Patient Guidelines for a Successful Medical Travel Experience

The Global Healthcare Accreditation (GHA) Program for Medical Travel Services is pleased to provide the following recommendations and guidelines specific to medical travel patients. While this information will be helpful for all types of medical travelers, it should be especially beneficial for patients who are paying for their procedure out of pocket and perhaps making many of the medical travel arrangements on their own. For healthcare providers who may be reading this article, we encourage you to adapt the information below to your particular circumstances and share it with your own medical travel patients if appropriate.

Whether you are planning to travel for medical care within your own country or across the globe, you as a patient or companion should be as informed and prepared as possible to ensure you mitigate potential risks and challenges associated to undergoing surgery or treatment in general and medical travel in particular.

No one can guarantee you’ll have a problem-free medical travel experience. However, there are actions you can take to anticipate potential challenges, ensure you are better prepared and ultimately, we hope, facilitate a safe and positive medical travel experience.

1.Focus on Quality first

Patients engage in medical travel for many different reasons including affordability (patients looking for less expensive medical care options), accessibility (patients looking to schedule treatments quickly), availability (patients looking for procedures that are not available in their own country or city) or better quality (patients looking for the doctors and facilities with the most experience and cutting-edge medical technology). Regardless of your reason for choosing to travel for treatment, in order to increase the likelihood of a successful procedure outcome and quality patient experience, look for healthcare providers that:  

• Perform high volume number of procedures associated with your condition. You may want to consider a specialty hospital, teaching hospital, or one that does research or has clinical trials related to your condition. Often it will have a physician (or physicians) on staff who is a recognized expert on your condition and/or is experienced performing the specified procedure or treatment.
• Are transparent about the qualifications and experience of their physicians. For example, information about physicians including CV’s and number of procedures performed is available on the organization’s website or can be obtained by request.
• Continually monitor and improve their quality of care. Ask the healthcare provider if it has a quality improvement program and to provide you the data on healthcare outcomes they are monitoring. The World Health Organizationdefines an outcome measure as a “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” Outcome measures (mortality, safety of care, readmission, patient experience, etc.) are the quality and cost targets healthcare organizations are trying to improve.[1]
• Possess a medical travel program or international department. This will ensure there is a dedicated office and staff who understand your specific needs as a medical travel patient and can arrange the necessary clinical, travel and hospitality services.
• Are accredited nationally or internationally. Some examples of national accrediting bodies include Joint Commission in the U.S, India's National Accreditation Board for Hospitals and Healthcare Providers (NABH) and Thailand's HA Accreditation. Well-known international accrediting bodies include Joint Commission International (JCI), Accreditation Canada and Det Norske Veritas (DNV). Although accreditation will not guarantee a positive healthcare outcome, it does signal that a particular hospital or clinic has invested significant time and resources to improve quality of care processes and patient safety protocols that promote successful clinical For patients it is an assurance that high standards of safety and quality of care are in place and that the medical provider cares about delivering quality services to its customers.

The Global Healthcare Accreditation (GHA) Program is different from the organizations listed above. While these programs traditionally focus on the clinical aspects of care for the entire organization, GHA conducts a deep review of an organization’s medical travel program to mitigate vulnerabilities across the entire medical travel care continuum (every touch point from your first contact with the healthcare provider until you return home). GHA provides measurable value to traveling patients by ensuring that the hospital or clinic has instituted processes that are customized to your unique needs and expectations in areas such as cultural and language competency, communication and education, patient advocacy, physical environment and travel and tourism, among others.

2. Talk to your doctors before traveling for care

Talk to both your primary care practitioner and the overseas surgeon before making a final decision to travel abroad. While your primary care practitioner may not always be enthusiastic about your medical trip, it is important that he or she is aware of your decision and is committed to monitoring your recovery once you return home. In case of a complication after returning home, you don’t want to find out at the last minute that your doctor is unwilling to provide follow-up care. Additionally, it is recommended that you request a conference call with the destination physician to ask questions about the proposed treatment and to ensure you feel comfortable with him or her treating you. Prepare a list of questions prior to the call and be ready to answer any questions the doctor may have about your medical history.

The American Society for Aesthetic Plastic Surgery provides a list of questions[2] for patients traveling abroad that are also applicable for other treatments:

• Am I a good candidate for this procedure?
• What will be expected of me to get the best results?
• What is the length of the recovery period, and what kind of recovery help will I need?
• Will I need to take time off work for my recovery? If so, for how long?
• Are there alternative procedures I could consider? What are their pros and cons?
• Who on your staff will be performing my procedure and what are their qualifications?
• Do the key personnel at the surgeon’s office and in the operating room speak my language of choice?
• What risks and complications are associated with my procedure and how are they handled?
• Is there an acute care hospital nearby if complications should arise? Is it a fully licensed, modern facility (for patients having surgery at an ambulatory surgery center)?

