Category Archives: Transparency

Gauze: A Film by Suzanne Garber

Nearly a year ago, while channel surfing, I came across a short film being shown on my local South Florida Public Broadcasting System (PBS) station.

As I missed most of it, I was able to learn the name of the filmmaker from the credits, and saw that she had interviewed some of the leading names in the medical travel space.

One individual I saw listed in the credits was Keith Pollard, with whom I was connected with on LinkedIn, and had communicated over the years since I began blogging about medical travel. I reached out to Keith to ask him to put me in touch with the filmmaker, Suzanne Garber.

I later learned from Keith that before she gave Keith her permission to forward her email address to me, she wanted to know if I was legitimate. Keith vouched for me without hesitation, and I reached out to Suzanne.

Unfortunately, due to ownership of the rights to the film by PBS, it has taken nearly a year for me to get to see it. What follows is my review of her film, “Gauze Unraveling Global Healthcare”.

The film is a personal account of Suzanne’s exploration into the difference between US healthcare, with its bureaucracy and lack of transparency regarding cost to patients; plus its affordability, accessibility, and quality — the three characteristics of healthcare, according to Suzanne.

Suzanne had gone through some personal medical issues, and the film begins with her discussing statements she received that were very expensive. At one point, she describes how she was forced to sign a form at a hospital in order to get service that said she was responsible for the full amount if her insurance company refused to pay.

She asked the woman at the desk who gave her the form if she knew what it would cost her, and the woman replied that she did not know, so Suzanne said that she was signing away her right to know how much it could cost her.

Then Suzanne asked some of her friends the following question: where is the best healthcare?

Having been an executive credentialing hospitals for a company she was working for, Suzanne had vast experience visiting hospitals, and had personal experience of being admitted to a hospital in Spain as a child. She decided to go and visit some of the hospitals that cater to medical travel patients.

From 2014- 2015, she visited 24 countries, 174 hospitals, and interviewed over five dozen international healthcare experts. She wanted to know the answer to the following questions: Where to go, and where not to go?

But it was when she had a medical diagnosis of cancer that she traveled thousands of miles, flying from Philadelphia to Chicago, to Tokyo, and then to Bangkok, where she went to Bumrungrad Hospital. By that time, her position had been eliminated, she was unemployed and uninsured, so she took the chance and went.

She traveled to Singapore to get a second opinion with an orthopedist. A doctor there wanted to perform a bone density scan, and even though she brought along all of her MRIs, CAT scans, etc., the doctor had her go downstairs, wait forty-five minutes, and then go back upstairs to see the doctor after the results were entered into the computer.

In all, it cost Suzanne $29 dollars, not the amount she was quoted back in the US. And all this took one day.

As part of her journey, she visited the UK, India, and visited several hospitals in France. And what she found was that there is no one way to improve our healthcare, but it is possible. We need to ask questions, we need to contact our elected representatives, and we need to take responsibility for our healthcare.

A personal note: This film when shown on PBS last year, had a long list of names Suzanne interviewed. In addition to Keith Pollard, one other person, Rajesh Rao of IndUSHealth, was someone I met in 2014 at the ProMed conference in Miami Beach. Some other names in that list were familiar to me, but as of this screening, does not appear. One more comment, I was able to view the film online, but am not able to provide readers with a copy of it in this post.

This is a very important and timely film that should be viewed by both the health care industry and those in the workers’ compensation industry who have panned the idea of medical travel. The mere fact that Suzanne paid only $29 for a bone density scan, when she was told it would be $7,300 in the US, is not only criminal, it is insane to keep insisting that medical travel for workers’ comp is a stupid and ridiculous idea, and a non-starter, as one so-called expert has written.

When are you people in work comp going to wake up? You and your insurance carriers are being ripped off by an expensive medical-industrial complex. But you just go on doing the same things over and over again, and expect different results, or you boast that frequency is going down, yet medical costs are still too high. The choice is yours, but don’t keep making the same mistake.

I want to thank Suzanne for her patience in bearing with my periodic emails regarding my viewing the film, and for being courageous enough to put her personal struggles with health and health care front and center, and comparing it to our so-called health care system. I hope that Gauze Unraveling Global Healthcare will be seen by all those interested in better health care for all Americans, workers or not.


