August 22nd, 2010 by Christian Seebode

Medical tourism is special in many aspects. Patients travel first to be treated. Main drivers for this behavior are quality and/or price. This makes medical tourism a real market scenario with real customers.

Patient Choice

The first remarkable thing about medical tourism is choice. Whatever the reason is that patient choice is often not possible in general healthcare it is possible in medical tourism by definition. It is not that you select or are forced to select the hospital or doctor around the corner you actively select a treatment and a destination or vice versa. The combination counts and makes the difference. Being treated abroad is way more complicated than it is at home for a number of reasons.

Among them

  • Distance. Travel is needed to become treated. This has to be considered in schedules, indications and post treatment plans, just to name a few
  • Culture and Language. Healthcare has not the same value in different cultures and even if it does, people talk about it in different languages and nomenclatures
  • Procedures and quality. Changes from one hospital to another and even more from one country to another. Even if medical science is global, quality still has a long way to go to claim this. Transparency is just another issue.
  • Patient context. What is this? When a patient moves across borders he carries along his data, relationships, contracts everything that counts in a healthcare situation. It is still an illusion that this context is completely preserved in the country of treatment. But it is a goal. Patients contact to families, access to medical data, insurances etc. , all this changes in the country of destination

But whatever the reason is the core procedure is to execute choice. But what is needed to do this? Do we need to know everything in order to make a good decision or is choice just an inevitable evil?

First let’s have a look on what drives choice in medical tourism. Quality? Price? Both!

According to a recent survey (http://www.imtj.com/articles/2010/medical-tourism-climate-survey-30055/) the most important factors influencing patient choice in medical tourism are

  • Expertise and qualifications of the doctor/dentist
  • Comments and ratings by other patients
  • Fluency in the patient’s language (English, French and German are the most commonly supported languages within the destination countries).

In other words: Patients require transparency and communication about quality. But it is not the mere information that is most influential. What really is impressive is that the communications about choices of other patients are considered important. Trust is crucial for a community to provide guidance and reciprocity (’tit for tat’, http://en.wikipedia.org/wiki/Tit_for_tat) (http://portal.acm.org/citation.cfm?id=1067860.1067864). But even if you are only a lurker in communities (only reading, rarely writing http://en.wikipedia.org/wiki/Lurker) you PAY attention which means you contribute to the community and to the social capital it represents. In a healthy community everybody can follow without running the risk of being information overloaded (http://www.citeulike.org/user/phauly/article/825577).

This is what is important for a community to leverage patient empowerment in order to support choice. The patient-centeredness of a community is the adequate amount of information and knowledge it represents. This is why it works usually completely self driven.

Patient Communication

Communities that are based on patient-patient communication are only one possibility. Within the process chain of medical tourism there are other players involved. The main issue of medical tourism is that most of these relationships are remote. For remote relationships, especially in healthcare special conditions apply. A huge communication effort is needed to make this work but there usually is no coordinating instance, because interests or business models are decoupled. The only entity present in all steps is the patient himself. This makes the patient the natural hub for all communications but is he or she really involved? I doubt there are hard facts available analyzing the relationship of communication skills and possibilities for patients in medical tourism but at least a result form a 2008 survey (http://www.treatmentabroad.com/medical-tourism/medical-tourist-research/) suggests that language barriers are a common cause for dissatisfaction.

On the other hand clinics that offer on international markets do have an considerable advantage to follow JCI accreditation requirements.

JCI accreditation regulations require

All written and oral communications with the patient must be in a language and a format the patient understands; the patient’s understanding is to be verified. The organization should also provide caregivers for patients who speak the same language or translators.

