Pre-screening Travel Patients: Four Things You Must Know

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The following was originally published in the October 2019 special print edition of Medical Tourism Magazine, which was initially available at the 12th annual World Medical Tourism & Global Healthcare Congress in Abu Dhabi.

Medical travel can offer patients many benefits such as rapid access to care and improved quality, service and savings, but not all patients can or should travel for treatment.

There are many elements – some obvious, some not so obvious – that should be evaluated in advance to determine if a patient is a good candidate for medical travel. To ensure patients are safe and fit for medical travel, it is important for healthcare providers to implement a pre-travel risk assessment protocol that considers the following four factors:

Health of the Traveler & Appropriateness of Treatment Being Sought

LIKE local patients, medical travelers may have pre-existing illnesses such as diabetes, cardiovascular disease, hypertension, or other co-morbid conditions.  When uncontrolled, these conditions can make medical travel dangerous and potentially fatal.  

UNLIKE local patients, healthcare providers must identify these conditions remotely prior to travel. Equally important, healthcare providers must assess whether the requested or recommended treatment will benefit the patient or place them at further medical risk.  The recommendations for treatment abroad for elective or semi-elective treatments often come from their primary care physician, the destination physician, or sometimes even from the patients themselves.

Risks Related to Travel

Travel creates increased stress on the body’s physiologic systems—early morning wake-up calls, crowded airport shuttles, long waiting times, and then a long flight home cramped in a narrow cylinder packed with people. Patients can minimize the discomfort by flying in business class or choosing bulkhead seats, but there are still potential risks involved, especially with long flights after surgery. One of the most dangerous conditions is deep vein thrombosis (DVT) and pulmonary embolism [1].

Another risk factor for traveling patients is exposure to people with infectious diseases not found in their own country of residence. Some nations, due to geographic environments and/or socioeconomic factors, have a higher incidence of infectious diseases, including tuberculosis, Hepatitis A & B, amoebic dysentery and other diseases rarely found iin most of the developed world [2].

These pathogens present a real threat to a person following a major surgical procedure when the immune system is unaccustomed to this exposure. There may also be similar risks related to tourist sightseeing activities and even the type of accommodation chosen by the patient.

Recommendations:

  • To ensure travel-related risks are addressed and monitored, healthcare providers should review existing clinical guidelines to ensure they encompass potential risks related to medical travel such as infectious diseases and DVT. Readily available guides to specific infectious disease risks and precautions are readily available from internet and government embassies and international security websites.
  • Patients may want to consider the benefits of travel insurance information and medical assistance companies to help prepare for potential local hazards, infectious diseases, and security issues.

Patient Expectations

Patients may have unrealistic expectations regarding their treatment or procedure outcome as well as the medical travel experience.

A patient traveling for a facelift, for example, may have unrealistic expectations regarding outcomes including expected aesthetics, improvements, and recovery. When the bandages come off a few days later and reality sets in, he or she may feel anger, anxiety, or emotional issues aimed at the surgeon or healthcare provider.

Another patient may expect everyone in the hospital to speak his primary language fluently. When he or she arrives at admissions and observes hospital staff struggling to communicate or using interpreters, there is often increased anxiety about the upcoming procedure.

Recommendations: To reduce patient dissatisfaction, it is important to:

  • Properly educate patients in advance of their trip. This can be accomplished via links to website content, email communication, and calls.
  • Set reasonable expectations that can be clearly understood and conform to the level of understanding and intelligence of the individual patient. Ask the patient to confirm he/she understand these expectation. This should be documented.
  • When talking to potential patients, healthcare providers should use open-ended questions that encourage potential patients to elaborate as opposed to simply answering “yes” or “no.” Allowing potential patients to open up and expand on their expectations regarding the treatment and medical travel experience will give physicians and case managers a better chance of spotting potentially risky patients. These efforts can provide insight toward a patient’s capacity to tolerate travel  to an unfamiliar country or city.
  • Healthcare providers should be crystal clear about all aspects of the treatment plan, travel itinerary, and inclusions and exclusions in the price estimate provided. Making available FAQs or a “What can I expect” page on the organization’s website is a great way to educate potential patients in advance about the medical travel experience.Setting proper expectations from the beginning will minimize the possibility of problems and dissatisfaction down the line.

The Patient’s Financial Circumstances

Some self-pay patients may also pose a financial risk to themselves and the healthcare provider if they do not have sufficient funds to cover medical complications, should they occur. According to the Kaiser Family Foundation, almost half of Americans said they would have difficulty paying an unexpected $500 dollar medical bill [3].

Recommendations: While this may be a sensitive topic, it cannot be ignored when healthcare providers are seeking the patient’s best interests and trying to ensure a sustainable medical travel program.

  • Transparency about costs, potential complications, and those persons responsible for extra medical expenses should be clarified with the patient in advance his/her trip.
  • Asking key questions like “How are you going to pay for the procedure?” and “Do you have complication insurance or funds to cover the costs of medical complications if these were to occur?” will help identify patients who may not have the financial means to cover unexpected expenses. It also offers healthcare providers the opportunity to guide patients to additional options such as financial assistance or medical complication insurance.

Benefits of Pre-Travel Risk Assessment

The value and benefits of a comprehensive pre-travel risk assessment protocol are many:

  • Ensure the traveling patient’s well-being
  • Improve treatment outcomes
  • Reduce costs
  • Shorten hospital stays
  • Reduce patient cancellations
  • Increase patient satisfaction

Finally, the pre-travel screening process is critical for giving a good first impression of a healthcare organization. A positive patient experience that starts prior to travel can set the tone for the entire care encounter.

REFERENCES:

[1] Ethical and legal implications of the risks of medical tourism for patients: a qualitative study of Canadian health and safety representatives’ perspectives. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586128/. Retrieved 11/02/17

[2]  Ibid.

[3] Ballooning bills: More U.S. hospitals pushing patients to pay before care. https://www.reuters.com/article/us-usa-healthcare-hospital-payments/balloon-ing-bills-more-u-s-hospitals-pushing-patients-to-pay-before-care-idUSKBN17F1CMRetrieved 11/5/17