THIS WEEK IN MEDICAL TRAVEL TODAY
Volume 1, Issue 6
by Amanda Haar, Editor
A few weeks ago I got a call from a colleague asking me what I knew about medical tourism. As it turned out, I knew quite a bit. Three years ago while working for a publishing company that specialized in health and wellness and managed care topics, I had the opportunity to work with several folks from Bumrungrad on effective ways to promote this new concept of ‘medical tourism.’ Since that time, I’ve followed the growth of the industry with great interest and intrigue.

So it seemed only natural that I should say “yes” when asked to take the role of editor for Medical Travel Today.

Clearly, medical travel looks different today than it did at the time I first learned of it. The changes that have taken place were driven by improvements in the specific industry as well as in the way care is delivered across entire spectrum of healthcare. For example, today there is an accreditation program in place for health tourism companies. In the Spotlight Section, we talk with Neilesh Patel and Elliot Mendelsohn, founders of this accrediting body, HealthCare Tourism International, about how this new program will affect both patients and providers.

As always, we invite your thoughts and comments. If you are interested in seeing more on a particular topic related to medical travel or would like to contribute your own article, please feel free to email me at ahaar@cpronline.com.

Cheers,
Amanda Haar, Editor

SPOTLIGHT
World’s First Accreditation Program for Health Tourism

Elliot Mendelsohn

Neilesh Patel

It’s in the interest of everyone involved in medical tourism to make sure that the consumer experience is safe and secure at every level. From basic travel arrangements and secure transportation to, of course, the competence of the clinicians and quality of care provided by a recovery facility, every aspect of the experience has an impact on overall customer satisfaction.

One organization that’s spent the last year focused on creating standards for the non-clinical aspects of medical tourism is HealthCare Tourism International (www.healthcaretrip.org). Founded in 2006 by Neilesh Patel and Elliot Mendelsohn, HTI launched the world’s first accreditation system for health tourism companies in October.

Medical Travel Today spoke recently spoke with the company’s founders to learn more about this exciting new development in the industry.

First, tell us a bit about HealthCare Tourism International and what inspired you to create an accreditation system.

NP: HTI is a non-profit organization providing accreditation for non-clinical organizations and companies involved in medical travel. That includes medical tourism operators, travel agents, travel coordinators, hotels, recovery facilities, bed and breakfasts, and other types of accommodation units.

We also operate a free patient portal at www.healthcaretrip.org where consumers can find non-biased information to help them with decisions related to medical travel. We provide statistics, links to various organizations, and companies, etc.

And for consumers who have encountered issues in their experience, we also mediate disputes between the consumer and the service providers. And again, it’s all free.

The concept of an accrediting body came to us just over a year ago. Because of the way the industry evolved, it was regulated by mostly by tourism bureaus rather than ministries of health. That struck us as unbalanced and not necessarily in the best interest of the consumer. We felt the industry should be governed by both tourism and ministries of health.  Especially since patient safety concerns are not limited to the hospital arena.

EM: Right. And because of our collective backgrounds in medical research, devices, and Neil with the FDA, we felt that a more clinical slant was needed. We thought that if we could give consumers a better means for evaluating the companies and organizations their going to partner with, it would be a benefit to both consumers and the industry.

Recognizing that you only launched a month ago, how are things going?

NP: Things are going great. Right now we have 30 accreditations in process with two of those organizations currently refining their business practices to be in line with our standards.  We expect to have the first couple accreditations in place by before the end of 2007.

What’s also exciting is the global nature of the organizations seeking the accreditations. We’re currently working with groups in Turkey, India, Argentina, the Phillipines, Thailand, and the UK.

Our hope is that, in time, we’ll be a sort of UN for medical tourism where people can seek unbiased information and the various parties involved in the industry can come together for roundtables, to share ideas, and look for better ways to improve what they do.

How difficult is accreditation to receive?

EM: It works largely like any other accreditation process. First, the interested organization needs to sign up for a free membership account and public profile on our consumer portal www.healthcaretrip.org

There is an application fee and once that’s received, we send out the accreditation protocol. After reviewing that and evaluating how their operating procedures align with our standards and making any necessary adjustments, they complete an online membership application. We process all applications within two weeks of receipt. If necessary, we’ll schedule a site visit.

