Practice makes perfect...a message for medical tourism providers and patients

In the largest ever study of hospital mortality rates published in the UK,"death rates for emergency patients jump 6 per cent when newly qualified doctors start work. The Health Services Journal reports that "the traditional first day for NHS doctors is the first Wednesday in August. Researchers found that patients brought into hospital the week before were more likely to survive.....Researchers could not find a definite reason for the higher mortality rate, but said early August was known as an “unsafe period” in hospitals due to the influx of new doctors"

Now, what can we conclude from this?

Might I suggest that doctors with more experience are better than those with less experience? It goes without saying, really.

So, how does this help the medical tourist who is trying to make a decision about which doctor or specialist overseas to choose for their operation? The problem of patient choice in healthcare whether it is a choice of an overseas surgeon or a domestic surgeon is the "how do I know that he's any good?"issue. In the UK, we're probably ahead of the game in enabling patients to make informed choices about treatment. The NHS web site is has been renamed "NHS Choices" and in recent years there's been a drive to expose data on clinical outcomes and surgeon and hospital performance, and make this freely available to patients.

One of the strengths of the UK healthcare system (and one of its shortcomings!) is that the vast proportion of healthcare is delivered by one healthcare provider - the NHS. This means that data on processes, outcomes, performance and patient satisfaction is fairly standardised, thus enabling valid comparisons to be made between one hospital and another, between one specialist and another.

Let's imagine that I need a knee replacement. Under the NHS, I can choose to go to any hospital in the UK, not just my local hospital. But let's assume that I want to stay fairly local. Here's some of the data I can access about my local hospitals through NHS Choices. For each "quality factor", I have highlighted the best result.

Impressed? Which hospital would you choose? Or which hospital would you rule out of consideration? The above table only scratches the surface of the data that is now being made available to patients. I could also compare the quality of the food, levels of service and so on. And I can also begin to make comparisons between individual surgeons.

Where does this leave the medical tourist? The reality is that there are few countries where this kind of comparative information would be made available to the patient. And the reality is that different healthcare systems often measure things in different ways, so that comparing outcome data from a hospital in Thailand with outcome data from a hospital in India might be very difficult.

So, the medical tourist probably needs to ask some very basic questions about the hospital and specialist. One of which is a fundamental measure of "how do I know that he's any good?” It's "how many times have you done this operation before?" "Practice makes perfect" as the recent study demonstrates. Choose a surgeon with experience in exactly what you require. If you're looking for a knee replacement, choose an orthopaedic surgeon who does knee replacements and virtually nothing else. Don't choose a "general" orthopaedic surgeon who does “everything under the sun" - knees, shoulders, feet, hips etc.

And ask the guy "how many have you done this year?"

Transparency and fraud in health tourism

One of the criticisms of buying services via the web is that you cannot always be sure with whom you are actually dealing. This is especially true in the field of health and medical tourism. When you visit a site about medical tourism:

• How do you know who is behind the site?


• How can you tell what they actually know about health tourism and healthcare in general?


• How do you know if you can trust them?


• How do you know where the patient's money is going?

Next month, I'm speaking at the Annual Conference of the European Healthcare Fraud & Corruption Network (EHFCN) in Edinburgh. The Conference theme is "Cross-Border Healthcare in Europe: A Gateway to Fraud and Corruption?".

The European Healthcare Fraud & Corruption Network (EHFCN) is the only European organisation dedicated to combating fraud and corruption in the healthcare sector across Europe. The network represents 23 member associations in 10 countries, which provide healthcare services to millions of people in Europe.

According to EHFCN, "the healthcare sector appears to be particularly vulnerable to corruption. The large amounts of money involved and the complexities of many healthcare systems play a role as well as the fact that there are many processes with high risks of bribery"

And now it is turning its attention to health tourism.

As a web publishing company in the healthcare sector, it's important that Treatment Abroad is transparent, and that when we're publishing health advice on our various web sites, we ensure that the information is written by qualified medical professionals. We make sure that all of our sites go through the Health On the Net Foundation's certification process. (I recommend that all healthcare sites go through this process.) And our company has a Medical Director to oversee what we do - Dr Nick Plowman from St Bartholomew's Hospital in London.

But in the world of medical tourism, is there a problem with lack of transparency and is there significant potential for fraud?

In researching my presentation for the EHFCN conference, I've taken a look at transparency in medical tourism. I did the usual Google searches and I came across Health-tourism.com for the first time: It states that is "a guide for medical tourism, bringing you reliable, objective and useful information that will help you plan your medical travel".

While I was browsing the site, I came across this:

• Medical Tourism Transparency Award - "we have created the Medical Tourism Transparency Award. This is a badge awarded to websites of medical tourism providers whose website information meet the criteria below."

Now, let's be clear, the guys at Health-tourism.com may be decent and honest people, with the best interests of medical travelers at heart. But it was their "Medical Tourism Transparency Award" that caught my attention. Health-tourism.com says that "The purpose of this award is to encourage providers to supply necessary information on their web sites - making it easier for you to make an informed decision.

So, I put Health-tourism.com through a "Transparency Test".

I looked all over the site....

