Following our recent article on "How can patients judge quality in medical tourism?", Caroline Ratner spoke to Mike Silford, who runs Perfect Profiles, the longest running facilitation company for dental tourism to Hungary about the important role of facilitators in medical tourism and their role in directing patients towards quality healthcare providers.
What are the advantages of using a medical tourism facilitator?
One of the main advantages of using a facilitator is that we have access to information that the individual medical tourist couldnâ€™t possibly know about. Weâ€™ve been doing this for eight years and send about ten to 15 patients to Hungary and Poland a week which means that weâ€™ve got a huge amount of experience.
We get to know clinics and doctors and we can see from the money invested in a clinic and we know from a doctors C.V. what are their qualifications and areas of expertise. We also know from our experience that many doctors are not the best business people and a facilitator provides the commercial bridge to the patient, and often we are able to offer patients cheaper prices than if they go directly to the clinic.
From a medical point of view we know what certain clinics can and canâ€™t offer a patient which a lone patient might not be able to find out about. For example, two or three clinics in Hungary and Poland that are currently advertising directly to clients cannot deal with all the procedures that they are offering and are outsourcing medical staff - a lone traveller would never know this.
Can you understand why some people are critical of medical tourism facilitators?
Yes, of course, but it is inevitable considering how quickly this industry has grown in the past few years and I agree that there are a number of facilitators that have literally come off the plane and are working out of their back bedroom promoting the first clinic they found or promoting the only clinic that they have visited and been treated by. But they may have no idea if the clinic could offer the same service and treatment level for another kind of procedure. At the same time, there are a number of companies like Perfect Profiles who have pioneered the industry over a number of years, who are experienced and have solid reputations for helping patients through the process from start to finish and who really know what they are offering patients.
I see some clinics in Budapest advertising directly online that simply do not have the same facilities or experience as others. At least there is some vetting made by a facilitator, as in comparing clinic set up with one against another, as a result most facilitators are using reputable clinics.
What is the difference between a medical tourism agent and a medical tourism facilitator?
In my view, an agent is a company that, for a small commission, finds and arranges the initial appointment, but then has no control over the patient once they arrive overseas, leaving the customer care and logistics of transfers to the clinic overseas to manage. At Perfect Profiles, we independently arrange and support the patient overseas, and also offer independent arbitration between the patient and clinic, both overseas and in the UK. Also due to the volume we supply, we negotiate preferential rates and higher guarantees for our patients that would not be the same if they went direct to the clinic. I must admit that this is a constant misconception that we come across with prospective patients, thinking it is cheaper to go direct but it really isnâ€™t!
How does a good facilitator operate and what systems do you have in place to monitor quality of clinical practices and patient care?
A good facilitator should be able to answer questions and help obtain information on specific medical questions.
When we speak to patients we work through questions about what could go wrong and what back ups are in place. Weâ€™ve checked out the clinics and looked at the pitfalls and refer back to surgeons and doctors for them to answer questions and have open and honest negotiation with them. When individual patients have problems it is much harder for them to communicate with staff and resolve issues. Thatâ€™s what the facilitator does and of course we know what to look for and what questions to ask and will dismiss any clinics that tell us theyâ€™ve never had a problem with patients during or after treatment.
If patients have a problem with the management system or processes we use different back ups. Itâ€™s important for the patient to understand that we know how the local systems work and we know how to resolve the majority of issues which an individual traveller would probably not be able to do.
Of course patients say they want the â€œbest doctorsâ€ but as a facilitator our experience of working with some of the "best" doctors and medical institutes in Hungary is not all what medical tourism is about. What I mean is that the "best" doctors and professors only understand medicine and the truth is that medical tourism is a commercial business. The patient is paying big money and as a result will have different and greater demands than if they were being treated by their domestic health service. Facilitators understand but lone patients do not necessarily understand this and often clinics and hospitals donâ€™t understand the needs of medical tourists....which are different from local patients.
We understand that there is a fine line between medicine and commercialism and part of our role is to help the doctors and institutes understand this and educate them on the needs of foreign patients. An obvious example is that a doctor, without medical tourism experience, will want to treat a foreign patient in the same way as they would a domestic patient and will think that the medical tourist can come back and forth for follow up consultations and treatments without appreciating that this patient will incur extra costs to do this. They are also not always used to the demands and questions made by a paying patient, being more used to telling the patient want they have to do and dismissing the patient until next time. Again this is where a good facilitator is important.
What do you think are the biggest potential pitfalls for the lone medical tourist in dealing with foreign doctors/clinics?
I think the biggest problem is communication. Probably the most important role of the facilitator is to understand the language and being able to communicate properly by mediating between patients and medical staff. Though our doctors speak very good English, we find that many of our problems come from simple language/cultural differences and misunderstandings.
For example, the Hungarians use the word â€œmustâ€ rather than the word â€œneedâ€. This scares patients because the implication is that a particular treatment is imperative and it can be off putting and unnecessarily worrying for the patient. Without UK based or natural English speaking staff to support the medical tourist, I believe resolving issues and aftercare problems could be a nightmare, if you are in a foreign country alone you have no one to advise you apart from the clinic where you are having your procedure. As facilitators we understand the nuances inferred by words that a lone traveller may miss, which means that we can guide patients to make informed decisions. Our many years of experience mean that we know how to interpret what is being said.
Another problem is fulfilling patientâ€™s expectations and we would rather turn a patient away if we donâ€™t feel the surgery can solve the problem or achieve what the patient wants. Now of course a clinic might not do that if patient approaches them directly and then the patient will have a bad experience.
Do you think there needs to be a trade association and a of code of practice or guidelines for facilitators to help reassure patients that they are using a reputable company?
I am not sure people would put any store into whether or not a company was a member of an association. In our experience the main driver is price, especially with dentistry and cosmetic surgery although with elective surgery other factors come into play when patients make their choices.
Anyway, we are to a large extent self regulating and if we have lots of problems with a clinic we get on top of it. We rely on patient feedback and from the local office staff so we can nip a problem in the bud at ground level and Iâ€™m not sure an association would make any difference to how we operate or how issues would be resolved. So even though a clinic might be a member of an association it wonâ€™t give any real guarantees and a patient booking directly with a clinic will not know if there have been problems preceding their visit and therefore membership to an association cannot guarantee patient safety.
What about accreditation of overseas hospitals and clinics?
I think that an accredited clinic helps inform patient choice but as facilitators we would still do our background checks even if a clinic has been accredited and even then it doesnâ€™t necessarily mean that the clinic is best for what a particular patient needs.
What do you think would be the most useful type of regulation for the industry?
I would like to see a crackdown on pricing policies; if this was any other industry UK Trading Standards would not let companies get away with the practices employed by some facilitators and individuals. Two of our larger dental competitors in Hungary, with clinics in London, state clearly that they do not believe in hidden extras - then add on abutment costs and surgical costs separately or worse, further down in the small print. OK, they will argue they are not "hidden" because they are there. But I put this down to the language barrier, people not really understanding that "not hidden" means the pricing is clear from the outset. We are currently in a situation where we are having to consider breaking up our implant prices, because our base price (which is inclusive) is looking grossly uncompetitive. But, coming from a "travel background" that has been through this "from/come on pricing" decades before, I have a resistance to falling back to those dark ages
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