GLOBAL: International comparison of healthcare systems

A new Commonwealth Fund report has assessed seven industrialized countries on the performance of their health system in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives. The Commonwealth Fund is a private foundation supporting independent research on health policy. 27,000 patients and primary care doctors were surveyed across all seven countries as part of the study.

The Netherlands ranked first overall, closely followed by the UK and Australia. The UK performed well when it came to quality of care and access to care. In relation to access, the study says: "The UK has short waiting times for basic medical care and non-emergency access to services after hours, but has longer waiting times for specialist care and elective, non-emergency surgery." The Netherlands ranked very highly on all waiting times measurements. When it came to efficiency, the UK and Australia ranked first and second.

Despite having the most expensive health care system, the United States ranks last overall. While there is room for improvement in every country, the U.S. stands out for getting poor value for its health care dollars, ranking last despite spending $7,290 per person on health care in 2007 compared to the $3,837 spent per in the Netherlands, which ranked first overall.

Report author Karen Davis comments, "It is disappointing, but not surprising that, despite significant investment in health care, the U.S. continues to lag behind other countries. With enactment of the Affordable Care Act, we have entered a new era in American health care. We will begin strengthening primary care and investing in health information technology and quality improvement, ensuring that all Americans can obtain access to high quality, efficient health care."

On measures of quality the United States ranked sixth out of the seven countries. On two of four measures of quality ? effective care and patient-centred care ? the U.S. ranks in the middle. However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. On measures of access to care, people in the U.S. have the hardest time affording the health care they need, with the U.S. ranking last on every measure of cost-related access problems.

Overall rankings -

1. The Netherlands

2. United Kingdom

3. Australia

4. Germany

5. New Zealand

6. Canada

7. United States

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GLOBAL: Global initiatives for the medical tourism industry

KEMP Healthcare
With patient care and safety emerging as a major concern, a US/UK healthcare company plans to launch a certification service for hospitals in India in early 2011. KEMP Healthcare Ltd plans to launch a Quality of Care certification service that will bring to a hospital evidence-based quality improvement measures that have been tried and tested in international healthcare systems as reliable processes. The company is targeting hospitals that are keen and committed to provide better care to their patients and want to build on their existing strengths to excel on the 5 stars of quality, safety, timeliness, effectiveness of care, and patient satisfaction. Appraisal of successful incorporation of these 5 stars by KEMP Healthcare would result in achievement of certification and the hospital could promote itself as a 'KEMP 5 Star Certified Hospital'.

The aim is to enable consumers of healthcare in India to make an informed decision when choosing hospital for themselves and their families. The company says it will give the hospitals additional credibility, confidence and visibility within an increasingly competitive market and claims to make them more attractive to foreign patients visiting India for medical tourism. KEMP Healthcare is a trans-Atlantic co-operation that brings US and UK healthcare expertise together, to provide evidence-based solutions to healthcare systems globally so as to improve efficiency and deliver quality. How a company that has no international track record in this sector, and with a name that means nothing to medical tourists or agencies, plans to compete with established international accreditors and persuade hospitals to use it instead, is an interesting question.
Mercury Healthcare
Mercury Healthcare of the USA has launched a UK subsidiary in London to help it develop in Europe and Commonwealth countries. It will provide training, consulting, and support services to the Central and Eastern European medical tourism markets and government agencies throughout the Commonwealth and the European Union. Mercury Healthcare is also a medical tourism agency with a network of hospitals and other healthcare providers in more than 25 countries, including more than 200 hospitals and over 15,000 doctors, dentists and allied health providers.

MedRetreat
With global growth and many newcomers attempting to enter the business, hospitals may find it hard to decide whether an agency is reputable and likely to bring it volumes of good business, or one just seeing the industry as a quick way to make money with little effort and no long term concern on whether patients or hospitals get what they want. Patrick Marsek, of MedRetreat, a US based medical tourism agency warns, "The best agencies have trained staff, industry experience, and proven processes that guarantee a safe and stress-free experience for medical travelers. Unfortunately, some may not possess the qualifications necessary to ensure a positive medical travel experience. To ensure that the medical tourism industry continues to flourish, overseas hospitals must take great care when choosing agencies as affiliates. A single patient mishap can effectively put an overseas medical provider out of the health tourism business for good. Even if a hospital has provided superior quality care, it may lose business if a medical tourist who is dissatisfied with the service speaks to the media about having a bad overseas experience. That there is no official accreditation agency to identify and evaluate quality standards for agencies makes it difficult for international hospitals to know which offer top quality.”

