An estimated 750,000 U.S. residents travel abroad each year to receive medical care.* This multibillion-dollar business known as “medical tourism” continues to grow annually, particularly among patients seeking cosmetic, dental, cardiothoracic, and orthopaedic procedures, according to the Centers for Disease Control and Prevention (CDC).†
Surgeons and primary care physicians should encourage patients who are considering undergoing a procedure outside of the U.S. to learn as much as possible about a prospective foreign health care institution, warn them of the potential risks of medical tourism, and make sure they receive proper follow-up care when they return home.
U.S.-based health care providers can look to The Joint Commission’s affiliate, Joint Commission International (JCI), as a resource for their patients considering medical tourism. JCI is the leader in international health care accreditation, and its rigorous accreditation process evaluates organizations for compliance with scientifically based standards that focus on quality improvement and safe patient care, similar to the processes used in the U.S. for Joint Commission accreditation.
Risks of medical tourism
Although the direct impact of medical tourism on U.S.-based physicians is minimal, its potential risks may be serious for patients, including the following identified by the CDC*:
- Communication barriers: Communication barriers may occur when patients do not fluently speak the primary language of the country where the medical procedure is taking place, which may result in misunderstandings regarding their care. JCI-accredited health care institutions must ensure that patient education and follow-up instructions are presented in a form and language that the patient understands.
- Different standards of care: Different standards of care may exist abroad. For example, blood donor selection and collection may vary. JCI standards address quality-control measures for blood banks and transfusion services and require that organizations adhere to applicable laws, regulations, and recognized standards of practice. JCI standards require a qualified individual to oversee the services and processes for blood donor selection and collection, storage, compatibility testing, and distribution. In addition, clinical guidelines and procedures must be implemented for the handling, use, and administration of blood and blood products.
- Counterfeit or poor-quality medication: Counterfeit or poor-quality medications may be more common outside the U.S. JCI standards address the management and safety of medication, including specific requirements for storage and establishment of a medication recall system. The standards also require facilities to identify and evaluate potential supply chain risks for critical supplies, including medication, to prevent contaminated or counterfeit products from reaching patients.
- Complications when returning home: Flying home after undergoing a medical procedure can increase the risk of blood clots and other complications in the recovery period. Providers at JCI-accredited organizations must use relevant criteria or indications when assessing a patient’s readiness for discharge and transportation needs. Follow-up instructions must include information about when to obtain urgent care.
Ideally, medical tourists should receive a copy of their medical record and test results from their foreign health care provider; at a minimum, they should be provided with a copy of their discharge summary. JCI standards require organizations to provide a discharge summary to the health care practitioner responsible for the patient’s continuing or follow-up care. If the health care professional is unknown, the discharge summary should be given directly to the patient and include specific information, such as diagnoses, significant findings, procedures performed, medications administered during hospitalization or treatment, medications to be taken after discharge, and follow-up instructions.
Medical tourism has associated risks, but JCI accreditation is one way U.S. patients and providers can evaluate a potential health care institution located abroad. To date, the JCI has awarded accreditation to more than 600 health care facilities in 60 countries.‡
A resource for patients considering medical tourism outside the U.S., and for all Americans traveling internationally, is JCI’s consumer website, www.worldhospitalsearch.org. JCI-accredited organizations may be searched by country or specialty. The website also includes information on being an informed patient, immunizations and vaccines, staying healthy when traveling abroad, useful international health care-related terms and symbols, and country health profiles.
For more information on JCI, go to www.jointcommissioninternational.org.
*Centers for Disease Control and Prevention. Medical tourism—getting medical care in another country. Available at: http://www.cdc.gov/features/medicaltourism/. Accessed July 8, 2014.
†Centers for Disease Control and Prevention. CDC Health Information for International Travel 2014. New York: Oxford University Press; 2014.
‡Joint Commission International. World hospital search. Available at: http://www.worldhospitalsearch.org/. Accessed July 9, 2014.