International Patient Guide - A Step-by-Step Guide to Planning a Safe Healthcare Abroad 23 April 2013 This step by step guide has been prepared for those considering medical treatment in a foreign country. Although the idea of traveling abroad to receive medical treatment may appear daunting at first, the fact is that more and more people are turning to this option in order to receive the treatment or surgery they need and may not be able to get at home, for any number of reasons. Below you will find an easy to follow guide to assist you in looking into this option, and then preparing for your medical adventure to an exotic destination. The benefits of making this decision may surprise you, as you research and plan your trip. Not only will you receive world-class care abroad, with internationally trained doctors using state of the art equipment, you will be cared for and looked after in ways you’ve never experienced at home. Before or after your medical care, you’ll also be able to use your savings to explore and learn about another part of the world. We recommend that you read through the guide below in its entirety at first. Then, select the particular items that are relevant to your case to explore further. As you learn more about your medical tourism destination, you will develop the peace of mind you’ll need to begin to take the steps necessary to make this healing journey a reality. Step 15 at the end of this guide concerns medical tourism agents and companies. There may be a number of reasons why you might prefer to have established professionals handle everything for you. If this is the case, these people are available to assist and guide you through the entire process. You’ll also want to consider having a companion join you on your medical journey. There will most likely be times when a partner, spouse, or friend will be of great assistance and comfort to you, depending on the seriousness of your procedure or surgery. You may find that your companion is more than happy to accompany you, not only to be with you through this time, but to enjoy the non-medical aspects of your adventure abroad. The key to a successful venture is careful planning and preparation. Once you’ve done all your research, bookings, and planning, you and your potential companion can then simply follow the flow of your itinerary. You’ll be able to relax, get what needs to be done accomplished, and not have to think about what to do or where to go next. We hope you find this guide of use as you prepare, plan, and receive your international medical experience. We wish you all the best on your decision to explore treatment options abroad. Step 1. Research: Determine the viability of foreign medical treatment Step 2. Look closely into the medical treatments available at your destination Step 3. Work on your shortlist of treatment centers and doctors Step 4. Interrogate the treatment centers and the doctors Step 5. Choose a treatment facility and a doctor Step 6. Prepare your pre-admission information materials for your chosen facility Step 7. Finalize all the important information and get a complete quote Step 8. Schedule your appointment Step 9. Plan your travel itinerary and make your bookings Step 10. Visit your treatment facility and receive a pre-treatment assessment Step 11. Get your operation or receive your treatment Step 12. After your surgery or treatment Step 13. Calculate the total cost of your international medical vacation Step 14. Prepare for the unexpected Step 15. For those who decide to work with a medical tourism company or agent Step 1. Research: Determine the viability of foreign medical treatment Step 1 involves collecting as much information as possible, then organizing and evaluating it. Consider all the treatment options and alternatives as well as potential complications and the typical length of the recovery process. Discuss the options with your primary doctor and other specialists. Decide whether foreign medical treatment is a viable option for you. Talk to your partner or companion and take all factors into account: time, money, travel, treatment, recovery, and anything else that is of concern to you. Once you know all this, you’ll be in a good position to proceed to the next step knowing that travelling abroad is indeed a reasonable, desirable, and advantageous choice for you to receive the medical treatment you need. Step 2. Look closely into the medical treatments available at your destination Now that you’re moving forward with your plans, dig deeper into the medical treatment available in your chosen destination and the facilities where it is offered. Not all treatments and operations are available everywhere, so make sure that you can get first-class treatment at a certified hospital where you have chosen to go. This is obviously the most important decision you’ll be making, so take your time, look into all the options, evaluate each one, ask questions and then make a decision. Avoid the medical service providers and doctors who are impatient or impersonal; there are many others available who will provide you with the respect and patience you deserve. You are in total charge at this point, so choose carefully. Make a short list of two or three of the places that you have found that best meet your criteria. You should continue revising this checklist until you feel comfortable making your final decision. Then, discuss your various selections with someone you trust and seek testimonials and recommendations from others who have already done what you are now planning. One day, you will be the one in a position to advise others. But right now you must focus on looking for the best hospital or clinic and doctor to handle your specific needs. Step 3. Work on your shortlist of treatment centers and doctors Now that you’ve chosen some hospitals or clinics, contact them and test them. Begin with their website’s contact form; this will be a good first test of their responsiveness and professionalism. If you do not here back from them, move on to others on your list. If they can’t manage their emails, they can’t manage your care. Once you’ve made contact, ask them some of the preliminary questions you’ve prepared in advance: what is the treatment process for your condition at their facility; who would be doing the required procedure; what are their qualifications; what are the total costs, including pre- and post-surgery tests, medications, and service; how long do you need to be in country; and what are the other terms and conditions? You’ll need to know exactly how long you’ll need to stay after your treatment to avoid any complications that might occur – you don’t want something happening to you that you need to deal with a few days after you return home. If you’re ever unsure about any of these issues, either push for more information or seek the help of a medical travel agency which has experience with the type of treatment you are seeking. You should be confident of every step of the process before finalizing your plans to undergo treatment abroad. Be sure to advise them of any complicating factors you may have that they will need to be aware of to give you an accurate estimate. For example, having certain allergies, being pregnant, having HIV or diabetes and