Additional questions to consider include:

• Is there an increased risk of combining travel with the surgery/treatment and, if so, how will the risks be mitigated?
• What are my rights and responsibilities as a patient? Can I review in advance any consent forms that I will need to sign onsite?
• What happens if there is a complication and what will be the additional cost, if any.
• What happens if something goes wrong and I choose to seek legal redress? Where can I review information about my legal rights and options?
• How will my private healthcare information be safeguarded?

If you feel the physician is having difficulty understanding you or you have a gut feeling the he or she is not the right doctor for your needs, say so. You should never feel pressured to proceed with your treatment unless you are comfortable with the competence and character of the destination physician.

Finally, you will also want to address questions regarding travel logistics with the appropriate hospital or clinic staff (often this will be international patient department or a dedicated call center). For example:

• Who will pick me up at the airport?
• Should I bring a companion?
• Do I have to obtain a visa?
• What accommodation options do you recommend and are they experienced handling patients recovering from my condition?

3. Ensure language and culture barriers will not be an issue

It is important to ascertain if language and/or cultural barriers might be an issue during your medical trip. The Global Healthcare Accreditation (GHA) Program standards mandate that patients’ cultural values are taken into account when developing a care plan and that patients are properly informed on all aspects of their care plan in their language of choice. Numerous studies have shown a strong correlation between language barriers and a poor patient experience and even bad healthcare outcomes.[3] There is also evidence that cultural competency improves the quality of healthcare for patients.[4]

Potential red flags to look out for before traveling for care:

• You sense that the destination physician does not understand your questions and comments.
• You are you having difficulties understanding the physician.
• The physician or hospital/clinic staff do not seem to give enough importance to your stated cultural or religious values regarding elements such as your health beliefs, social norms or dietary preferences.
• The website and written communication from the healthcare provider suffers from serious grammar and spelling issues.
• The healthcare provider does not have professional interpreters available that speak your language of preference.
• The healthcare provider acknowledges that they have not treated many patients from your geographic region or cultural/language background.

If you have concerns about potential language and cultural barriers, don’t be afraid to bring these up with the destination physician and hospital staff to see if they can be addressed to your satisfaction. If not, it is probably better to choose a different healthcare provider, if this is an option.

4. Consider the medical travel destination

Before making a final decision about the destination healthcare provider, take some time to do a little research about the country or region to ensure you are comfortable with factors such as:

Safety

• Crime

No destination is completely free of crime and all cities have certain areas that are safer than others. Most often it is just a matter of using common sense or requesting advice from locals before heading out for dinner or sightseeing. Ask the hospital or clinic if they have any safety tips or advice. Some medical travel destinations have experienced an increase in gang or drug related violence, so it is a good idea to check with your embassy regarding any travel alerts or safety recommendations.

• Political unrest

Occasionally, some countries may experience sudden political unrest that can lead to potentially dangerous situations for travelers. Again, check with your embassy regarding any travel alerts or safety recommendations.

• Infectious diseases

The outbreak of infectious diseases is another potential concern. In recent years, countries from Latin America to Asia have experienced mild to severe outbreaks[5] that have put the international healthcare community on alert. A couple of good resources to check for latest alerts are the World Health Organization and the U.S. based Centers for Disease Control. Additionally, it is important to ask the destination hospital or clinic what policies and protocols it has in place to mitigate the risk of patients bringing infectious agents into or out of the country and how it reduces the overall risk of infections occurring within the hospital (e.g. hand hygiene, sterilization of instruments and equipment, and proper disposal of infectious waste).  

• Terrorism

While terrorist activity can strike anywhere around the globe at any time; certain countries or regions have experienced more terrorist activity than others in recent years. Make sure to stay abreast of the latest news and security warnings via your embassy and the destination hospital before scheduling your surgery or treatment abroad.

• Severe weather

Severe weather, earthquakes or flooding cannot always be avoided. However, certain areas are more prone to severe weather than others, especially in certain seasons. For example, if you are planning to travel to South Florida, the Caribbean or the Yucatan peninsula, you need to be aware that hurricane season is from June 1st until November 30th.  Other areas of the world have their own seasons for harsher weather. If you are going to schedule a treatment during these times, consider travel insurance or choose flights that can be changed without a penalization fee.

Proximity

How far are you willing to travel? This question has implications beyond comfort and convenience; your own safety can be at stake, as traveling long distances after surgery can increase your risk of dangerous health conditions such as Deep Vein Thrombosis. Consult your primary care practitioner as well as the destination physician for their recommendations.

Entry requirements and controlled substances

Each country has their own legal requirements to allow proper entry in to the country. These may include visas and/or mandatory immunizations for certain infectious diseases. Visa processing, in particular, can be a lengthy process (especially for certain destinations) so check with the destination embassy or consulate for details prior to confirming your medical trip. Oftentimes the destination healthcare providers can provide the necessary information and, in some cases, facilitate arrangement of the visa.