The accreditation decision is made by HTI.

NP: It’s important to stress that no member of HTI has any financial or personal stake in any for-profit health tourism companies, hospitals, accommodation units, insurance companies, or providers. Our assessments are completely unbiased.

How do you see accreditation impacting the quality of care in the near- and long-term?

NP: It’s all about patient satisfaction. Patient satisfaction will be the largest metric. We’ll be using surveys, looking at the number of disputes, government actions against companies, response time to issues and the number of incidents that have affected consumer satisfaction and safety.

In future years, those will be the things that largely determine whether an company gets or keeps accreditation.

EM: I want to mention thought that we’re not attempting to tell companies how to stipulate their performance measures. Many of the large hospitality and service companies already have very solid systems in place for assessing customer satisfaction. We’re very happy to base our assessment on those. What we’re looking for is a mutually agreeable means for measuring performance. If they’ve got it, great. If not, we’ll guide them in developing a system.

NP: Right. With all that in place, it will ultimately make it easier for consumers to pursue medical tourism and they’ll be more confident in their endeavors.

Thank you gentlemen for your time and best of luck in your endeavors.

HealthCare Tourism International recently launched the world’s first international accreditation system for Health Tourism Companies. The U.S.-based, 501 (c) (3) non-profit organization’s (NGO) mission is to improve the patient safety, integrity and efficacy of the medical tourism.

“After almost two years of development, our mission is to uphold and improve the reputation and safety of the healthcare tourism industry by promoting safe healthcare tourism practices among our members,” says Neilesh Patel, Founder of HealthCare Tourism International. “It was clear that only a non-profit organization could provide unbiased accreditation while still incorporating accreditation criteria input from companies.” HealthCare Tourism International received its non-profit status ruling from the IRS in late November, and is the world’s first non-profit organization to receive such a ruling.

The HealthCare Tourism International team is comprised of medical, dental, tourism and business experts from all facets of healthcare. The accreditation process entails improving the non-clinical aspects of the health tourism experience, which makes it a complementary system to the Joint Commissions International clinical accreditation system. Aspects such as business practices, recovery options and language abilities all include areas covered by the accreditation system. A separate protocol has been developed for the following types of health tourism companies: hotel providers, health tourism travel agencies, non-ambulatory transport vehicles, hospitals with concierge services, airlines, translator/conveyance companies and insurance companies. Applications for self-certification and accreditation are accepted on a rolling basis and for the first year, only self-certification is granted. In the second year, applicants can apply for accreditation that may involve submission of documents and, in certain cases, onsite surveys.

Applications are now being accepted at the organization’s web site www.healthcaretrip.org . For more information, contact Neilesh Patel, CEO / Founder, HealthCare Tourism International at Neil.patel@healthcaretrip.org .

ISSUES AND ANSWERS
Exclusive to Medical Travel Today by Joseph McMenamin, Partner, McGuireWoods LLP

Legal perspectives on medical tourism...a follow up statement.

The Liability Exposure of Medical Matchmakers

In a previous issue of Medical Travel Today, http://www.medicaltraveltoday.com/MTTE-01-01.html, I claimed that it would be difficult to bring malpractice cases successfully against companies engaged in assisting Americans to travel abroad for healthcare, companies I referred to as “matchmakers.” I stand by that position. Such companies are not healthcare providers, and malpractice, by definition, arises when a healthcare provider breaches the standard of care applicable to it. Such standards do not apply to entities that are not healthcare providers, and so cannot be breached by such entities.

Since that original publication, however, the initial statement has been cited for the proposition that “medical tourists would have no recourse through the American court system.” I did not make such a sweeping claim before, and I deny it now. First, in the litigation climate prevailing in the United States, it would be rash for anyone to assume that any entity is immune from suit absent some express legal authority so providing, and perhaps not even then. Second, the mere fact that a malpractice case against a matchmaker would probably fail does not preclude other types of liability exposure. Malpractice is merely one species of the tort of negligence, a cause of action for harm alleged to have arisen from a failure to exercise reasonable care. While medical standards of care would presumably not apply to non-healthcare providers, ordinary standards of care would. If the matchmaker were careless in the way it handled arrangements for a traveler, it presumably would be vulnerable to suit from a traveler who could show he had been injured as a result. Presumably, the plaintiff would seek to offer the practices of competing companies to attempt to establish the standard against which the defendant’s would be compared. Nor is tort the only potentially feasible theory. Certainly if it mishandled its client’s money, for example, a matchmaker might be held accountable for the traveler’s losses on a breach of contract claim. Most important, if the matchmaker made representations about the qualifications of foreign healthcare providers or the quality of foreign healthcare institutions, and the plaintiff could persuade the finder of fact that he had been defrauded by those representations, then an action for damages in fraud or breach of warranty might lie.

