In June 2007, the American Medical Association (“AMA”) released a report entitled “Medical Travel Outside the U.S.,” that tried to explain why people are going abroad for medical care. According to the AMA, the primary reasons that Americans are traveling for treatment are the ever escalating-cost of healthcare and the lack of affordable health insurance.
On June 16, 2008 the AMA re-entered the conversation with Guidelines on Medical Tourism. These guidelines address important issues of patient safety, transparency, financial incentives, after care, and legal liability. The AMA’s contributions to the medical travel industry at such an early stage is notable and important. Many American doctors strongly disapprove of patients who seek care abroad and few will agree to provide follow-up care for returning medical travelers. Those doctors are understandably concerned about incurring liability for another physician’s malpractice.
Widespread resistance in the medical community led many to believe that the AMA would either ignore or actively oppose the development of the medical travel industry. Instead, most were surprised by the AMA’s desire to get out in front of the issue and announce guidelines that some view as a traveling patient’s bill or rights.
As the health insurance industry and employers begin to explore the cost savings and benefits of medical travel, the AMA’s contributions promote patient safety and protection. The AMA has legitimized a nascent industry with only limited support from mainstream healthcare networks. Since the AMA entered the discourse, more and more health insurers are evaluating whether medical travel makes sense today, tomorrow or sometime soon.
At this stage, AMA does not seem intent to stamp out medical travel. This may be due in part to the movement’s consumer-driven nature and the reality of restricted resources at home. Instead, the organization of medical professionals will propose model legislation to all states that protects patients who go abroad for treatment.
2. The Guidelines and Who Will be Impacted
The AMA’s Guidelines on Medical Tourism are enumerated below. Each addresses important components of patient decision-making, safety, protection and recovery.
a. Medical care outside of the U.S. must be voluntary.
b. Financial incentives to travel outside the U.S. for medical care should not inappropriately limit the diagnostic and therapeutic alternatives that are offered to patients, or restrict treatment or referral options.
c. Patients should only be referred for medical care to institutions that have been accredited by recognized international accrediting bodies (e.g., the Joint Commission International or the International Society for Quality in Health Care).
d. Prior to travel, local follow-up care should be coordinated and financing should be arranged to ensure continuity of care when patients return from medical care outside the US.
e. Coverage for travel outside the U.S. for medical care must include the costs of necessary follow-up care upon return to the U.S.
f. Patients should be informed of their rights and legal recourse prior to agreeing to travel outside the U.S. for medical care.
g. Access to physician licensing and outcome data, as well as facility accreditation and outcomes data, should be arranged for patients seeking medical care outside the U.S.
h. The transfer of patient medical records to and from facilities outside the U.S. should be consistent with HIPAA guidelines.
i. Patients choosing to travel outside the U.S. for medical care should be provided with information about the potential risks of combining surgical procedures with long flights and vacation activities.
Generally, these guidelines appear to be directed to health insurers and employers incorporating foreign providers into healthcare plans and to a lesser extent medical travel experts coordinating the patient travel experience. The Guidelines seek to protect patients from being pressured by healthcare payers to accept lower quality care without recourse in the event of a bad outcome. The AMA repeatedly stresses the importance of informing patients of their rights and recourse, the hospital and doctor’s credentials, and potential risks associated with combining travel activities with surgical procedures.
3. Implementing Key Guidelines
a. Patient Safety
The majority of the AMA’s Guidelines are aimed and ensuring patient safety. The Guidelines call for treatment abroad to be voluntary and for financial incentives to not restrict treatment options. This measure is meant to avoid patient coercion and withholding important information about available alternatives. The AMA also requires that institutions treating patients be accredited by recognized international accreditation bodies. This rule tries to ensure that patients are treated in safe and clean facilities that meet international standards of patient care, infection control and hygiene. The AMA also requires that patients be informed of the risks of combining surgical procedures with travel activities. The Guideline’s proscription against transferring patient medical records in violation of HIPAA aims to reassure patients that their privacy rights will continue to be safeguarded abroad.