Source: ISO news (www.iso.org)

With the current level of income disparity between nations, even those geographically close to one another, it is hardly surprising that the provision of public services can vary a great deal from country to country. This is nowhere more the case than with healthcare, in which the relatively new phenomenon of “medical tourism” is already booming.

Paul Webster, 43, from Highbury, London, is a seasoned medical tourist who has travelled abroad for a variety of procedures over the last five years. These include cosmetic surgery in Thailand, a knee arthroscopy in India following a rugby injury, and a slipped disc in Cape Town, South Africa, where he spent his recovery time relaxing by the pool. Paul opted to go abroad for surgery as he was able to avoid a waiting list at his local hospital and the cost of treatment was around 30 % of the cost of private treatment at home. More recently, having struggled to find a good local dentist, Paul’s dental clinic is now in Krakow, Poland – a low-cost flight away.

It’s not something most people would choose to do unless they really had to. Illness, short or long term, is unpleasant and painful enough, but to travel whilst ill would, to many people, seem unconscionable. And yet, to many more, it is exactly what must be done. Quite simply, if an individual’s home country is unable, for whatever reason, to provide the requisite healthcare, why should they not seek it elsewhere? Medical tourism, as it has become known, is a booming and massive industry.

The organization Patients Without Borders estimates that “the market size [for medical tourism] is USD 65 to 87.5 billion, based on approximately 20 to 24 million cross-border patients worldwide spending an average of USD 3 410 per visit, including medically-related costs, cross-border and local transport, inpatient stay and accommodations"1). By any consideration, therefore, medical tourism is already a huge market and one that, in the short and medium terms, is only likely to grow.

So what are the most common conditions for which people become medical tourists? The short answer to this seems to be almost anything. Patients Without Borders publishes a long list of illnesses and conditions: from non-life-threatening cosmetic surgery and dentistry to cancer and reproductive care. And it is precisely because there are so many different treatments now on offer for so many different conditions that International Standards are so vital for the world’s medical travellers.

Another question closely related to this, of course, is why do people travel for medical care? The obvious answers are the high costs for treatment and lengthy waiting times for medical procedures in many countries, supported by easier and cheaper international travel. But these are not the only reasons. Some patients value the better quality of the medical infrastructure in certain countries and undergo measures that cannot legally be offered at home, such as fertility treatment for those who want children.

Sometimes, a particular country may have an excellent reputation for treatment of a certain condition and patients may even opt for a medical trial that is not taking place anywhere else in the world, let alone their home country.

Sometimes the reason for travelling can be something as seemingly banal as the weather: many people find dialysis, for instance, much more comfortable when they can receive treatment beside the sea and under a sunny blue sky.

More broadly, there is a huge number of stakeholders in medical tourism and the value chain for medical tourism is long and often complex. It stretches from the very first moment a company contacts a hospital to request a quotation to post-treatment when the patient goes home. There are very many critical points along the way and it’s important for certain countries to develop this kind of business – as long as it is undertaken in a very secure way.

Yosr Nefzaoui, Project Leader of ISO 22525 on medical tourism, is the manager of Tunisia-based travel agency SAFAR – a subsidiary of the Service Medical International Group (SMEDI) which has been operating in Africa since 2007 – as well as holding the presidency of the Medical Tourism Committee at the Tunisian Federation of Travel and Tourism Agencies. She points out that Tunisia is receiving many patients from North and sub-Saharan Africa where the healthcare systems are not meeting the needs of patients.

Tunisia’s current stance on healthcare is very impressive, in both the public and private sectors. A brief look at the statistics says it all: there are 115 health clinics, with 4 700 beds, 100 haemodialysis centres, 150 diagnostic X-ray centres, 232 laboratories for medical analysis, over 5 300 GPs’ surgeries, over 1 600 dental offices and nearly as many pharmacies. And yet it is probably fair to suggest that Tunisia does not have the reputation in healthcare in the same way that countries like Germany and Switzerland do. These two countries are renowned for being organized and efficient but there is no real reason why Tunisia, and similar countries, should not receive some recognition and that is where International Standards will bring so much benefit.

To avoid any harm to the health of travellers, all players in the value chain should comply with certain requirements in order to limit the risks. International Standards will define the very broad range of requirements for various sectors concerned, from the organization of the stay by travel agencies to the quality of care delivered by the healthcare facilities.

In this case, the International Standards under development are focused on four areas:

• Pre-travel and pre-treatment process
• Treatment process
• Post-treatment process
• Return home and follow-up

Overall, standardization of the patient’s experience of medical tourism will improve the quality of care and patient safety as well as the satisfaction of the patient. This can be of great value not just to patients but to all stakeholders, and to all of us. And, as so often, the committees who draft and deliver International Standards are undertaking vital – and in the case of medical tourism, perhaps even life-saving – but invisible work.

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