Authors: Karen Timmons, Erik Fleischman M.D., Bill Cook
Medical travel can offer patients many benefits such as rapid access to care and improved quality, service and savings, but, not all patients can or should travel for treatment. There are many elements – some obvious, some not so obvious – that should be evaluated in advance to determine if a patient is a good candidate for medical travel. To ensure patients are safe and fit for medical travel it is important for healthcare providers to implement a pre-travel risk assessment protocol that considers the following four factors:
Health of the traveler & appropriateness of treatment being sought
LIKE local patients, medical travelers may have pre-existing illnesses such as diabetes, cardiovascular disease, hypertension or other co-morbid conditions. When uncontrolled these conditions can make medical travel dangerous and potentially fatal. UNLIKE local patients, healthcare providers must identify these conditions remotely prior to travel. Equally important, healthcare providers must assess whether the requested or recommended treatment will benefit the patient or place them at further medical risk. The recommendations for treatment abroad for elective or semi-elective treatments tend to come from their primary care physician, the destination physician or sometimes even from the patients themselves.
Recommendations: To ensure a patient will benefit from treatment being sought and will be healthy enough to travel and undergo a procedure or treatment, it is recommended that healthcare providers:
- Send potential patients a medical history questionnaire to gather data about their health history including previous surgeries, illnesses, co-morbidities, unhealthy habits or medications that they may be taking.
- Request and review medical records and diagnostic tests, especially x-rays and scans.
- When possible, communicate with the referring physician or primary care practitioner to gather information and identify any red flags that may have not been apparent in the medical history questionnaire and exams.
- When possible, schedule a conference call between the patient and the treating physician. A conversation between the treating physician and patient prior to confirmation of a procedure is one of the most effective ways to screen potential medical travelers. With the patient´s medical information in hand, the physician can ask more specific questions regarding chronic illnesses, allergies and current medications; information that will help determine if the patient is an appropriate candidate for the treatment. It is also a great opportunity for the patient to ask questions and establish a trusting relationship with the treating physician.
Risks related to travel
Travel creates increased stress on the body’s physiologic systems–early morning wake-up calls, crowded airport shuttles, long waiting times, and then a long flight home cramped in a narrow cylinder packed with people. Patients can minimize the discomfort by flying in business class or choosing bulkhead seats, but there are still potential risks involved, especially with long flights after surgery. One of the most dangerous conditions is deep vein thrombosis (DVT) and pulmonary embolism. Another risk factor for traveling patients is exposure to people with infectious diseases not found in their own country of residence. Some nations, due to geographic environments and/or socioeconomic factors, have a higher incidence of infectious diseases including tuberculosis, Hepatitis A & B, amoebic dysentery and other diseases rarely found in most so-called developed first-world nations. These pathogens present a real threat to a person following a major surgical procedure when the immune system is unaccustomed to this exposure. There may also be similar risks related to tourist sightseeing activities and even the type of accommodation chosen by the patient.
- To ensure travel related risks are addressed and monitored, healthcare providers should review existing clinical guidelines to ensure they encompass potential risks related to medical travel such as infectious diseases and DVT. Readily available guides specific to infectious disease risks and precautions are readily available on the internet and via government embassies and international security websites.
- Patients may want to consider the benefits of travel insurance information and Medical Assistance companies to help prepare for potential local hazards, infectious diseases and security issues.
Patients may have unrealistic expectations regarding their treatment or procedure outcome as well as the medical travel experience. A patient traveling for a facelift, for example, may have unrealistic expectations regarding outcomes including expected aesthetics, improvements and recovery. When the bandages come off a few days later and reality sets in, he or she may have anger, anxiety and emotional issues with the surgeon or healthcare provider. Another patient may expect everyone in the hospital to speak his or her primary language fluently. When he or she arrives at admissions and observes hospital staff struggling to communicate or using interpreters there is often increased anxiety about the upcoming procedure.
Recommendations: To reduce patient dissatisfaction it is important to:
- Properly educate patients in advance of their trip. This can be accomplished via links to website content, email communication and calls.
- Set reasonable expectations that can be clearly understood and conform to the level of understanding and intelligence of the individual patient. Ask patients to confirm they understand these expectations. This should be documented.
- When talking to potential patients, healthcare providers should use open-ended questions that encourage potential patients to elaborate as opposed to simply answering “yes” or “no.” Allowing potential patients to “open up” and expand on their expectations regarding the treatment and medical travel experience will give physicians and case managers a better chance of spotting potentially risky patients. These efforts can provide insight toward a patient’s capacity to tolerate travel to an unfamiliar country or city.
- Healthcare providers should be crystal clear about all aspects of the treatment plan; travel itinerary and inclusions and exclusions in the price estimate provided. Making available FAQs or a “What can I expect” page on the organization’s website is a great way to educate potential patients in advance about the medical travel experience.
Setting proper expectations from the beginning will minimize the possibility of problems and dissatisfaction down the line.
The patient’s financial circumstances
Some self-pay patients may also pose a financial risk to themselves and the healthcare provider if they do not have sufficient funds to cover medical complications if they occur. According to the Kaiser Family Foundation, almost half of Americans said they would have difficulty paying an unexpected $500 dollar medical bill.
Recommendations: While this may be a sensitive topic, it cannot be ignored when healthcare providers are seeking the patient’s best interests and trying to ensure a sustainable medical travel program.
- Transparency about costs, potential complications and those persons responsible for extra medical expenses should be clarified with the patient in advance his/her trip.
- Asking key questions such as “How are you going to pay for the procedure?” and “Do you have complication insurance or funds to cover the costs of medical complications if these were to occur?” will help identify patients who may not have the financial means to cover unexpected expenses. It also offers healthcare providers the opportunity to guide patients to additional options such as financial assistance or medical complication insurance.
Benefits of Pre-travel Risk Assessment
The value and benefits of a comprehensive pre-travel risk assessment protocol are many:
- Ensure the traveling patient’s wellbeing
- Improve treatment outcomes
- Reduce costs
- Shorten hospital stays
- Reduce patient cancellations
- Increase patient satisfaction
Finally, the pre-travel screening process is critical for giving a good first impression of a healthcare organization. A positive patient experience starting prior to travel can set the tone for the entire care encounter.
 Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586128/. Retrieved 11/02/17
 Ballooning bills: More U.S. hospitals pushing patients to pay before care. https://www.reuters.com/article/us-usa-healthcare-hospital-payments/ballooning-bills-more-u-s-hospitals-pushing-patients-to-pay-before-care-idUSKBN17F1CMRetrieved 11/5/17