Fam Tours for Self-Insured Employers

The subject of medical travel for self-insured employers is one that this blog has rarely discussed from the point of view of the medical travel facility.

Previous posts here have discussed a possible scenario for medical travel by self-insured employers under workers’ comp, the experience of one company that did so for its employees under their group health plan, and why self-insured employers are failing to adopt medical travel, as well as other posts that briefly mentioned self-insured employers.

Yet, at no time has this reviewer, in the position of content writer, ever discussed how the medical travel facilities can market their services to potential self-insured customers.

A new book by Maria Todd, her sixteenth in fact, does exactly that. Organizing Medical Tourism Site Inspections for Self-Insured Employers is a well-written manual for medical travel facilities seeking to highlight the services they offer by hosting site inspections, or more colloquially known as “fam tours,” or familiarizing tours.

Note: This writer had participated in only one fam tour to medical facilities when I spoke at a medical tourism conference in Mexico in 2014.

Knowing the Customer

Dr. Todd’s book focuses on the ways medical travel facilities can know their customers by knowing which self-insured employers are more likely to develop a medical travel program for their plan beneficiaries, and the criteria the Plan Administrators will look for to engage their services and the conditions under which such travel is possible.

One example given is if flying time to a medical tourism destination is less than three hours by plane. For American workers, who have US passports, longer distances would eliminate travel to parts of Asia, the Middle East, parts of South America, and Russia. Such locations would be possible if the employees were working there or nearby, and they were the closest facilities available.

She also discusses what will attract multinational employers who have workers around the world to select facilities that can handle industrial accidents, as well as general health and rehabilitative services. Some employers may be self-insured for their domestic employees, but purchase an insurance cover called an International Private Medical Insurance, or “IPMI.”

Selling Solutions

To educate hospital executives and managers on how to sell solutions to Plan Administrators, Dr. Todd includes a chapter on a topic she says executives and managers often do not consider important.

The chapter focuses on what not to say or do when conducting a site inspection. You, as the seller might consider certain areas of your facility important to highlight, or is one that you take pride in, but may not be something your guests are particularly interested in.

One such area is Accreditation. Not knowing abbreviations for accrediting organizations such as the Joint Commission International (JCI), or what the big deal is about accreditation, is something the executives and managers need to be aware of beforehand and to be prepared to explain why it is important.

Proper accreditation will go a long way to ease their minds over deciding to use that facility, and being presented with an unfamiliar or disreputable accreditor, or one whose certificates are not worth the paper they are printed on, is something to be aware of also.

Another area of concern when hosting a site inspection is scientific presentations. It is quite possible that some of your guests may be physicians and nurses who will benefit from seeing such presentations, but for those Plan Administrators who are not medical personnel, such tours maybe considerably boring, if not completely too technical for them to comprehend.

Technology Tours

A similar mistake made is taking business-focused guests to see the technology the facility has installed and uses. Dr. Todd recommends they create a spreadsheet of the expensive equipment they have and write a short blurb about each.

Her main point is this: Plan Administrators are seeking three things: transparency, good value, and superb, culturally-sensitive customer service.

Other areas to avoid on Fam tours

The Emergency Department, laboratory, radiology and imaging department, cardiac catheterization lab, and the PET/CT, and PACU’s are a waste of time, per Dr. Todd, and may even disturb the patient’s privacy and recovery.

Final five chapters

The final five chapters deal with developing relationships, the contracting and provider network criteria (where to get preliminary data, contract terms and payment agreements, and avoiding payment hassles with the right language), the basics of ERISA (ERISA fiduciary responsibilities, self-insurance plan sponsorship not limited to the US, and government employers pay for healthcare services outside of their countries), how to prepare for site inspections, and lastly, rate proposals.


Dr. Todd’s book is a must for any self-insured employer considering a medical travel program for their beneficiaries. For those employers who self-insure for general health care, this book provides them with the knowledge they need to have to explore doing so. For those self-insured employers who self-insure for workers’ comp, this too is an important book.