• It says that it's run by Find Global Care.I can't tell who they are or what their qualifications are.


• In the lengthy disclaimer it says "the content on this website has not been reviewed or prepared by medical professionals.


• And it says that the "relationship between the visitor/user and FGC shall be governed by the laws of Cyprus". Why Cyprus?


• I can't find any names at all.


• I can't find out who owns the site or the company.


• I can find an address - 1B, Pinetree Boulevard, Old Bridge, New Jersey.

I'm an inquisitive person.....

I did some digging for information on Find Global Care. But all I could find... was another web site - half built at www.findglobalcare.com and an entry on WikiCompany with no information on the company ownership.

So I thought I'd pay a visit to 1 Pine Tree Blvd, Old Bridge, NJ 08857, USA using Google Maps Streetview. (Isn't the web a wonderful thing?). I'm not an expert on US arrchitecture but judging by the Real Estate sigh outside and the building, this looks like an apartment building. But who lives there? And who's behind the business? And what does he or she know about health tourism?

Next, I checked out the domain name. It's registered to Udi Shomer from Illinois. Perhaps he's behind the business? Who is he? I don't know. But it's not a common name, and the web may have some info on him?

There's only ten results for a search for "Udi Shomer" on Google. (Hey, that's close to being a Googlewhack!). Let's take a look at the Udi Shomers on the web:

• There's an Udi Shomer who has an entry in the Lonely Planet guide to Thailand.


• There's a listing page for Tai Chi in Thailand.


• And there's a few references in Israeli job sites (I think).


• And that's it.

There's a clear message here for medical tourists who use the web to research healthcare services.

• Look (very carefully) before you leap.!

And if anyone knows who runs Health-tourism.com, ask them to get in touch, so that I can fill in the gaps.

Dental tourism...Let's work together

The Irish Dental Association is the most recent medical professionals body to publish a "survey" raising doubts about medical tourism.
In a recent press release from the Irish Dental Association, they state that "3 out of every 4 Irish dentists are treating patients for problems arising from treatment abroad. Let's take a look at the background to the survey, and examine some of the real concerns that are raised.
The Consumers’ Association of Ireland has published research about the high costs of dental treatment in Ireland. The Irish Dental Association accepts that Irish dentists are not immune from the wider economy and the bottom line is that Ireland is a high-cost economy. As a result, significant numbers of Irish dental patients travel for treatment to minimise treatment costs. Some of these are cross border dental tourists. Many services carried out in Northern Ireland are between 25% and 45% cheaper than the same services in the Republic, according to the study published in the Consumers’ Association of Ireland’s magazine Consumer Choice. And of course, many Irish patients take advantage of low cost treatment in countries such as Hungary and Poland. Several Budapest dental treatment providers have offices or representatives in the Republic of Ireland.
According to the Irish Dental Association survey, 76% of Irish dentists in private practice [more than 3 out of 4] have had to treat patients for problems linked to the dental treatment they received abroad.
First, we need to examine the basis of this claim.

• There are approximately 1,700 dentists in private practice in Ireland at present.
• 440 Irish dentists responded to the survey.
• 334 said that they are treating problems arising from treatment overseas.
• So.... in fact 334 out of 1,700 said that they were seeing problems which is 20%. Obviously, this assumes that those who didn't bother are not seeing problems.

When reviewing such surveys conducted by on or on behalf of professional associations, we have to bear the following in mind:

• Inbuilt sample bias: People who see a problem are more likely to respond to a survey on that issue, than those who don't. We've seen similar bias built into surveys conducted by a PR agency in behalf of the British Association of Plastic Surgeons.
• Motivation: We always need to remember that professional associations represent the interests of their members. Losing patients to Belfast or Budapest hits the pockets of private dentists.

Nevertheless..... the Irish Dental Association has made some valid points. Are there concerns for dental patients who travel for treatment? Yes. Are the problems as big as the Irish Dental Association suggests. No.

At the end of the day, the Irish Dental Association also has the best interests of Irish dental patients at heart. Dr Donal Blackwell of the Irish Dental Association says that that one of the problems is that when considering travelling abroad for dental treatment, patients tended to focus on short term, aesthetic results rather than the long term quality of the care they receive and suggests that people travelling abroad for dental treatment actually don't know what they need when they enquire about costs. He's certainly right in some cases.

So, what's the solution and what's in the best interests of dentists and patients?

I'd like to see the following:

1. The Irish Dental Association issuing guidance for dentists and patients when considering dental tourism. See the UK General Dental Council's Dental Tourism Checklist on Treatment Abroad.
2. Irish dentists providing assessment and follow up of patients who travel abroad for treatment.
3. Irish dentists visiting some overseas dentists to get an understanding of how they work and their clinical skills and quality.
4. Irish dentists forming partnerships with overseas dentists, so that patients who need extensive treatment but can't afford Irish treatment have access to the treatment they need under the supervision of their own dentist.
5. Overseas dentists communicating with the patient's Irish dentist when a patient turns up in Budapest or Krakow - informing the patient's Irish dentist what work is to be undertaken, and providing post treatment reports on the work that has been carried out.

Common sense really. So, let's work together!