In the second of a series of three articles, Zahid Hamid from the UK facilitator, Euromedical Tours, looks at the requirement for aftercare for the medical traveller, and the current shortcomings in the delivery of a comprehensive and effective medical travel experience.
Medical travel is an industry where the effects of globalisation are incomplete. The resultant distance that separates the patient from the service provider calls for devising care pathways distinct from local healthcare delivery and more elaborate in their structure and content.
The travelling patient has bespoke requirements before and after treatment, when remote from the service provider, and very specific ones when under treatment in hospital. Whilst this latter area yields the oft repeated mantra about language, culture, family, dietary requirements, etc., the former is at best glossed over and only sparingly addressed in a quasi, unstructured and inconsistent manner.
Certification is not a panacea for what ails medical travel
Hospitals are cosy in the belief that having JCI or a similar accreditation attends to every patient concern before treatment and conveys a sense of responsibility for post-treatment care. In the last six years, not one of the 700 patients facilitated by Euromedical Tours and Right Choice UK has ever asked if a hospital has JCI or any such accreditation. The consumer is blissfully unaware of the existence of such standards, regulation or certification and what it may mean for them.
What the patient needs is the conviction and confidence of making the right choice before they proceed for treatment and the comfort that there will be aftercare available upon their return. This is where hospitals fall woefully short of meeting patient expectations; the patient makes a leap of faith of varying degrees of courage, desperation or in sheer ignorance.
What will make for a confident and well-informed decision means knowing;
a) What treatment is needed – the diagnosis
b) Who will perform it and how experienced are they – specialist credentialing
c) Where will it take place – facility credentialing
d) How long will it take and what will it comprise – treatment planning
e) How much will it cost and what is included – cost control and transparency
f) What happens when the patient returns home and needs attention – aftercare
g) What if the patient needs corrective, revision or follow up treatment – treatment warranty or guarantee
The sum total of the answers to these questions will account for the ‘Push’ Factor which complements the ‘Pull’ Factor, coming from the overplayed attributes of quality, availability and price. Together, they provide a measure of the overall value for money proposition.
It may be argued that this is already being done. However, it is the shades of grey that appear in the script rather than it being rendered in black and white that detract from credibility and, therefore, the Push. More often than not, this information is served by a facilitator, equally distant, but hungrier than the hospital and unregulated. So the promise is made by a third party who has no control over the delivery of the services. The process is shorn, at the outset, of the ethical approach synonymous with medical practice.
Service provider outreach is all important
In an ideal world, hospitals should reach out and establish a presence in countries in their catchment area from where they wish to attract patients.
In the real world, this is possible and indeed desirable in Africa, Middle East, South Asia and Central Asia and the Asia-Pacific regions where there are huge gaps in access to healthcare alongside a surfeit of facilities in relatively developed countries. The process needs the vision to fathom the economies of scale, the will to harness them and an institutionalised approach to deliver a viable and sustainable model for regional healthcare delivery.
In the developed world, it is well-nigh impossible to conceive of healthcare outsourcing being allowed to proceed unabated when it is the largest area of public expenditure at home and by far the biggest employer. The European Union directive on Cross Border Healthcare is a prescription necessitated by the judgement in the Yvonne Watts’ case and similar cases. It is a feel-good, tick in the box solution rather than a route to region-wide delivery of healthcare to the consumer.
In contrast, it is the private healthcare initiative in areas like cosmetic surgery, dental treatment, infertility, etc., within Europe that flourishes.
Hungarian, Italian and Belgian ‘specialist mobility’ provides the benefit of one-to-many, offering consultations and treatment outside of their countries of origin as an example of the kind of outreach required to mobilise confidence and set up patient streams. EU DIRECTIVE 2005/36/EC on the automatic recognition of professional qualifications makes possible the free movement of professionals in seven ‘sectoral trades’ that include doctors and dentists.
Telemedicine in medical travel
Second to a personal, patient–practitioner consultation must be the medium for virtual consultation. Telemedicine needs to find application beyond the perfunctory academic, feather-in-the-cap existence to a functional medium that brings the patient and practitioner on the same platform and allows for real time monitoring, evaluation and diagnostics. This will deliver pre-treatment confidence and enhance the post-treatment comfort zone of the potential patient. Who gives advice and where, and which country’s jurisdiction applies to the process, may become a potentially contentious issue. Let us get that far and, once the questions are asked, standards for ‘e-consulting’ and telemedicine will fall into place. This is true for every region, consistent with its dictates, and a ‘must-have’ if medical travel is to come into its own.
Only when we have deployed these constituent elements of the healthcare travel model will the certifiers of international patient care and medical tourism have the physical attributes to verify the practice of what they preach.
Empowering medical travel facilitators
In the absence of a physical presence, specialist mobility or telemedicine links, hospitals need a surrogate that we have come to know as the medical travel facilitator. Given the remit, the facilitator must be based in the country of patient origin as the destination facilitator is defunct in this role.
Not only the remit but also the substance of the patient engagement in medical aspects must be scripted and choreographed by the service provider. There must also be financial guarantees in place to support provision of post-operative care to patients on behalf of hospitals, when and where needed. Patients have come to accept facilitators as an essential accompaniment that bridges complementary care pathways to and from the hospital. Hospitals need to recognise this dependence and lend credence to their representation by proxy, particularly so, when the proxy does not have medical expertise. However, this should be seen as hospitals empowering facilitators and not lead to facilitators becoming sole representatives of hospitals or, conversely, a hospital as being solely represented by a facilitator. Patient choice must prevail and the hospital-facilitator relationship must not prejudice the facilitators’ role as a patient advocate.
The second oldest profession will retain currency in healthcare travel until such time service providers come around to calling a spade a spade and taking the bull by the horns to drive it home! In the meantime, let’s to learn walk before we start to run.
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