Medical Tourism in Developing Countries

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Promoting Medical Tourism ● 149Table 6.1 JCI accredited medical institutionsCountry Hospital City Date ofaccreditationIndiaApolloIndraprastha ApolloWockhardtChennaiNew DelhiMumbai1/20066/20058/2005JordanKing HusseinAmman 2/2006Cancer CenterPhilippines St. Luke’s Medical Center Quezon City 11/2003Thailand Bumrungrad Bangkok 2/2002;4/2005Source : Joint Commission International, Accredited Organizations, www.jointcommissioninternational.com/international.asp, accessed June 7, 2006.governments, hospitals, and other health care organizations in the improvementof standards. It is likely that countries where medical tourism is mostactively promoted will be requesting accreditation in the future.Accreditation does not imply that all information pertaining to medicalmishaps is recorded. Even in the more developed countries, with longstandingtraditions of quality control, there are few comprehensive ways offully grasping the extent of medical errors. Moreover, there is not even amandatory reporting system or a method of enforcing all but the mostegregious medical mistakes. 32 The United States has passed an act asrecently as 2005, the Patient Safety and Quality Improvement Act of 2005(PSQIA), that urges health professionals to voluntarily report their medicalerrors to one of several certified patient safety organizations. Reportingerrors will advance the quality of medical care insofar as it will help healthprofessionals learn lessons from past mistakes. 33 It is possible that developingcountries, in order to indicate their success, will comply more faithfullywith reporting than Western countries, especially those in which litigationis common.Credentialing, LicensingJust as hospitals use accreditation to signal quality, medical staff use credentialsand licenses for the same purpose. These are granted to individualsupon proof of competency and are not transferable across people or, for themost part, across countries.As in the case of hospitals, doctors and nurses first seek licensing from thedestination-country authorities. For countries promoting medical tourism,
150 ● Medical Tourism in Developing Countriesthe certification requirements vary. For example, in Mexico, it is theSecretariat of Health, a national entity, that grants licenses to physicians whoare then allowed to practice anywhere within the country (by contrast, in theUnited States, licensing of doctors is done at the state level 34 ). In the UnitedArab Emirates, it is the local level that has taken control of licensing, as, forexample, Dubai’s Healthcare City (DHCC) has its own licensing departmentthat is part of the Center for Healthcare Planning and Quality. It reviews alllicensure applications, serves as data repository for licensing credentials, andsubmits documents for source verification. 35 Finally, it makes recommendationsto the DHCC Licensing Board.Certification is imperative for quality control in wellness tourism also.The Thai Ministry of Health is working with the new Thai Spa Associationto come up with procedures for certification since, according to a survey,in 2001 there were 230 operators that attracted some 2.5 million clients,80 percent of them from overseas. 36 Traditional healers and pharmacists, aswell as doctors, nurses, and dentists, must have knowledge of their professionsand according to a law on professional standards and ethics, they mustregister with the Ministry of Public Health. 37 In India, the Department ofTourism classifies all Ayurvedic centers into two categories, Green Leaf andOlive Leaf, and will not take any responsibility for those centers that arenot classified in one of these two categories. If providers want to exportsome of the medicines they use, they then need additional certificationregarding the lack of metals in the medicines. 38However, as in the case of hospitals, internationally recognized licensesare stronger signals of quality and expertise. At this time, there is no suchinternational institution that grants international certification to practicemedicine. In his study of medical credentialing, David Warner discussespredictions that in the future internationalization of credentialing will bethe norm so that physicians (and nurses and engineers) are universallylicensed, not just in their own countries. 39 Under these circumstances,assurances of quality will become globally valid rather than national.In the absence of international credentialing, it might behoove the staffat LDC hospitals to be accredited by international or source-country institutions.Since foreign doctors wishing to practice in the United States haveto pass an equivalency exam, so too the doctors dealing with U.S. patientsabroad might try to pass that exam to convey to potential patients thatthey are equally well trained. Currently, for example, credentials can stillbe a barrier to internationalizing health care. By statute 42 U.S.C.1395y(a)(4), Medicare will not accept—pay for—teleradiology that is readand interpreted abroad. The idea, embedded in the health-care system by
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List of AcronymsAIDS Acquired Immun
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2 ● Medical Tourism in Developing
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10 ● Medical Tourism in Developin
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Table 1.1 Economic indicators and t
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Plastic Surgery is Not Peanuts ●
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212 ● Notes2. Simonetta Zarrilli,
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214 ● Notes30. Joint Commission I
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216 ● Notes65. Mattoo and Rathind
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220 ● Notes29. Larry Solomon, “
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224 ● Selected BibliographyBower,
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226 ● Selected BibliographyJohans
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228 ● Selected BibliographyRoffe,
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232 ● Indexbrain drain/gain 105-9
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234 ● Indexdestination countriesa
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236 ● Indexhealth careon airplane
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238 ● IndexJJohanson, Misty 44, 9
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240 ● Indexmedical tourism (conti
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242 ● Indexpublic health (continu
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244 ● Indextourism sectormarket s
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