Is the medical care equal to, or better than the US?

As my business professors would answer...that depends.

What metrics and outcomes are you comparing and how are you comparing them? If you are comparing the World Health Organization's statistics on healthcare monitors we, in the US are doing a terrible job. If you are asking for the ability to go to a cutting edge tertiary care hospital and receive the latest greatest and hopefully best options we have more than you can imagine. They are however very expensive and not cost effective solutions to large scale healthcare issues.

Now mentally go to a community hospital or an inner city hospital faced with significant budget issues and concerns. There are less choices and less cutting edge (read more expensive) options available. Some places must transfer out heart attack patients for cardiac catheterizations. Other hospitals must transfer patients out for brain surgery emergencies and others for trauma patients. So if you had one of these conditions and the facility you wound up at does not treat that condition than you are at an potentially inferior hospital for that specific condition.

Some hospitals only specialize in a specific disease class or age groups. Examples would include cancer specialty hospital, eye institutes, orthopedics facilities and geriatric or pediatric hospitals. So arguably if you are in one of these hospitals and develop a condition outside their scope of practice you may receive inferior care or need to be transferred to receive adequate care.

Now move to a nitty gritty facility with many poor people who are very ill consuming many precious resources. They should have access to their needed medical care. But can the facility or the government spend endlessly to provide the latest, greatest and most expensive care?

Given the scenarios, I think we can agree that in the US there are different levels of care available which create a significant impact on the care received by our citizens.

Now let us move outside the US and examine this question again. Is it possible that there are hospitals outside the US who exist in countries that provide the latest, greatest care for those who can afford it? The clear answer is Yes. Then move to areas similar in capability to the US and the same gradients of care options appear.

As a medical traveler, you want to be helped in identifying the best facilities and the best providers for your condition in these locations. Then you can comfortably say that the care is comparable. On a more granular level you can say that the care is better than or equal to the US. But the question at that point is more a matter of all the amenities that you can afford when you select medical travel. These options are not even considerations when in the US seeking medical care.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

What about my rights to privacy, can they be enforced?

The US laws overseeing the release of medical record information and patient confidentiality laws is called HIPAA. While in the US as a patient these regulations oversee your privacy. That does not guarantee your privacy. It ensures that every step is taken to protect your concerns and if a breech occurs you are told about it and the individuals who were unauthorized to view your records are held accountable. This can mean criminal prosecution with financial penalties and jail time. You as a patient may have civil recourse as well. For that you would seek legal counsel.

Protecting your privacy overseas has its challenges. Consistently the facilities I have visited express a desire to ensure your privacy was a priority. However the legal remedies and accountability are inconsistent. Having said that, any destination facility that wants to continue working in this space will need to move closer to the customers (your) needs and make these issues more defined and favorable for our clients privacy needs. It is my belief that they are doing that and actively work to ensure your best interests are served.

We need to be careful in assuming that everything needs to be enforced in a legally binding manner as in the US. It may be that culturally violating a confidence is unacceptable and perhaps carries more impact than our system. Issues like privacy can be different and better outside our borders than the methods we choose to address them locally. It is worth asking your medical travel company how the destination(s) you are choosing are working to ensure your privacy.

Be Well, Travel Safe

Jim McCormick MD
Premiere Medical Travel Company
818.917.6189

What do the AMA guidelines for Medical Tourism mean?

They are a set of principles that are a balance between the acknowledgment that this industry exists, is here to stay and a need to meet their member's concerns. Medical Travel and tourism are future competitors with general US medical practice. The industry is not large enough to be a business concern, but it is predicted to grow to that point.

The guidelines are available at the AMA website. It is worthwhile to discuss them. The first one: Medical Tourism must be voluntary. Yes I agree voluntary, but who or what company would force this option upon an unwilling client? Forced care overseas is a recipe for a medical and public relations disaster. So I agree voluntary, but the Medical Tourism industry has ethical participants.

In the second, third and fourth, there are important issues that are discussed. It is very important for many reasons to have Joint Commission International or International Society for Quality in Health Care certification. These two bodies ensure that facilities are using the right process and procedural mechanisms to ensure patient safety. The countries and facilities have the same quality assurance that we do or a different, but equivalent, process for assurance. This is important to the longevity of the industry. They are benchmarks that help us interpret important safeguards across cultural, political and language barriers.

The next two are intimately tied together. Follow-up care must be financed and coordinated prior to departure. A less well defined one: coverage for travel outside the US for medical care must include the costs of necessary follow-up care upon returning to the U.S. I am a strong proponent of aftercare. It is essential that this is available to the patient. Who should pay for the cost of after care is a more difficult question. Should the insurance company who receives the financial benefit of success care rendered abroad? Should the patient who is uninsured seeking the care overseas at a steep discount to the price a U.S. physician and hospital would charge? Should the destination facility be responsible for this fee? Should the facilitators? The premise is medically correct, aftercare should be available upon return. The business aspects of who pays for are open for discussion.

Physician outcome data and HIPAA Compliance issues are reasonable requests as goals. We do not have full transparency on specific physician outcomes and do not fully enforce HIPAA in the U.S. that is our goal, to move the country in that direction. It is the right goal for everyone. Our colleagues abroad may feel it is unreasonable to ask for a perform better than we do on our own metrics. But the goal is valid.

The last one we fully embrace at Premiere Medical Travel. First and foremost is the healthcare. We have taken a particular stance in calling ourselves medical travel and not medical tourism. We believe tourism highlights the tourism component too much. For simple procedure or health check ups, this is feasible, but to recover from major surgery while on safari is unreasonable. Health first, experience next and everything should follow properly.

In general the AMA has it right in our view. There are some gaps in expectation and performance domestically on the aftercare, payment, outcome measures and HIPAA issues that warrant further examination. We can only expect others to perform at the level we set, embrace and enforce for ourselves.

Travel Safe, Be Well.

Jim McCormick, MD
Premiere Medical Travel Company, LLC
818.917.6189

How do the privacy laws work when I choose medical travel?

For patients in the US, there are strict laws (HIPAA) that prohibit the release of medical records without permission of the patient. This prohibition extends to spouses and domestic partners etc. 

When you leave the US, and our jurisdiction, you enter another one. Local laws will prevail. There may be no privacy laws to enforce. Votes can be cast with the choice of a destination that values your privacy.  This is an indirect means of enforcement.

You can ask for a privacy clause to in your contract. The contract enforcement will likely be in the other country, where the services are rendered. A client who has their privacy compromised, would likely have to file their lawsuit in another country which can be very difficult.

Carefully choose your facilitator and website. Travel service placement providers may not be subject to HIPAA.  Choose a company that holds your privacy dearly. They should maintain your privacy whether the regulations apply or not. The release of patient conditions can be damaging to the patient, the company and the industry. It is bad patient care and bad business.

One health care worker released medical records to a tabloid. The person is now facing federal criminal (penalty and jail) and civil suits that far exceed the few thousand dollars she received for the release.

Jim McCormick, MD

Premiere Medical Travel