The likelihood that the Affordable Care Act will be repealed or replaced, with something worse, or with nothing at all, grows stronger every day now. Once that happens, premiums will rise, and alternatives such as medical travel will seem much more plausible and cost-effective.

While this book was written from the perspective of the seller of healthcare services, purchasers of such services, either domestically or internationally, can benefit from reading it. Not knowing what to look for will only cost you time and money and be harmful to the health of your plan and your employees. I highly recommend this book to you.

Ten Facts About Medical Travel

Maria Maldonado has put together a list of ten facts about medical travel that people in the workers’ comp world should know about.

While it is true that there have been serious medical issues abroad, the same medical errors can and do occur right here at home. One particular one that stuck in my mind some years ago was a patient at a hospital in Tampa who had the wrong body part removed.

Also, there may be some who question whether the JCI’s accreditation is sufficient enough to justify patients going abroad, but absent any other reputable institutions, the JCI will have to suffice as a starting point or floor to which any such future institutions will have to better.

Here is the link to Maria’s post:

Challenges Facing Work Comp

In three weeks, members of the medical tourism industry will gather in Puerto Vallarta, Mexico to attend the 6th Mexico Medical Tourism Congress.

You may recall that I was invited and attended the Congress last year, and was invited again this year. However, due to personal and financial reasons, I am not attending this year.

I am however, posting my PowerPoint presentation below for your viewing, with narration by yours truly. I hope you find it interesting and informative.

Challenges Facing Workers’ Comp (PowerPoint)

Challenges Facing Workers’ Comp (video)


Don’t Drink the Kool-Aid Just Yet

While the Tennessee Legislature has put the issue of opt-out on hold for this year, the South Carolina Legislation is moving ahead with opt-out, according to James Moore’s blog piece today.

David De Paolo and I have both come close to drinking the Kool-Aid on opt-out expansion, but until there is transparency and real data that opt-out offers employers and employees better medical care, opt-out is just another right-wing, anti-worker, pro-business scheme that will take this country back, quoting Grover Norquist, back to the 19th century, when workers had no rights when they got hurt, and had to sue for benefits, if they were lucky to get to court.

It figures that the state that seceded from the Union first, would jump on the opt-out bandwagon.

As I said last week, it’s a double edged sword; only one edge is up against the throat of the American worker.

For opt-out to be truly worthwhile, it has to prove it is better than what we have now, with all that we know about the high cost and abusive practices of certain bad actors, but it also has to provide the injured worker with the opportunity to get medical care where the cost is lower, the quality is better, and is offered as an option.

Given that opt-out’s biggest proponents are funding the organization called ARAWC (A-Rock), there will be many who will oppose or question the push towards opt-out expansion nationwide.

There has to be a better way to lower the cost of medical care in workers’ comp than doing it on the backs of injured workers. In other words, don’t drink the Kool-Aid just yet.


I am willing to work with any broker, carrier, or employer interested in saving money on expensive surgeries, and to provide the best care for their injured workers or their client’s employees.

Call me for more information, next steps, or connection strategies at (561) 738-0458 or (561) 603-1685, cell. Email me at: Ask me any questions you may have on how to save money on expensive surgeries under workers’ comp. Connect with me on LinkedIn and follow my blog at: Share this article, or leave a comment below.

The Stench of Fraud, Continued

In The Stench of Fraud: Why Workers’ Comp Can No Longer Be a Closed System, I briefly mentioned the plight of one individual, who I called “Ms. X”.

I called her that because her case is still winding through the medico-legal system in her state, and I do not want to prejudice her case, or add to her woes by embarrassing her, even though she herself is bringing light to her situation by using all resources available to her,

But I felt that once I mentioned her in my previous post, it was alright to expound on the subject of fraud, and discuss her case without identifying her personally.

According to her own words to me [bracketed below] and in her correspondence to others, this is how her nightmare began:

I am an injured worker who was maimed by the medical providers in the insurance carrier’s network of medical providers. Mine is a long story that began December 12, 2011 when I was hurt at work.

[A herniated lumbar disk from working in a sitting position in excess of 65 hours one week and during that week, picking up boxes of banking and files from time to time. I began to feel discomfort in my lower back, went home, took it easy over the weekend, went back to work on Monday, worked for approx. an hour or hour and a half, got up, went to the copy machine, made my copies, bent over to pick them up and then that is when the disk herniated.]