Controlled substances:

Additionally, each country has their own regulations regarding which medications (especially controlled substances) are allowed into the country and what, if any, restrictions they may have (a controlled substance is generally a drug or chemical whose manufacture, possession or use is regulated by a government and whose general availability is restricted).[6] A medication that is considered over the counter in your own country of residence could require a prescription in another country or may even be prohibited. Make sure to communicate with the destination healthcare provider about the medications you will be transporting into the country and ask them to inform you about any restrictions for entry.

4. Financial matters

Imagine the following scenario: after several months of planning and anticipation you have finally arrived at a hospital in Thailand to undergo your treatment. As you complete the necessary admission forms, a hospital representative takes your credit card to process payment. A few minutes later, he comes back to inform you that the transaction has been denied. To avoid this or similar situations and the unnecessary stress and anxiety that tend accompany them, take the following precautions:

• If you receive a price estimate from the destination healthcare provider, ask how long the price is valid for. This is especially important if your procedure or treatment is being scheduled several months in the future.
• Ask what IS included and NOT included in the price estimate or procedure package. For example, some healthcare providers may include pre-operative exams in the price estimate, others may not. Some may include airport pick-up and transfers, others may not.
• Find out who is responsible for extra expenses. This could simply mean that the surgery took an hour longer than expected or that you required an additional night in the hospital (oftentimes these types of expenses are covered by the hospital within the procedure package), or the extra expenses could be related to a more serious medical complication that the hospital may not cover.
• Inform your bank that you will be traveling abroad (specify the exact dates) and using your credit card to make some large payments. As noted in the hypothetical example above, banks may deny charges if they are not aware that you will be using your credit card outside the country. Also, be sure to ask if your bank charges fees for foreign transactions (many do).
• Ask the destination healthcare provider about its cancellation and refund policies should you have to cancel the procedure prior to traveling (assuming you have made a deposit).
• For certain high-risk procedures you may want to ask the hospital if it can provide recommendations as to a medical complication insurance that you can purchase. As the name implies, this insurance will cover complications related directly to your procedure.
• Ask if you will receive an itemized bill before you leave the hospital.

5. Choose your companion(s) wisely

Bringing a companion along with you on your medical trip is always advisable, especially if you are undergoing a major surgical procedure. The physical and moral support they can provide is especially beneficial during the recovery process when you are at your most vulnerable. However, not everyone is ideally suited to being a medical travel companion. Some people may look at the trip as a chance for a free vacation; others will nitpick and complain about everything, causing you additional stress and worry, ultimately hindering your recovery.

To avoid these types of situations, medical travel companions should be educated about their role and responsibilities during the trip. The destination physician or international patient department will usually be happy to help in this regard – as it will make their lives much easier and facilitate a better patient experience and clinical outcome. It is important for your companion to understand that their primary role during the trip will be to take care of you. They must be willing to put your needs ahead of their own and assist you during the recovery process. For example, they might have to help you navigate the hospital or clinic in a wheelchair, bring you ice to chew on after surgery or simply offer their shoulder for you to cry on. This does not mean they cannot have some leisure time to enjoy the local culture and attractions, however, their primary purpose will be to support you and look out for your wellbeing.

Conclusion

As you prepare for your medical trip, keep in mind that most healthcare providers are striving to offer you the highest quality patient experience possible. Consequently, they will attempt to put forth their best efforts to address your unique needs as a medical travel patient. The healthcare providers who are most successful, however, and the ones you should seriously consider (once quality and expertise with your condition have been established), are those who understand and are proactive about your unique needs as a medical travel patient, rather than reactive. Healthcare providers who are reactive to your needs as a medical travel patient, may deliver a high-quality patient experience occasionally – being dependent on the whims of chance and circumstance. Delivering a high-quality medical travel patient experience consistently, on the other hand, requires top-down implementation of standardized policies and protocols, as well as services, across the entire medical travel care continuum. We hope this article has made this point clear, and we wish you a successful medical travel journey.

For a list of healthcare providers who have verified policies, protocols and services in place specific to medical travelers, visit the list of GHA accredited organizations here.

[1] https://www.healthcatalyst.com/insights/top-7-healthcare-outcome-measures

[2] https://www.smartbeautyguide.com/planning-toolkit/planning-resources-checklists/questions-to-ask-your-plastic-surgeon/

[3] Sameer Al-Harasis. Impact of language barrier on quality of nursing care at Armed Forces Hospitals, TAIF, Saudi Arabia. http://www.me-jn.com/August%202013/language%20barriers.htm.

[4] https://hpi.georgetown.edu/cultural/

[5] http://jacksonholeradio.com/2019/03/wyoming-department-of-health-warns-medical-tourists/

[6] National Alliance for Model State Drug Laws. Retrieved from http://www.namsdl.org/controlled-substances-and-prescription-drugs.cfm

*Medical travel is also commonly known as medical tourism or health tourism.

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