hospital to the host
country.
Where
current national and international accreditation fall down is that it is either
pass or fail, and does not embrace the extra needs of medical tourists. Some
form of star system grading hospitals and clinics for medical tourism would
help customers decide whether they wanted the Hilton, a backstreet bed and
breakfast, or a large tent!
Ian Youngman is a writer and researcher specialising in insurance and health. He writes regularly for a variety of magazines, newsletters, and on-line services. He also publishes a range of insurance reports and undertakes research for companies. An ACII, with an honours degree in Economics from the University of Liverpool, Ian was a co-founder of The General Insurance Market Research Association. He also has widespread experience within the insurance industry at management level, working for brokers, a bank and an insurance company.
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