Matchmakers should be cautious, then, about making representations about institutions and professionals, at home or abroad. From a liability standpoint, it would be much safer to assist with travel arrangements only, rather than to make recommendations about specific doctors or hospitals. Even matchmakers employing professionals with relevant expertise, such as physicians or nurses, should avoid making statements that could be construed as promises. A general understanding that a particular doctor in a foreign country has skill in performing a specified procedure is far from assurance that in the care of a given patient on a given date that doctor will do a good job. If such a doctor decides to make representations about his own capabilities, and the matchmaker plays no role in advancing the doctor’s marketing objectives, it will be in a far more defensible position than it would be if it promoted the doctor’s services itself.

Matchmakers should also be cautious about becoming involved in the accreditation of foreign healthcare organizations. Only those with the required knowledge, skills, training, and experience should undertake such an effort. Evaluating a domestic hospital typically takes several days when carried out by an experienced, multi-disciplinary team using sophisticated, well-tested metrics. Even then, the review may not be exhaustive. A cursory inspection should not provide the basis for extravagant assurances. Even those who conduct scrupulous, searching inspections should issue disclaimers cautioning that a favorable review is not tantamount to any sort of guarantee.

The risk involved in making excessively enthusiastic marketing statements may equal or exceed the risk posed by malpractice claims. Depending on the jurisdiction, the statute of limitations for breach of warranty or fraud claims may well be longer than it is for negligence. The emotional impact upon the finder of fact may be more significant in claims of fraud, implicating intent, than in claims of negligence, implicating mere carelessness. Tort reform legislation that may cap damages in malpractice cases may provide no analogous protection for claims sounding in fraud. And while oath-sayers can be found today to testify to nearly anything, there remains in malpractice litigation a duty to show via expert testimony the standard of care, its breach, and a causal relationship between the alleged breach and the harm complained of. To the extent this requirement does create at least a theoretical obstacle to the plaintiff’s recovery, there is no comparable requirement in fraud. Finally, malpractice coverage may well not extend to fraud claims. Matchmakers should be very cautious, then, about making representations about the quality of care that medical tourists will encounter abroad, and if they decide to do so, they should issue appropriate disclaimers at the same time.

The odds are good that at some point some person will claim to have been hurt by the conduct of a matchmaker. The odds are equally good that some fraction of those so claiming will seek whatever remedies they may be able to find at law. It would not be surprising if some succeeded.

Joseph McMenamin is a partner at the law firm of McGuireWoods LLP in Richmond, Virginia. McMenamin was a university-trained internist and a practicing emergency physician before being admitted to the bar. He holds medical (1978) and law (1985) degrees from the University of Pennsylvania, and served a straight medicine residency (1978-1981) at Emory University and Grady Memorial Hospital in Atlanta before joining McGuireWoods in 1985. His practice areas include: Pharmaceuticals and Medical Products; Health Care; Toxic Torts; E-Commerce; and Insurance.

Devon M. Herrick, “Medical Tourism: Global Competition in Health Care,” National Center for Policy Analysis (NCPA) Policy Report No. 304 (November 2007), ISBN #1-56808-17802, http://www.ncpa.org/pub/st/st304/st304.pdf, last visited 23 November, 2007.

PERSPECTIVES
Medical Tourism Association Launches New Magazine, Prepares for First Member Conference1 at the Medical Tourism Conference at Consumer Health World

The Medical Tourism Association spent two weeks overseas in meetings with hospitals in Taiwan and the Philippines. Taiwan is starting to position itself as a major player in medical tourism and several of its lead hospitals are moving forward on plans to attract foreign patients. The hospitals in Taiwan are state of the art and our visit was extremely productive.

