How does a medical tourist make a valid comparison of a doctor, hospital or clinic in one country with a doctor, hospital or clinic in another? The simple answer is that he or she can’t. And the truth is that it may never be the case (well not in my lifetime). In the hypothetical world, we talk about patients making informed choices about treatment....about how we can provide them with the information that they need to compare healthcare providers and make valid decisions about which one is the “best”, the “safest”, the “highest quality”. But even if someone is only interested in treatment within one country, this may be impossible. In a country such as the UK where there is a national publicly funded health system it becomes more of a possibility. In the UK, there are quality indicators, performance measures, and outcome data that are collected in the same way and analysed in the same way across all healthcare providers (whether they are public or private hospitals). So, patients can make reasonably valid comparisons of healthcare providers. However, in many countries which are promoting themselves as medical tourism destinations, there may be no strategy or system for collecting data on quality, performance and outcomes on a national basis. So, making an “informed choice” even within that country becomes a virtual impossibility.
A partially informed (or misinformed...) choice: In the real world, can a medical tourist make an informed choice about treatment when comparing different hospitals in different countries? The simple answer is.... no. At best a medical tourist can make a partially informed choice. And in some (perhaps many?) cases, a medical tourist may make a misinformed choice. Let’s take what looks like a simple indicator.....outcome measures for cardiac surgery. Let’s say that you need a heart bypass operation. You cannot afford the surgery in your own country, so you start to explore what it might cost if you went overseas. You identify a few countries that look attractive in terms of price, but how can you compare the likely outcome of your operation at different hospitals in different countries? It can’t be that difficult.... Can it? It can... Even with something as well researched as heart bypass surgery, there is still no international consensus on how outcomes should be measured (or there are “competing “ views), and how these data should be adjusted to take account of risk.
Measuring quality of care: Measurement of quality of care depends on:
- (1) the choice of outcome (is it about surviving the operation, the number and /or complexity of complications after surgery, the risk of post-operative infection, the length of stay in intensive care, the readmission rate or life expectancy post-surgery?)
- (2) the source of data used to determine outcome (i.e. who supplied it, and how objective were any assessments undertaken)
- (3) and the data used to account for patient risk when measuring outcome.(i.e. older patients with co-morbidities and poor general health will have worse outcomes) So, you can see how difficult it is to compare outcomes and safety in healthcare. If doctors and researchers are struggling to make valid comparisons, what hope does a patient have? Within the medical tourism industry, there are some who believe it’s easy to “compare apples with apples” in healthcare. If consumers can compare cars based on standard Euro NCAP safety ratings, then why can’t they compare hospitals and doctors? But people are more complex than cars, and fixing people is far more tricky than making cars.
Fixing the problem: There is no easy fix, and it’s probably a long way off. The work of the OECD's Health Care Quality Indicators Project (HCQI) illustrates the problem and how far we still have to go to solve it. This project aims to help healthcare policy-makers and researchers to measure and report on the quality of medical care. In this case, 'quality indicators' (QIs) means indicators of the technical quality with which medical care is provided, i.e. measures of health outcome or health improvement attributable to medical care. Many OECD countries have already embarked upon national strategies to begin collecting technical quality indicators, and establish benchmarks for performance measurement. They have made progress in implementing quality indicators at the level of providers (such as hospitals or doctors). BUT these national activities do not lead, except by accident, to internationally comparable quality indicators.
Why? Because:
- (1) There is a lack of international agreement on the most promising indicators.
- (2) There are many definitions of each indicator that could be adopted.
So what can a medical tourist do? With the adoption of the EU Directive on Cross Border Healthcare, the European Commission is keen to see the OECD Health Care Quality Indicators Project succeed but states “there is so far little possibility for international benchmarking of the quality of health care.” So,the EU Directive may help to move things forward, but slowly. In the meantime, patients will have to make choices based on partial information. What’s my advice to a medical tourist? Keep it simple. If you need knee surgery, choose a knee specialist not a general orthopaedic surgeon who treats hips, shoulders,hands etc. Confirm that he is truly a knee specialist. Find out what research papers he has published. Find out what specialist associations he belongs to related to knee surgery (e.g. the British Association for Surgery of the Knee, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, The Knee Society). Find out how many procedures he carries out each year of the type that you need. If you need a knee replacement, how many of these does he actually do? If you need ACL reconstruction, how many of these does he actually do? Ask for contact information for previous patients from your country. And.... ask him for details of the quality indicators he uses or his hospital uses to monitor his performance. But don’t expect to compare these with indicators from elsewhere! Source: IMTJ