On the day that I was hurt at work, the human resources manager told me that she was going to call the insurance carrier to find out what to do or where to send me. When she returned, she wanted me to sign a “release letter”. I had just gotten that job on November 16, 2011. I got the message that someone there didn’t want me to file a WC claim by virtue of the effort to induce me to sign a release letter. I needed that job and hoped that my back would feel better. I didn’t sign a release letter but I did write a letter indicating that I was hurt at the copier but that I didn’t want to go to their Doctors. I asked if I could go home. At some point, the HR manager gave me a couple of Advil and water for the pain. I had gone home from there – Monday, 12/12/2011. By Thursday, 12/15/2011, my back did not improve, so I placed a call into the HR Mgr. and said that I need to see their Doctors… the HR Mgr. responded by saying something to the effect “Why, you don’t have any money to go to your own Doctor?” (Not verbatim). I was taken aback by this. She knew I was hurt at work. She continued by saying, “We have a release letter signed by you!”. I responded by saying something to the effect that I never signed a release letter. We argued… and so on.

She goes on to say in her correspondence that:

…former employer who fired me less than 3 months after I filed a WC injury. On the very day that I filed a WC claim, my employer placed an ad on Craigslist to replace me. I didn’t learn until sometime in May 2012 that my former employer lied to the insurance carrier about the circumstances of my injury and what I had said. For the record, I was hurt at work and due to the working conditions and surroundings, including my desk and number of hours that I had to work, 65-66 hours the previous week. Our office had very little storage, therefore, myself and the other Escrow Officer, had to pack up boxes of files for closings and banking. We lifted these boxes weekly and sometimes daily due to the lack of space.

Because of what has happened to me, I have been upfront with Doctors outside of the workers comp system. At one of the Doctors, a pain management Doctor that I went to see in early 2014 – March or so, one of the female investigators that I had seen near my apartment on prior occasions (or was her twin) showed up and was placed inside a room before I was, I arrived first, was placed inside the room next to her. During that visit to the Doctor after being placed in the room next to the investigator, the receptionist from the front desk asked me several times if I did recreational drugs and had I ever done recreational drugs. Clearly, a continued effort to create a negative review of me and/or my history. Another Doctor who I visited to get a referral to an orthopedic Doctor insisted that what I describe does not happen. She said that there are no instances in the US of a person being forced under anesthesia. Further, she said that I was delusional and that I should see a psychiatrist, and that the pain that I have is psychologically driven and not real pain.

She was given three epidurals, and this is what happened to her after the first epidural, which went without incident:

I was forced under anesthesia for simple lumbar epidurals. At the 2nd epidural procedure, after objecting to anesthesia, I was told I had no choice, that it was the policy of the surgery center (_____ ___ Outpatient Surgery Center) that all patients must undergo anesthesia. I awakened from that with severe neck pain and slight left arm pain. My Doctor had injected my neck, left side of my spine, left leg with some sort of chemical that tingled and popped like Alka Seltzer. In fact, the tingling went from my lower left lumbar down my left leg all the way up my back and felt like a popping sensation in my head. I was there to receive a lumbar steroid epidural injection and “trigger point shots” in the left side lumbar area.

