Dorjan Marusic‚MD,Chairman Board of Directors
Dorjan Marusic‚MD Chairman Board of Directors

For example, some patients wait-listed for treatment in Italy go to Slovenia and arrange prompt access to hip and knee replacements. In other countries, the high cost of local health care is a major factor in prompting patients to seek treatment elsewhere.

The majority of EU citizens receive healthcare in the Member State where they live, via the health system through which they are covered or insured. However, in some instances, it may benefit the patient to obtain healthcare in another European country – for example, where there may be better expertise available, lower costs, better availability of certain highly specialised treatments or where waiting times are shorter.In the USA, many Americans lack health insurance. These individuals, along with ‘underinsured’ Americans, often cannot obtain affordable care at local hospitals and clinics. To find affordable care they must travel to such countries as Mexico and India.

Some patients travel abroad for medical interventions that are not approved in their home country. For example, many patients obtain stem cell injections of unknown therapeutic effect and degree of risk by traveling to clinics situated in such countries as China, India and Ukraine.Labels used to describe patients traveling abroad for care include ‘medical tourists’ or ‘medical travelers’.

In EU cross border directive has been addopted in 2013 enabling EU citizens to go for healthcare in other EU Member State.However there is something called »Prior authoristation«.

For example in England, NHS England will need to consider each application carefully. Generally, reimbursement  will not usually be retrospectively authorised where the patient should have applied for prior authorisation but did not do so – unless exceptional reasons apply in a particular case, for example circumstances where it was not possible for the patient to have applied for prior authorisation before receiving the treatment or service in another EEA State.

This would be determined on a case-by-case basis, taking account of the facts of the case. Retrospective authorisation and reimbursement will be given in cases where the initial decision to refuse authorisation or reimbursement is overruled on review or appeal.Where prior authorisation has been requested, the Directive gives Member States the discretion to refuse only in the following four circumstances:

a) Where the patient will, according to a clinical evaluation, be exposed with reasonable certainty to a patient-safety risk that cannot be regarded as acceptable, taking into account the potential benefit for the patient of the sought cross-border healthcare; (e.g. from poor quality care or unproven procedures)

b) Where the general public will be exposed with reasonable certainty to a substantial safety hazard as a result of the cross-border healthcare in question; (this might include where a patient who had a highly contagious disease wanted to go to another state for treatment or where a patient with mental health problems and a history of violence requested authorisation)

c) Where this healthcare is to be provided by a healthcare provider that raises serious and specific concerns relating to the respect of standards and guidelines on quality of care and patient safety, including provisions on supervision, whether these standards and guidelines are laid down by laws and regulations or through accreditation systems established by the Member State of treatment; (this would require evidence from the appropriate regulator or authority)

d) Where this healthcare can be provided on its territory within a time-limit which is medically justifiable, taking into account the current state of health and the probable course of the illness of each person concerned (i.e. where the Member State healthcare system can provide the same or equivalent treatment in a medically acceptable period of time based on an objective assessment of the individual patient’s condition).

As mentioned above in c) accreditation system may be one of the way to demonstrate that healthcare organisation keeps quality of care and patient safety under control. When establishing international networks of health-care providers, medical tourism companies should be restricted to arranging health services at hospitals and medical clinics that have undergone international accreditation by International Society for Quality (ISQua) in Health-Care-accredited organizations. ISQua, the ‘accreditor of accreditors’, accredits international accreditation organizations for Quality in Health.

Precisely what constitutes reasonable and sufficient ‘international accreditation’ standards for hospitals, clinics, blood services and laboratories will become increasingly significant as growing numbers of patients cross borders in search of health care.Recognizing the numerous organizations involved in national and international accreditation, marketing and provision of global health services by medical tourism companies should be restricted to facilities accredited by recognized international accreditation bodies.

Medical tourism companies that arrange care at unaccredited international health-care facilities should have their licenses revoked. Hospitals and clinics seeking to attract international patients should undergo international accreditation review before joining the global health-care networks established by medical tourism companies. As health care becomes increasingly global, regulatory standards will also have to become transnational in scope.

Sources:

  1. Cross Border Healthcare and Patient Mobility in Europe ; Information to accompany the implementation of Directive 2011/24/EU – on patients’ rights in cross-border healthcare
  2. Milstein A, Smith M . America’s New Refugees—seeking affordable surgery offshore. N Engl J Med2006;355:1637-40.
  3. Lee JY, Kearns R, Friesen W. Seeking affective health care: Korean immigrants’ use of homeland medical services. Health Place 2010;16:108-15.
  4. Enserink M. Selling the stem cell dream. Science 2006;313:160-3.
  5. MacReady N. The murky ethics of stem-cell tourism. Lancet 2009;10:317-8.
  6. Scheper-Hughes N.Keeping an eye on the global traffic in human organs. Lancet 2003;361:1645-8.