Medical Tourism in Developing Countries

148 ● Medical Tourism in Developing Countriesorganization is striving for quality patient care. To be accredited, hospitalsmust abide by internationally set rules and standards. Hospitals mustundergo site inspections and must submit hospital statistics (pertaining to,for example, performance) for external evaluation. Accreditation is conductedby agencies in three locations: the destination country, the sourcecountry and the international community. 26 While all are important, it isthe last that serves as an umbrella to the industry. The largest hospitalaccreditation agency in the United States is the Joint Commission onAccreditation of Healthcare Organizations (JCAHO). The JCI is theworldwide arm of the JCAHO. It uses education, accreditation, consultation,and publications to improve health care across the globe. It works withpublic and private health-care organizations in over 60 countries. Accordingto the JCI, accreditation standards are based on international consensuspertaining to standards. It sets uniform expectations for hospitals withrespect to structures, processes, and outcomes. 27 There are six programs foraccreditation: international standards for hospitals, clinical laboratories, carecontinuum, medical transport organizations, ambulatory care standards,and disease- and condition-specific care standards.Since it began its international program in 1999, the Commission hascertified 81 hospitals across the world. Among the ten countries understudy, only four have accredited hospitals (see table 6.1). Contrary to expectations,these countries do not contain the only accredited sites in thedeveloping world. As of mid-2006, there is only one accredited medicalinstitution in Africa and it is not in South Africa, where medical tourismhas proliferated, but rather in Ethiopia. 28In the Middle East, Jordan has one accredited hospital, while Saudi Arabiahas five; in Central/South America, Costa Rica and Chile have no accreditedinstitutions while Bermuda and Brazil do. This might be explainedby the fact that some countries, like Brazil and Saudi Arabia, havelong-standing centers where they have treated foreign patients, long beforelarge-scale medical tourism took off as part of the globalization of healthcare. As Maureen Potter, executive director of the JCAHO, noted in 2006,the number of foreign hospitals seeking international accreditation has beenaccelerating. 29 A review of accredited hospitals reveals that in developingcountries, there has been an increase in activity in 2005–06. 30 In thePhilippines, for example, so far only St. Luke’s medical center has met allinternational standards for accreditation, but other centers have applied andare in the process of being evaluated (such as Asian Hospital in Alabang,Capitor Medical Center in Quezon City, and Medical City in MandaluyongCity 31 ). Moreover, the Philippines, South Africa, Argentina, Chile, andJordan have all made use of the JCI’s consultant services aimed at guiding