The next epidural procedure, I made it clear I that I did not want to be placed under anesthesia not only on the phone (a day prior to the procedure) but also before the procedure in pre-op and I re-stated the same in the operating room for everyone to hear. I restated that I was to get a local pain blocker (just as I had during the first lumbar epidural). Instead, my Doctor abruptly shoved the needle into my back without any pain blocker whatsoever. I could feel the needle going through the textures of my back (not precisely or with care into the spinal area where the disk is). My head flew up as I screamed “Wait!” or “Stop!”. He would not relent! As my head hit the operating room table (where a towel and prop to lay my head was), he moved the needle inside me to the nerve in my back next to my spine and held it against the nerve! The pain was so excruciating that I bit into the towel that was for my head to rest on and screamed with the towel in my mouth. Pure agony! He would not stop! I had no choice once again but to give into anesthesia. When I awakened, I thought to myself, Oh my God, they didn’t! I had injuries now throughout my back, neck, shoulders and arm. I could feel the nerves firing all over my back and next to both sides of my spine from the injections of some sort of chemical (the Alka Seltzer feeling again) that over the coming months, burned and corroded the ligaments in my spine, tendons and muscles in my back. It felt as though I was being burned from the inside out. PAIN from burning, PAIN from damage and maiming! I can now and then could feel that some of the tissue/muscles were pushed away from my spine creating the feeling of divots or holes on both sides of my spine. I could feel what seemed to be a muscle pushed away and hanging down on to the right mid side of my person. The ligaments that are in my neck and run up into my skull feel damaged, sore. My spine felt “chiseled” in specific areas most prominently in the top of my back and neck and the bottom near the lumbar sacrum area. I now have instability in my spinal column. I can feel the vertebrae in my spinal column moving not in sync with the other vertebrae…

There is a lot more detail to her case that is beyond the scope of this blog to address, but I am sure my readers have gotten a clear idea of what she has gone through. As a former Claims Examiner and Claims Administrator for a wrap-up insurance program, I have never seen, nor heard of such abuse inflicted upon an injured worker.

This poor woman, who was just doing her job, was taken advantage of by a broken, corrupt and dysfunctional workers’ compensation system that makes the injured worker seem like the guilty party, when it is the providers and legal system who are guilty of injuring and maiming the worker.

To illustrate just how they are characterizing this woman, here is another part of her correspondence regarding an attempt to make her out to have a psychological problem:

The insurance carrier and/or it’s attorneys are working hard to impair my credibility. Several attempts to have me include a psych claim ,since I finally realized that I was being maimed, have been made. Even the AME has placed a notation in his last report that is false – saying that I have ongoing psychological “???”. For the record, I haven’t any history of psych issues. This is a lie that is meant to bode well in favor of the defense. I have never before had a psychological condition. I did mark on a form that I was depressed but that was due to the pain! Not anything else.

In my insurance career, I came across another poor soul who suffered from depression due to the pain he suffered as a result of his injury. At the time, I was the No-Fault Claims Supervisor of the NY office of an automobile insurance company that insured Black Car limousines (Owner and Owner and Another). A Coptic Christian gentleman from Egypt cried in my office before he was seen by our medical consultant. Recognizing that my job was to limit the amount of money we paid to this individual, I did speak to our consultant just prior to the examination. It was the least I could do for this person. So reading what Ms. X has written does not surprize me in the least.

A letter Ms. X forwarded to me from a defense attorney even stated that her epidurals were harming her and not helping. This letter was part of a plan to get her to settle for a few thousand dollars. The lawyer’s text is as follows:

Additionally, the applicant appears to not be benefitting from the treatment, in fact, the treatment by both the employer’s physician and your physician [addressing claimant’s former attorney] appears to be harming rather than helping the applicant.

She also stated in her correspondence that she discovered that:

…some of my medical forms, surgery reports, paperwork had been falsified, changed over and above my signature and due to the anesthesia form (copy handed to me) was marked differently than the first page that I signed and more.

Finally, to make matters worse, she received a letter from a law firm representing her workers’ comp primary physician, demanding her to cease and desist from making false and libelous statements on the internet about their client. From what I understand, this is the physician who the defense attorney said above was harming her. It is no wonder that by mistreating Ms. X this workers’ comp doctor prompted her to take the actions she did to warn people about his conduct.

As I mentioned in the last post on this subject, Ms, X would have been homeless if it was not for her sister. She was subsequently fired from her job as a Manager of her department by her employer after filing the workers’ comp claim.

The events and actions discussed by Ms. X and disclosed here by me, further elaborates just how much the stench of fraud and abuse in the system has become unbearable. These words that I have quoted are but a small part of the whole story Ms. X has told people about, but it is clear that there is something rotten in the state of CA, if not in the state of Denmark, paraphrasing Shakespeare. And we all know that when something is rotten, the stench is overpowering.