( http://www.medicaltourismmag.com/issue-detail.php?item=60&issue=3# )

A patient centered website considers exactly these requirements and keeps a track record of all medical and non-medical communications in the language of the patient. This means the application model supports whether direct translations or a translator service or the internationalization of the application model. The latter needs some coding standard of a medical terminology like SNOMED-CT or the like. But patients may not be able to use medical terminologies in the first place. This is why a didactic concept is needed to provide patients with the necessary knowledge. My favorite is the combination of a human guide or patient manager with the possibility to keep track records of all communications. This would be in line with the above JCI requirements. In any case the communication efforts for medical tourism require

  • A central reference or repository to track all communications. The model could be similar to a blog. The main requirement is that it tracks ALL communications and is able to store links, tags and other meta-information to support causality and knowledge
  • The possibility to assemble official documents from all communications. Documents that have to be signed or viewed by other parties are the basis for business. Examples are contracts or patient targeted education for procedure
  • T he possibility to search and sort by date, tag or any other classified attribute

Patient Involvement

Another aspect of patient communication is patient involvement. Patient involvement implies a continuous participation in the process. This is only possible with a certain amount of understanding what is going on. Medical tourism especially puts some difficult barriers in the way. These barriers are linguistic and cultural but also procedural. In fact because of the multitude of parameters added in comparison to near shore treatment finding an optimal pathway for the patient is a huge effort. This is why in medical tourism a patient involvement is more than required. It is mandatory. The story behind patient involvement is patient safety. Every patient should claim a maximum of participation in his own interest. The maximum is limited by cognitive barriers but it is recommendable to learn as much as possible about the process. So the patient involvement begins with actively searching an adequate offer. Treatment offers should be backed up by second opinion services offered by independent experts or authorities. Patients should learn ask the relevant questions themselves. Before selecting an offer a patient should be able to express in his own words what he or she is going to select. This is not a simple claim. Some procedures are simple in principle but how a patient really profits is sometimes subject to subtle science. A good example is fertility tourism. Patients looking for fertility treatment are often desperate need. A health condition which is sometimes not profoundly understood offers a probabilistic chance for happiness and a family. It is however in general unrealistic to claim that customers of fertility services really understand and take full responsibility of evaluating the quality of the service. This is even difficult for experts sometimes. But at the same time it is necessary for the patient as a customer to distinguish quality from lesser quality services (http://www3.interscience.wiley.com/journal/122443658/abstract). It is not enough to rely on ethics alone. Patient involvement through provision of educational services and transparency of procedures additional to the fertility treatment itself is a step in the right direction (http://www.ncbi.nlm.nih.gov/pubmed/11547268). A fertility treatment needs an elaborate plan that has to be agreed with and followed by the patients. Simple checklists or diaries are of considerable use here (http://humrep.oxfordjournals.org/cgi/content/full/24/6/1420). Patient Centered Information Technology supports this by providing interfaces to electronic diaries connected to EHRs. The important point is that a web based diary could be linked to the medical pathway information and to the educational content. Web 2.0 interfaces allow personalization and feedback for a richer user experience. Fertility clinics are better off providing this as part of patient CRM for international patients to better schedule the visit. Patient Centered technology still is very simple compared to the complexity of the treatment but effective in the sense to give patients a possibility to participate. Having web based interaction possibilities implemented treatment for medical tourism could start when the patient is still at home. This is true for all treatments that need a special preparation as for example fertility treatment.

Patient involvement in medical tourism can be facilitated by Patient Centered, web based interfaces for

  • Process scheduling. Early in the process patient can influence schedule, path and decisions. Risk can be assessed before traveling
  • Decision support. Educational services provide learning possibilities for better understanding and participation of patients
  • Feedback. The patient is a very good indicator for improvement of therapies and services

Conclusion

Patient choice, patient communication and patient involvement are 3 aspects of the same phenomenon in medical tourism. The goal is active participation and personalization of services. Communication comes along in different flavors. Communities are able to build trust for services and patient centered communication enables patients to follow all relevant communications even in different languages. Finally educational services are able to provide the necessary knowledge for the patient to participate in decision and execution of procedure in medical tourism

Patterns

community

guided search and communication

medical pathway

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