Wednesday, February 18, 2009

The smoke and mirrors of medical tourism

When is a medical tourism facilitator a medical travel agent?

According to our Medical Tourism Survey in 2008, around a third of UK medical tourists make their arrangements through a medical tourism facilitator. In some countries, such facilitators account for an even greater share of the market, and their influence is growing. The concern of many is the uncontrolled growth of the sector and the lack of regulation within it.

Let's say that I want to start a medical tourism facilitation business. How easy is it?

What do I need?
  • I need a name. I'll call my business "Magical Medical Travels".

  • I need a telephone. I've got one of those.

  • I need an internet connection. I've got one of those.

  • I need a web site to generate some patients. I can create something that will do the job, using a cheap package such as 1&1 web hosting.

  • I need some hospitals and clinics overseas that are prepared to pay me a commission, if I send patients to them. I'm sure that I can find a few of those.

  • I suppose I need to find someone in the destination country who can look after the patients while they are there.

  • ....and maybe some documents that I can get the patient to sign.

  • Oh, and it might be a good idea to invent a few patient testimonials...

  • Do I need to be medically qualified? Well, I'm known as Dr Pollard on several internet forums, and I have some drpollard@ email addresses, so that should be fine.

  • Cash flow. Well, if I take money up front from patients, and then pay the treatment providers late, that's not a problem. I'll buy some online advertising, and leave it a few months before paying the bill.

  • I'll pay a few hundred pounds to join one of the medical travel associations; that will give me some credibility.
It's pretty easy really? And that's how some (not all!) medical tourism facilitators have come about. Medical tourism is a very fragmented market and there's a pretty wide range of facilitators in the business.

Which brings me back to the title of this blog: "When is a medical tourism facilitator a medical travel agent?"

In the UK and Europe, that's actually quite an important question. Let's expand the question...

"What's the difference between a medical tourism facilitator who sells a consumer a package of accommodation, travel and treatment and a regular travel agent who sells a consumer a package of accommodation, travel and related holiday activities?".

In the UK, the activities of travel agents are highly regulated. For example, the "Package Travel, Package Holidays and Package Tours Regulations" were introduced to protect consumers from unscrupulous travel agents. A package is defined as the "pre-arranged combination of at least two of the following components - transport, accommodation, other tourist services".

So, is a medical tourism facilitator a travel agent? Some would say...yes!

And if that's the case, the Package Travel Regulations come into force and my new facilitation company, Magical Medical Travels might have some problems. It means my company will be subject to controls over:

  • What I can say in my brochure or web site.

  • The nature of any contracts I make.

  • The information I provide to the consumer.

  • Changes in price.

  • Security in the event of insolvency. ie. I will need to be bonded.

With regard to the latter, when someone books a holiday in the UK, many will look to see if the travel company is ABTA (Association of British Travel Agents) bonded. Which means that the company has placed a bond with an authorised institution, based on their turnover. The minimum bond is £20,000.

Even if you pay the bond, you can't join ABTA, unless you comply with their Code of Conduct, and submit to random inspection.

Let's compare this to the medical travel business, a sector that was once described last year by Avery Comarow, as the "The Wild West of Medical Care Abroad".

  • Anyone can set up as a medical travel agent/facilitator.

  • There's no regulation.

  • There's no compulsory code of conduct.

  • Anyone can join one of the associations such as MTA or IMTA.

  • There's no bond required.

So what's the industry been doing to fix the problem?

In the perfect world, we need an ABTA of the medical travel world - properly funded, run by a truly representative Board of Directors, that is answerable to its membership, that publishes an annual report and financial statements, that only accepts members who meet clearly defined criteria, that inspects member premises at random, and that requires all members to place a significant bond for the protection of medical travellers.


I doubt it.

What is more likely....

As medical travel grows, especially in a background of government driven initiatives such as the European Directive on Cross Border Healthcare, governments will begin to regulate medical travel facilitators and agents. Bodies such as ABTA in the UK and similar organisations in other countries would probably favour and support this.

"What makes a medical travel agent any different and exempt from regulation?", they would say.


Jack Lundberg said...

Well done and nicely said, Keith! This is an important and necessary direction for the industry to pursue, adopt and implement.

Maria K. Todd, MHA PhD said...

Nice job, Keith!

As president of the Council on the Global Integration of Healthcare, we are committed to moving in the same direction. We would welcome your input and direction at the Advisory Board level of our organization to work together with others in the facilitator and concierge communities of practice that would be willing to serve as a task force to take this from "not likely" to reality.