Yet, the medico-legal system is arrayed against Ms. X, and the end result, I am afraid will be that she loses, and her work comp settlement will be liened against by the primary physician’s attorney, or the case will be decided in the insurer/employer’s favor, and Ms. X will be unable to go back to work, and will be forever marked as someone who brings attention to herself and not in a positive light. And furthermore, she may be marked as having a psychological issue, when in reality, she is only trying to get the proper treatment for her herniated disk. This psychological defense strategy smacks of something the Soviets used to do to political dissidents.

One gets the feeling that even though the Soviet Union is no more, we are more like the Soviet Union and other authoritarian states, in that the individual is powerless against the power and prestige of physicians, hospitals, lawyers, the courts, and other medical providers, and the system itself.

If ever there was a more clearer case of why we need to transform workers’ comp from the broken, corrupt and dysfunctional system I have been describing these past two years, this case is it.

How different Ms. X’s life would have been if she had gone to an honest and reputable treating physician, received the proper medical treatment, and if necessary, gotten back surgery to repair her herniated disk, even if she received the surgery from her employer or insurance carrier in another country, as a medical tourism option.

And how different her life would be if she did not have to be threatened with a lawsuit from a shyster law firm that is representing a shyster physician, as well as being misrepresented by bad attorneys, so that I had to ask someone I knew if he could help her. There is a saying, “a fish rots from the head down”, and in this case, the stench of the fish called ‘Workers’ Comp fraud’ is taking down the entire system.

New Hospital Rating System: A Step in the Right Direction?


I received an invitation to connect on LinkedIn last Friday from Tucson Dunn, the CEO of Hanovera Healthcare International. After viewing his LinkedIn profile, I accepted his invitation. Prior to becomig CEO of Hanovera, Mr. Dunn was also the Chairman and CEO of the International Healthcare Commission (IHC) from June 2008 to June 2013.

Monday morning, I received an email from Mr. Dunn, introducing me to the International Healthcare Commission, and announcing that next month, the IHC will launch their “International Hospital Ratings” to identify hospitals that treat high numbers of foreign patients. Mr. Dunn also stated that this Award Mark will serve to attract more foreign patients to come to the top rated hospitals and cities.

According to Mr. Dunn, the Rating Criteria is simple and based on the annual volume of foreign patients treated (outpatient or inpatient) at the hospital. The ratings are listed below:

Over 1000 ― International Hospital rating
Over 5000 ― Distinguished International Hospital rating
Over 10,000 ― Outstanding International Hospital rating
Over 15,000 ― Premier International Hospital rating
Over 20,000 ― World Leading International Hospital rating

When I responded to his email, I asked him if this rating reflected actual medical tourists, i.e., those traveling from their home countries to a medical tourism destination, or does it include ex-pats living in those countries and getting medical care at those hospitals? I told him that many people engaged in the medical tourism industry have told me that most numbers are inflated with regard to actual medical tourists abroad.

In his follow up to my query, he said that was a very good question, and that it was the main topic of debate within the IHC for the past year. The final ruling, he said, leaned towards the Service Delivery itself. He also explained that if a hospital is treating vast numbers of international patients, then they know how to treat international patients, regardless of point of origin.

To summarize, he said, the award is not an indicator of inbound medical tourism, but rather a statement of capability based on performance. Same is true for Surgery Volume: If the hospital does 1000 CABGs in one year, then they probably know how to do CABGs. The Cardiac Surgery Award reflects the volume of Cardiac Surgery performed.

I responded that that will at least let those who are involved with inbound medical tourism, meaning both facilitators and patients, know which hospitals are the better ones in medical tourism destinations, based solely on the number of procedures performed at those hospitals. From those ratings, interested parties can probe deeper to find out just how good they are at performing those procedures, their success rates, outcomes, etc.

Mr. Dunn agreed, and then asked me to consider how many foreign patients come to the US for treatment per year. His reply stated that cost of those foreign patients was nearly US$5 billion worth. But as for which hospitals treat foreign patients, which hospitals have systems in place for large volumes, Mr. Dunn said, the IHC can help address those questions.

As an example, Mr. Dunn mentioned that the Medicover Hospital of Poland received a rating as a Distinguished International Hospital, based on the fact that they treated 8,614 foreign patients over the past twelve months. He went on to explain that if you were traveling as a tourist in Poland and needed a hospital, this award would be meaningful to you as a potential patient, since it would indicate that they have experience dealing with foreign patients, and that you would know that the staff could speak English.