The Medical Tourism Association was also a special guest of the Ministry of Tourism in the Philippines for a medical tourism conference and we provided the keynote speech. The association interacted with hospitals and medical tourism companies from many different countries. The most well received speech at the event was, “Legal issues and liability surrounding medical tourism,” delivered by Renee-Marie Stephano, the Association’s General Counsel. Hospitals from around the world and medical tourism companies were excited to hear the first real speech explaining the scope of liability which hospitals and medical tourism companies face when dealing with international patients. They also were very pleased to receive advice on how to reduce their risk and liability.

The Association also met with the Philippines Medical Tourism Association and a partnership was formed. After visiting several hospitals in the Philippines, it is clear that the Philippines soon will emerge as another major player in medical tourism.

The week of November 26, 2007 marked the release of the first hard copy print edition of the Medical Tourism Magazine, the magazine published by the Medical Tourism Association. Each issue covers medical tourism throughout the world, including a special focus on a specific country. The first issue will spotlight Costa Rica, with subsequent editions focusing on India, Taiwan and the Philippines, and others to be determined. The magazine is a trade magazine written by people involved in the industry, not by outside journalists. The association wanted to give the magazine “reality” and to be a very useful guide for anyone in the industry or looking to be involved in it.

An electronic version can be downloaded for free on the association website at www.MedicalTravelAuthority.com or a hard copy can be requested by e-mailing the Association at info@medicaltravelauthority.com . Subscriptions are free.

On December 2, 2007 the Medical Tourism Association heads to Washington, D.C. to hold its first Association membership meeting at the Medical Tourism Conference at Consumer Health World on Monday, December 3, 2007, 8:30 am - 12:30 pm, Hyatt Regency Crystal City, Arlington, Virginia. Please contact the Association for more information on the meeting.

The Medical Tourism Association is working very hard to bring together countries and hospitals from around the world to work together. To continue towards this end, the Medical Tourism Association this winter and spring are expected to visit the following countries: Korea, Singapore, Malaysia, Thailand, Vietnam, Panama, Arab Emirates ( Dubai), Jordan and Israel. The Association is gaining support throughout the world as people involved in the medical tourism industry wish to help protect the industry and to help it grow in a very positive direction.

There's a new website in the world of medical tourism—one that’s designed to benefit both members of the medical travel industry and the medical traveling patient. World Medical Resources (http://worldmedicalresources.com) is a triple-purpose site: a searchable database of service providers around the world, a provider of credential verification reports on physicians and dentists, and a central repository of data and information regarding medical travel.

Extending beyond the realm of just physicians, dentists, and hospitals, the providers listed will also include medical travel planners, recovery retreats, travel companions, local drug stores, local drivers, insurance and financing options, and any other service of interest to the medical traveler. All information will be presented from the perspective of the patient and will include data not normally available on typical travel sites (such as luggage assistance, medical transport assistance, etc.). The listings will also promote the local economy beyond the scope of just the medical community.

The site’s searchable database will be of great appeal to consumers seeking a specific experience. For example, if a consumer wants a hotel in Brazil with a 24-hour desk service or a physician in Turkey who does a specific procedure, they can search specifically for those parameters.

In addition, World Medical Resources will provide profiles on physicians around the world. According Sherry Weston, co-founder of World Medical Resources, “While it's easy to find background and credential information on physicians in the US, it can be very difficult in other countries. World Medical Resources will provide verification of medical schools, board certifications, and other information, enabling consumers to make their own evaluation and decision, to the extent that the information is publicly obtainable. The reports will identify which information is third party verified and which is not.”

Sandra Pennington, also a co-founder adds, “Our goals is to make the website the single central repository of data and resources for the medical travel industry. With no agenda other than to present information and resources, World Medical Resources will not make recommendations or evaluations on any service or provider.” The website features a for-fee listing of providers and businesses, the cost of which will be relative to the cost of the service being provided to the patient.

The website will be aggressively marketed to the public using both online and telephone sales.

With combined backgrounds that include sales, nursing, management, and programming, the sites co-founder and –owners, Sandy Pennington and Sherry Weston are in a unique position to recognize, appreciate, and act upon this new model of medical care.

