Medical Tourism: Passport to Cheaper Health Care?

The Risks Patients Face continued...

The first step is to ask the booking agency if they've done any vetting of the doctors and hospitals they propose. Stephanie Sulger, R.N., M.S., director of International Medical Services at MTI, says it's dangerous to research cost and take the rest on faith. "When someone who's desperate for care Googles 'cheap' and 'hip replacement' or 'gastric bypass,' they're likely to go with whatever they find because they've been led to believe that everything overseas is OK. It's not," explains Sulger. She says that the company spends 30 percent of its time researching overseas doctors, checking with the credentialing boards in each country, and verifying that any memberships they claim in important medical organizations are current. She says MTI no longer sends patients to certain hospitals because of concerns about some of their doctors' credentials.

Whatever efforts are made by booking agencies, what's missing is a comprehensive accreditation process by which established medical experts in the U.S. can evaluate foreign hospitals. In America, the gold standard is the Joint Commission, which evaluates some 15,000 health-care organizations (from hospitals to labs). JC has an international branch, Joint Commission International, which started accrediting in 2000. But so far its reach is too limited for its credential to be considered the last word. JCI currently accredits 127 international hospitals and has about 100 others now preparing for review. Foreign hospitals aren't required to apply, and many don't; some of those facilities may be substandard, but others are possibly put off because the process takes most hospitals 18 to 24 months and costs, on average, $30,000. So while the JCI credential is meaningful in judging a hospital, its absence may not be a problem.

Some experts even question the quality of JCI's reviews. "It's very difficult to evaluate the medical training of practitioners and the ongoing quality of facilities outside the country," explains Joel Miller, senior vice president of operations for NCHC.

Consumers looking beyond JCI for endorsements from the U.S. medical community may find themselves in a sea of salesmanship. The key is knowing which claims are legitimate. For instance, on its Website, Wockhardt Hospitals, Mumbai (a JCI-accredited facility in the Wockhardt Hospitals Group) touts its association with Harvard Medical International, a branch of Harvard Medical School. That affiliation is confirmed by HMI, which explains that although the Mumbai, India, hospital is not staffed with Harvard-trained doctors, as some prospective patients might assume, HMI has provided a range of training and education services to Wockhardt, from professional management to systems development to helping the hospital prepare for JCI accreditation review.

But not every hospital's claims are as substantial as Wockhardt's. In July 2007, when Good Housekeeping checked out the Website of the Asian Heart Institute in Mumbai, we found the logo of Ohio's Cleveland Clinic, an elite cardiac-care center. We also learned that the clinic's name appeared on AHI stationery and was engraved in stone at the Mumbai hospital's entrance. All this was news to Cleveland Clinic spokesperson Eileen Sheil, who says that her hospital's only connection with AHI was to consult on purchases of new technology and the use of medical equipment on an as-needed basis. "The Cleveland Clinic is in no way involved with hospital management or patient care at the Asian Heart Institute," Sheil says. The Cleveland Clinic terminated its already limited relationship with AHI in July, and is investigating the hospital's use of its logo. Within a week of Good Housekeeping's conversation with Sheil, the Cleveland Clinic logo was removed from AHI's Website.

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