About the International Healthcare Commission

The International Healthcare Commission is an independent healthcare ratings organization founded in 2009 in Atlanta, Georgia, and rates healthcare provider performance throughout the world. According to their website, the IHC is the Gold Standard for the international healthcare ratings industry. Likewise, they are the oldest, independent international healthcare performance ratings company. The IHC provides patients, referring physicians and payers with vital information they need when choosing an international healthcare provider.

The IHC supports hospitals, clinics and healthcare systems to achieve peak performance in international patient care. They help healthcare providers attract patient referrals. The IHC Rating Awards are recognized as Gold Seals of Approval, and they provide clear marks of distinction for performance, and they are evidence-based. The rating and award systems cover the following:

Foreign Patient Volumes
Surgical Procedure Volumes
Maternity Care

Their Mission

The International Healthcare Commission (IHC) works to guide patients and referring physicians to better healthcare providers. The IHC has been conducting healthcare market research in over 100 countries since 2009. IHC partners with hospitals, clinics, health systems and insurance companies to promote best-practice healthcare.

Their Ratings

International Hospital Ratings

There are five levels of International Hospital Ratings, and they identify hospitals that have dedicated systems, staff and resources for the care and treatment of foreign patients, as well as local patient communities.

International Hospital Rating

The IHC’s International Hospital Rating is the first rating level indicating that the hospital has achieved significant experience in the care and treatment of international patients. Hospitals achieving this level are rated and recognized as “International Hospitals” The criteria that determines this level is any hospital that treats over 1,000 foreign patients per year.

Distinguished International Hospital Rating

The IHC’s Distinguished International Hospital Rating is the second rating level indicating that the hospital has achieved substantial experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Distinguished International Hospitals”. The criteria that determines this level is any hospital that treats over 5,000 foreign patients per year.

Outstanding International Hospital Rating

The IHC’s Outstanding International Hospital Rating is the third rating level indicating that the hospital has achieved outstanding experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Outstanding International Hospitals”. The criteria that determines this level is any hospital that treats over 10,000 foreign patients per year.

Premier International Hospital Rating

The IHC’s second highest level of recognition is the Premier International Hospital Rating. This rating indicates that the hospital has achieved premier experience in the care and treatment of international patients. Hospitals achieving this level will be recognized and considered as “Premier International Hospitals”. The criteria that determines this level is any hospital that treats over 15,000 foreign patients per year.

World Leading International Hospital Rating

This is IHC’s highest rating for care and treatment of international patients. Only a few hospitals in the world ever achieve this level of experience and expertise. These elite hospitals are truly specialized in providing international care. Hospitals achieving this level are recognized and considered as “World Leading International Hospitals”. The criteria that determines this level is any hospital that treats over 20,000 foreign patients per year.

Surgery Excellence Ratings

IHC’s Surgery Excellence Ratings help patients, physicians and insurance companies identify surgical expertise and experience. Surgery Excellence Rating levels are based on annual number of surgical procedures within a surgical specialty area. These are the surgical specialty areas:

Cardiac Surgery Eye Surgery
General Surgery Gynecological Surgery
Neurosurgery Oral and Maxillofacial Surgery
Orthopedic Surgery Otolaryngology
Pediatric Surgery Plastic Surgery
Surgical Oncology Thoracic Surgery
Trauma Surgery Urology
Vascular Surgery

There are three levels of Surgery Excellence Ratings:

International Surgical Excellence Rating

The IHC’s Surgery Excellence Rating indicates that the provider has achieved significant experience in the selected specialty surgical area. Organizations achieving this level are rated and recognized as “Excellent” in the surgical specialty. The criteria that determines this level are 300 to 499 surgeries in the specialty per year.

International Five-Star Surgery Rating

The IHC’s Five-Star Surgery Rating indicates that the provider has achieved outstanding experience in the selected specialty surgical area. Organizations achieving this level are rated and recognized as achieving “Five-Star” performance in the surgical specialty. The criteria that determines this level are 500 to 999 surgeries in the specialty per year.