Medical Tourism 2008 - The World-Wide Business Guide is a groundbreaking new 600-page business report.

By 2010 medical travel is expected to be a $40-billion business, with over 780 million patients seeking care outside their principal country of residence.

This unique report investigates from a business perspective what is happening and will happen worldwide in all types of medical and health tourism.

The report asks

The electronic report has seven PDF modules. The Country modules profile 96 countries. There are separate modules for Asia, Americas, Middle East, Europe, and Africa/Australasia. The Agencies and Information websites module covers over 400 sites. The Background module includes Statistics, Customers, Types of treatment, Associations. Accreditation, Intermediaries, Insurance, Problem areas and much more.

Ian Youngman comments "Since starting to write on medical tourism and travel it has become clear that while there are lots of websites and a few books aimed at customers, and a handful of academic publications, what information there is for businesses and other organizations is scattered, often contradictory, and frequently spun in favour of a particular country. This aims to provide an unbiased detailed overview of what is happening and will happen in this increasingly important industry."

Contact:
Ian Youngman
Telephone Number +44 1508 470079
Email Address: pinewoodlodge@aspects.net

Ian Youngman is a specialist writer/ researcher and publisher of business reports and books, who writes regularly on the business of medical tourism for magazines and websites.

Washington, DC—3 December 2007: Healthy Travel Media and the Taiwan Non-Governmental Hospitals and Clinics Association (TNHCA) jointly announce the launch of the Patients Beyond Borders Taiwan Edition, to be published in English for international distribution in May 2008. The Taiwan Edition will be formally announced at the International Medical Travel Conference 3 December, in Washington DC.

The 336-page guidebook will offer an in-depth overview of Taiwan’s 20 international hospitals and clinics, selected health travel agents, nearby recovery and guest accommodations, and area travel information.

“Located centrally between Tokyo and Hong Kong and with some of the best healthcare in Asia, Taiwan receives visitors from more than 30 countries throughout the region and the world,” says Healthy Travel Media CEO Josef Woodman. “The huge Chinese population in the US and other nations makes Taiwan a natural medical travel destination.”

Prices for procedures are on par with leading healthcare providers in Singapore, Malaysia, and Thailand, and patients can receive 30-80% discounts on a wide array of treatments. Newly JCI-accredited hospitals, such as Min Sheng Healthcare and Wan Fang Hospital in Taipei, provide additional comfort to international medical travelers. At least three additional hospitals are expected to receive JCI-accreditation in 2008 .

“As our reputation as an international healthcare leader grows, we are pleased to offer the Patients Beyond Borders Taiwan Edition to a growing market of medical travelers,” says Dr. Mingyen Wu, CEO, Taiwan Task Force on Medical Travel and Secretary General of TNHCA. “Readers will see the vast diversity of medical facilities, treatments, and services offered throughout Taiwan.”

About Healthy Travel Media

Healthy Travel Media, an independent imprint based in Chapel Hill, NC, publishes books on medical travel, treatment, and wellness. Patients Beyond Borders is available at Amazon and bookstores everywhere. The Patients Beyond Borders Taiwan Edition is the second in the Patients Beyond Borders series of in-country editions of the same name. For more information, visit: http://www.patientsbeyondborders.com

About the Taiwan Non-Governmental Hospitals and Clinics Association

The Taiwan Non-Governmental Hospitals and Clinics Association (TNHCA) was founded in 1990 t o help hospitals promote information exchange and improve the service quality of health care. TNHCA’S Seven Mission are to: 1. advocate medical ethics and develop medical science; 2. help the government set up related health policy; 3. provide health management information and experience to members; 4. provide healthcare information to the public; 5. advance cooperation between medical organizations; 6. encourage the relationship between medical organizations, society, and related organizations; 7. preserve member rights and provide better service.

TNCHA CEO Dr. Mingyen Wu (back row, third from left), Healthy Travel Media CEO Josef Woodman (back row, fourth from left), and team members after signing agreement in Taipei.

For media queries, please contact:

United States
Heather LaGarde
Tel: +1 919.370.7380
Email: hlagarde@patientsbeyondborders.com
http://www.patientsbeyondborders.com

Taiwan
Ann Lee Hong, Esq.
Tel: 886 2 27391322, extension 14
Email: nhca03@gmail.com