Marsek continues- “Until such an agency exists, all international hospitals should take the following five steps before agreeing to an affiliation with an agency for the purpose of attracting patients.
??? ?Develop an affiliation approval process.
??? ?Verify that the agency is a legitimate business in good standing.
??? ?Insist that the agent visit your hospital.
??? ?Ask them to disclose their processes and fee structure.
??? ?Determine the level of service the agency provides.

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GLOBAL: Satisfied customers encourage others into cosmetic surgery tourism

A study of the experiences of cosmetic surgery tourists, led by the University of Leeds, challenges widely held perceptions about the safety and motives of people travelling overseas for treatment.

The two-year study, ‘Sun, Sea, Sand and Silicone’, is the first to use in-depth interviews, video and photo diaries and questionnaires to analyse cosmetic surgery tourism from the perspective of the patient’s experience. The study was funded by the Economic & Social Research Council.

Findings are based on the accounts of more than 100 patients from the UK, Australia and China, as well as 100 people involved in the industry.

While bad experiences have typically grabbed headlines, the researchers found that 98% of the patients would repeat the procedure in the same country and medical facility. Many patients also praised the clinics for diagnosing and treating underlying health problems during pre-surgery tests.

The profiles of the patients also challenge the stereotype of a cosmetic surgery tourist as being a wealthy, glamorous and globe trotting Westerner who is exploiting low-wage economies.

According to Professor Ruth Holliday from the University of Leeds, “The patients we interviewed were ordinary people on modest incomes ? administrators, nurses, shop workers ? who travelled abroad because they could not afford to have the surgery at home.? Some patients from the UK commented that private surgeons at home viewed them as walking cheque books, whereas surgeons abroad saw them as a whole person.”

Investing in their physical appearance was only one of four motivating factors for opting for cosmetic surgery. Other reasons given by patients were correction, such as ear pinning and nose reshaping; repair, such as post-pregnancy breast uplift or tummy tuck; and anti-aging, such as a face-lift or hair transplant.

The findings also show that the quality of the surgeon, rather than the desirability of the destination, was the key deciding factor in choosing the location. Many patients reported that they enjoyed some sightseeing during their trip, but the emphasis was on travelling for affordable surgery and then returning home as quickly as possible.

When asked how they had selected a surgeon, the researchers found that people preferred reading reviews from other patients, while the advice provided by surgeons, clinics or cosmetic surgery tourism agents was often seen as being tainted by profit motives.

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GLOBAL: New online medical tourism courses launched

US company, Medical Tourism Training, has launched five new online courses to provide fundamental information and skills vital to success, for industry professionals and consumers who want to learn about international health travel and medical tourism.

Developed by a team of experts including medical tourism experts with backgrounds in healthcare, business, education and law, the affordable and convenient course materials are based on international best business practices as well as experience in the sector. ?

The five courses-
??? ?Introduction to medical tourism
Focuses on five areas fundamental areas forming the basic understanding of medical tourism: its definition and history, factors driving the growth in the sector, major countries involved in international health travel and the services they offer; and current issues.
??? ?Basic medical terminology
Covers more than 225 words related to medicine and medical tourism. Throughout this class, words are spoken while each slide contains the written word, a phonetic guide to pronunciation, a definition, and images or photographs to maximize understanding and retention.
??? ?Telephone skills for the medical tourism professional
This is filled with practical advice as well as audio and video clips demonstrating the “Do’s” and “Don’ts” of telephone etiquette. It offers opportunities for you to practice and improve your telephone skills. Learn how to manage telephone interactions professionally so that you can consistently create positive impressions about you and your business.
??? ?Email etiquette ? netiquette
Proper business skills for communicating via email are vital to building and maintaining a global business. This course contains no-nonsense advice as well as audio clips demonstrating the “Do’s” and “Don’ts” of email etiquette. Sharpen your email communication skills to deliver improved customer service.
??? ?Essential skills for working with upset customers
This business skills development course provides essential tools to avoid or defuse negative situations as well as restoring business relationships following a harmful experience with upset customers. Through the use of narrative, audio and video clips, you will learn skills for better interactions with your clients, staff and management, and other professionals.