International Center of Excellence Rating

The International Center of Excellence for Surgery Rating is the highest international rating available. This elite rating indicates the organization performed over 1,000 surgeries in the specialty area within one year.

International Clinic Ratings

Like the International Hospital Ratings, there are five International Clinic Ratings. IHC’s International Clinic Ratings identify stand-alone outpatient centers that have dedicated systems, staff and resources for care and treatment of foreign patients, as well as local patient communities. And like the International Hospital Ratings, foreign patients have unique language, customs and cultural needs that must be considered when providing care and treatment. The international patients want to know that their provider can accommodate these unique needs. One of the best indicators of this capability is experience in treating significant volume of foreign patients each year. This volume indicator serves as the basis of IHC’s International Clinic Rating.

International Clinic Rating

The IHC’s International Clinic Rating is the first rating level indicating that the ambulatory care center has achieved significant experience in the care and treatment of international outpatient patients. Clinics achieving this level are rated and recognized as “International Clinics”. The criteria that determines this level is any clinic that treats over 1,000 foreign patients per year.

Distinguished International Clinic Rating

The IHC’s Distinguished International Clinic Rating is the second rating level indicating that the clinic has achieved substantial experience in the care and treatment of international patients. Clinics achieving this level will be recognized and considered as “Distinguished International Clinics”. The criteria that determines this level is any clinic that treats over 5,000 foreign patients per year.

Outstanding International Clinic Rating

The IHC’s Outstanding International Clinic Rating is the third rating level indicating that the clinic has achieved outstanding experience in the care and treatment of international patients. Clinics achieving this level will be recognized and considered as “Outstanding International Clinics”. The criteria that determines this level is any clinic that treats over 10,000 foreign patients per year.

Premier International Clinic Rating

The IHC’s second highest level of recognition is Premier International Clinic Rating. This rating indicates that the ambulatory care center has achieved premier experience in the care and treatment of international patients. Stand-alone clinics achieving this level will be recognized and considered as “Premier International Clinics”. The criteria that determines this level is any clinic that treats over 15,000 foreign patients per year.

World Leading International Clinic Rating

This is IHC’s highest rating for care and treatment of international patients. Only a few ambulatory care centers in the world ever achieve this level of experience and expertise. These elite clinics are truly specialized in providing international care. Clinics achieving this level are recognized and considered as “World Leading International Clinics”. The criteria that determines this level is any clinic that treats over 20,000 foreign patients per year.

What this means

Naturally, judging any enterprise by the volume of work performed does not necessarily tell us a lot about how well they perform that work. And knowing how many foreign patients a hospital treats per year does not tell us if these patients are real medical tourists, i.e., traveling from their home country to a medical tourism destination hospital, or are ex-patriots living in that particular country and getting medical care in a foreign hospital. This was the question I posed to Mr. Dunn earlier this week.

If that was the case, McDonalds would be a great company that serves the best hamburgers in the world, based solely on the billions of hamburgers sold, and on how many restaurants they have around the world.

What is missing from these ratings is quality of care, outcome measures, success rates of surgeries, and a host of other vital data which can tell a patient, their referring physician, their employer or their employer’s insurance company, that the foreign hospital and foreign physicians are just as good as or better than what is available locally.

Also missing from these ratings are the level of expertise of the physicians and nurses, and the professionalism and attention to detail that determines patient care. And finally, knowing whether or not the hospital or clinic has the latest technology and proficiency to use that technology is crucial to ascertain the true level of excellence of any hospital or clinic.

In many of my previous posts, the issue of transparency has come up, and generally I have written that the medical tourism industry needs to become more transparent on issues of price and quality, because that is the main selling point the industry makes to its customers and potential customers. Whether such transparency comes from the industry itself, or from outside, independent organizations like the International Healthcare Commission.

Like any other product or service, health care has its many rankings and ratings, but taken together, ratings from the IHC, JCI, NCQA, ISQua and other accreditation organizations, may be able to tell individuals, employers, and carriers that these facilities have obtained a baseline of care and expertise. More data is needed before medical tourism can be taken seriously as an alternative to high price and substandard medical care, but until that happens, this organization may be a step in the right direction.