We would also support the establishment of a Board of Examiners appointed by those in the industry who would be charged with the responsibility to vet the standards for certification, examination criteria, re-certification standards, medical travel facilitator body of knowledge, advanced levels of certification, and finally, an association that can financially support the development and operation of a training institute for professional development.

The CGIH is open to further collaborative dialogue from you and others who are interested in moving in this direction together.

Maria K Todd, PhD
Council on the Global Integration of Healthcare

Donnie V said...

Awesome article, Keith! I was browsing and came across an article about Satori World Medical in the US - I have been seeing that name a lot lately and finally did some research on the company.

Not only are they on top of the quality game, they are the first company that I know of that has something to offer the everyday, insured patient. Shared savings on the cost. I had never heard of an HRA before - now it's something I'm very interested in... What an incentive! Money to put toward your healthcare costs(I wish it was cash in the POCKET... but hey, it's good enough). I think ideas like these are going to push health tourism into a place where it will actually have an impact on domestic healthcare costs for expensive procedures. What do you think? I would love to hear your thoughts on global healthcare economy!

Anyway, great blog - I will continue reading on, forgive me if I missed a post on global $$ views.

Levent Baş said...

Brief article Keith ! UK has at least regulations , in Turkey the situation is worse. Such agencies can harm both the countrys medical tourism future and also the health of the medical toursits.

I think it will be very difficult to put this under contorol especially in the web . The accreditations like, the code of practice of treatment abroad, will be globally accepted and then this will be a proof and trust sign for the medical tourists searching for providers and facilitators.

I am totaly thinking in the same direction with you.

great blog, well done.
best regards

Levent BAŞ

glasgow dentist said...

One can think about the benefits of medical tourism but its very strange to think about it side effects.

glasgow dentist said...

Till now we can see the advantages and benefits of medical tourism but, hope there will not be any bad effects.

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Omar said...

Hi Keith

Nice article I must say but it is categorizing all the medical tourism facilitators as being in the same class in other countries. Yes medical tourism is an unregulated industry in our country India but still we have some of the best facilitators here. We have tie-ups, facilities that make us world class. So therefore I disagree with you on the fact that every facilitator out there in developing countries is not of quality.

Omar Siddiqui
MedAsia Travels

Nester said...

I think in the same way we can describe the same problem with communication agencies specialized in medical tourism. There are not enough regulations and understanding of trustfull sources such agencies use. Does not take much to set up a communication agency with 10-20 webstes which globally presenting itself as an authority in medical travel. If the info presented to the public by such agencies can be trusted, easy verified? Or may be such agencies as Intuition are NOT there to serve community looking for quality affordable healthcare abroad but they are there just to make money?
Think abou it....

Keith Pollard said...

I'm a believer in free speech, so rather than delete your comment, I have published it because it gives me the opportunity to respond.

Firstly, I note that "Nester" has a blank profile on Blogger and is thus making an anonymous post. I would be intrested to hear who "Nester" is and what sector of the industry he/she represents.

>>>Does not take much to set up a communication agency with 10-20 webstes which globally presenting itself as an authority in medical travel.

It does actually. We have been in the business for eight years and have invested heavily in both technology and content. Personally, prior to running Intuition, I worked in the hospital and healthcare sector for twenty plus years and have real life experience of managing the delivery of hospital services to medical tourists.

>>>If the info presented to the public by such agencies can be trusted, easy verified?

The problem is that it is fairly easy to verify the information that we as a healthcare communications agency provide. But it's very difficult for a patient to verify (or trust) the information that a medical tourism agency provides. One simple example, our company has a a Medical Director. We're a healthcare communications agency, so I think it's essential that there is "clinical responsibility". It's even more important that medical tourism agencies should be guided by a medical professional... but very few are.

>>>Or may be such agencies as Intuition are NOT there to serve community looking for quality affordable healthcare abroad but they are there just to make money? Think about it....

Well... if you think about it, that's the way that business works. Businesses deliver services to consumers and get paid for this. If we can provide information and guidance for medical tourists that helps them to make the right choics in medical tourism, and we do this well.... then our business will thrive and make money. Get it wrong and you go bust!

mark said...

Can the community regulate itself? In the days of the internet we can work together to publish our experiences with medical tourism facilitators. The bad eggs will stand out when people realise nobody has rated/reviewed them, or their reviews are highly negative.

Nobody can hide behind smoke and mirrors in the age of the internet.