All are available individually or in any combination and reflect the company's emphasis on the importance of excellent customer service. Ruth Rietveld-Kirwan explains, "Online courses provide flexibility for busy people who want to learn in the convenience of their own home or office, at their own pace, when they have the time.? It is an easy way for a global audience to access the information, training, and skills needed to succeed in medical tourism. These introductory courses are for individuals interested in learning more about international medical travel.”

The courses are designed for a wide audience including medical travel agents; international care coordinators; medical professionals; support staff in hospitals, clinics, private medical and dental offices, spas; travel agents; hospitality professionals; as well as prospective or current medical tourism clients and anyone who is curious about the medical tourism industry.

Elizabeth Ziemba of Medical Tourism Training says,” Our objective is to design content-rich, visually appealing courses that are affordable to just about anyone, anywhere.? Through the use of audio and video clips as well as a variety of quizzes, individuals can learn essential information and practice skills, bringing a higher level of professionalism and excellent customer service to the international health travel sector. While we are busy developing additional courses that will be at an intermediate level, our team has created courses that are an excellent introduction to medical tourism".

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GLOBAL: New portal claims to be first for medical evidence for spa and wellness therapies

The new SpaEvidence.com claims to be the world's first portal for medical evidence for spa and wellness therapies. It is an online resource dedicated to the medical evidence that exists for spa and wellness therapies. With thousands of clinical studies evaluating the effectiveness of approaches like hydrotherapy, massage or meditation, SpaEvidence makes it easy and free for people and medical, wellness and spa professionals to research what has been proven to work, what is not and for what conditions.

Professor Kenneth R. Pelletier of the University of Arizona says, “People assume that the clinical evidence always sides with conventional Western medicine, but the gold standard for medical research, the Cochrane Reviews, indicates that only 30%-35% of conventional medicine is adequately evidence-based. Increasingly more doctors agree that one of the largest bodies of medical evidence is the one demonstrating that lifestyle changes, mind-body approaches and stress-reduction have the largest impact, on the largest number of health conditions, for the largest number of people. This site is a breakthrough because the evidence already exists, but until now it has not been easily accessible.”

Dr. Daniel Friedland of SuperSmart Health adds, “The crippling costs of many traditional healthcare systems, which narrowly focus on sickness, pills and procedures - rather than prevention and lifestyle changes have become unsustainable for many people, governments and corporations. Hundreds of millions of people are now embracing smarter, prevention-focused, more integrative and personalized health approaches. But they demand the facts.”

SpaEvidence's key features:
??? ?Research: Users can search four of the most authoritative evidence-based medicine databases for studies on 21 spa and wellness approaches: Natural Standard, The Cochrane Library, PubMed and TRIP.
??? ?Spotlight: Highlights select medical studies for each therapy as a springboard to further research.
??? ?Studies-in-Progress: Visitors can investigate the clinical trials underway globally.
??? ?Conversations and contributions: Users can contribute studies and their own experiences/outcomes with spa/wellness approaches.

The portal's functionality will continue to expand, and additional spa and wellness approaches will be added regularly.

Susie Ellis of The Global Spa Summit says, “Our industries have long been accused of soft, anecdotal claims, when what was really missing was a resource to access the clinical research that supports so much of what we do. Some of the medical evidence for spa and wellness approaches is powerful, some is inconclusive, some is negative and far more studies need to be undertaken. But embracing transparency is the path to true legitimacy and industry growth, and I hope every spa and wellness center worldwide will use this portal, link to it and spread the word.”

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GLOBAL: The globalisation of fertility treatment

A huge variation in the availability and practice of fertility treatment is revealed in a new survey of 105 countries from the International Federation of Fertility Societies (IFFS). The UK has 66 clinics, Germany 120, Spain 200 and Italy 360. Japan has 615 clinics, and in India there at least 500 clinics.

Surveillance 2010 was compiled by Professor Ian Cooke of the IFFS, who says: "What is considered acceptable varies from country to country. These great differences in clinical practice do not show up in other fields of medicine, indicating that social or religious attitudes, rather than the best practice of medicine, often drive what is allowed. In Italy, the legal need to replace fertilised embryos goes against all clinical thinking. The variation in international laws relating to infertility treatment is one of the reasons that cause couples to seek cross-border treatment. Whilst this is unavoidable we call for international standards to ensure these patients receive consistent advice and safe treatment. Although a country’s law or professional society guideline for treatment may reflect the overall cultural view in that jurisdiction, it does not necessarily mean that all that country’s residents have the same view. They may then seek access to the treatment abroad."

The survey shows that many Catholic countries have strict controls on the use of embryos. Costa Rica declared IVF unconstitutional in 2000 because it regards the embryo as a person from the moment of conception. Costa Rica is the only one of 43 countries where IVF is illegal. The huge variety of what is or is not allowed, helps create cross-border fertility treatment. Many people travel abroad for fertility treatment and have success with no legal difficulty. The review of reproductive health services highlights large discrepancies in regulations and practice in several nations. As a consequence, some patients who go overseas may face legal or medical issues. A third of the 43 countries do not permit surrogacy

The European Society of Human Reproduction and Embryology (ESHRE) and IFFS are concerned that the safety of patients crossing borders is no longer assured due to lack of uniform clinical and safety standards between the different countries. ESHRE, in co-operation with national and statutory organisations, is developing a code of practice on cross border reproductive care that will lay out a set of rules that protects and reassures patients, donors, surrogates and future children.
Francoise Shenfield, of ESHRE’s cross border task force and author of the first study of European patients crossing borders to obtain fertility treatments says, "Although in principle the care of foreign and local patients should essentially be the same and fit the best possible standards, there is evidence that it is not always so."

Both international organisations support the rights of patients to travel to receive the best treatment. Ideally this should take place in their home country, but if patients need to travel to receive the best treatment, both societies support this decision. At the same time, ESHRE and IFFS call for the harmonisation of national standards to increase the safety of patients crossing borders to obtain fertility treatments in the hope that uniform standards of practice can ensure equitable treatment for all citizens.

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GLOBAL: Developments in air ambulance services

Although some patients can be safely transported by normal air or private road ambulance services, some need special facilities. In the Ukraine, Kharkove hospital needed to transfer a patient to Germany’s Leipzig University Hospital. The 51- year old man had acute respiratory disease syndrome, and to survive he needed facilities not available at Kharkov.Normal transport methods could have killed him.

ADAC-AirAmbulance had a solution. Using a Dornier 328 jet, there was enough space for the Leipzig hospital team and their intensive care equipment. A mobile ECMO unit, being used for the first ever time by the company, allowed the patient to be successfully transferred with a three-hour flight. All the time, he was under permanent manned intensive care, a new level of care in air medical transport. Germany’s ADAC-AmbulanceService is a subsidiary of the German car club ADAC, and a market leader in European medical assistance. It transports 16,000 patients each year with its own fleet of air ambulance aircraft equipped with the most up-to-date equipment.

International Air Charter (IAC) is offering the services of dedicated medical evacuation (medevac) aircraft to meet the growing demand in the UAE and the Middle East region. The regional demand for medevac services is forecast to rise even as huge investments in healthcare infrastructure and services continue to be made across the Arab world. The medevac market there offers considerable potential as the service providers are currently responding to 30 to 40 requests a month. While international missions used to involve mostly transports to medical facilities in Europe and the USA, the rise in the number of available high standard medical facilities in the Middle East has increased patient options and the frequency of medevac enquiries in the region.

IAC has 24-hour access to a fleet of dedicated medevac aircraft around the world and can respond to medical emergencies in a matter of a few hours via its network, while always adhering to the highest international safety standards. Elie Abdo of IAC says, “Medevac has become a more viable option for the UAE thanks to the influx of modern medical facilities within the UAE and throughout the region.”

American air ambulance group Sky Doctors has launched a corporate website after a lengthy legal struggle to acquire the company domain Skydoctors.com.An established air ambulance company for over 17 years, the team has flown over 75,000 air ambulance transports. Sky Doctors offers ambulance services via medical jets that cover long distances quickly while keeping the patient under medical supervision.

Acquiring the domain Skydoctors.com took considerable effort, as its previous owner was unwilling to sell the rights to the trademarked name. Eventually, a legal suit was avoided, as the company was able to secure the domain after a lengthy negotiation that lasted several years. The company says that recent US internet regulations and prominent legal battles over domain rights have shifted towards protecting businesses and reducing the effectiveness of domain squatters. The growing list of recent legal victories protecting corporations was a major factor in Sky Doctors successful acquisition of the domain.

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GLOBAL: Under 30s mix business and holiday travel and buy using social media

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