other conditions could have an impact on the treatment, length of stay and costs. Use this time to get an idea of the different facilities available for your condition. Scratch the bad ones off your list, and focus on narrowing down the good ones. Consider which facility you would feel comfortable staying in, and in some cases, trusting your life with. Step 4. Interrogate the treatment centers and the doctors Since your treatment is certainly a critical issue to you and your health, don’t hesitate to question the treatment facility and doctor about anything you’re unsure of. If this information is not forthcoming, cross them off your list and move on to the next place, until you find one that answers all your questions thoroughly, makes you feel comfortable and offers assistance as you need it. You’ll need to ask direct questions, including learning about your doctor’s experience and qualifications, what complications might arise as a result of your procedure, what type of anesthesia they will be using (if you are going to be put under), and other questions relevant to your particular case. You need to feel comfortable with the transparency and openness of this facility and confident to proceed, so this will be like a final screening process for you. Therefore, conduct a thorough interrogation; if you’re not up to it, ask someone familiar with you and your case to pose the questions. Here are some sample questions you might ask the doctor and the facility, depending on the type of treatment or surgery you will be having: What is your experience in performing this type of procedure? How frequently and when did you last perform this type of procedure? What is your success rate for this procedure? What are the frequency and types of complications that you have had performing this type of procedure? How many international patients have received this procedure at your facility? Could you send me a list of references of those that have had this procedure done at your facility? What accreditations does your hospital or clinic have? What qualifications do you hold, and where did you receive them? Will I need to undergo anesthesia during this procedure? Please elaborate on details, including anesthesiologist, type of anesthesia to be used, etc. Where will the procedure actually take place? What happens if something goes wrong and I need additional treatment or another operation? Who will cover these expenses? How long will I be hospitalized altogether? How much recovery time will I need? What can I do during this period? How soon after the procedure can I safely fly home? What happens if complications develop after I return home? How and who will deal with these complications? What is included in the price of the procedure? What is not included in the price of the procedure? Step 5. Choose a treatment facility and a doctor Armed with all the knowledge and data you’ve accumulated from your research, you’re now in a position to make the final decision as to which hospital or clinic and doctor you will use. Depending on the type of operation or procedure you will be getting, you may still be time to change your mind on the ground after physically examining the facilities and meeting your doctor. For more major operations that need advance scheduling and down payments, this is far less of an option. Nevertheless, if you are not happy with what you see, or concerned that things are not what you thought, you can always back out, though this will probably not happen. Step 6. Prepare your pre-admission information materials for your chosen facility Your doctor in the facility you have chosen will want to learn as much as he can about your condition. You should have all your x-rays, photos, medical history, MRIs and other relevant information scanned, so that you retain the originals. Ask your home facility to assist you with this or recommend services to you where you can make copies of these important files. Your treatment facility or doctor should also have requested this information from you. If they don’t, either ask them yourself what they need, or choose another hospital or clinic that does ask you for them; it is a potential red flag if they do not ask. Step 7. Finalize all the important information and get a complete quote After you have decided on your treatment facility, and discussed all the details of your medical trip, you need to get a complete, accurate quote for all the services, medicine, and treatment required. The medical facility should be advising you thoroughly during this process about time as well as any pre-surgical requirements that you need to know about, such as not eating for a certain length of time and not taking aspirin for a certain number of days before your treatment, if applicable. Be sure to ask them if there are other charges that will or might be applied, including nurses’ fees, service fees, special room fees, and costs for supplemental medicine. Even better, speak to one of the references that you have found, and ask them about their final bill, and if there were any surprises when they went to check out. This is a not uncommon occurrence in modern medical facilities, which are of course for-profit businesses as well. Step 8. Schedule your appointment According to the steps above, you should have been advised about scheduling procedures at your treatment facility for your situation. Depending on your medical condition and the treatments you are to receive, it is advisable to contact a hospital several weeks to several months in advance to ensure that you can receive treatment from the doctor you prefer when it is convenient for you. Typically, treatment abroad can be scheduled far more quickly than at home; however, it’s always best to inquire as early as possible, especially for more major procedures and surgeries. Step 9. Plan your travel itinerary and make your bookings Do not underestimate the time that will be needed for the actual planning and booking of all the legs of your trip. Again, start early so you will not have to worry about this when you’re concerned above all with your health, and getting the treatment you need. The following checklist covers most of the important components of your travel planning. Make all your reservations and bookings for air travel, accommodation and any tour packages you might wish to take. Get hotel recommendations from your hospital, clinic or travel broker, making sure it is located near your treatment center. Take into account recovery time and doctor’s recommendations regarding travel and any post-treatment activity. Figure how much time you’ll be spending in your destination country, then look into the specific visa requirements for your host country. The longer you need to stay, the more likely it is that you’ll need to apply for a visa from their embassy in your country. Make a travel packet of all your important documents, maps and information you’ll need in your treatment country. Leave one set of copies of your most important documents at home as a backup. Important documents you’ll need include: - Copies of your passport, air tickets, extra photographs and other essential medical paperwork. - Emergency contacts, including names and numbers of relatives, friends, employer and your home physician. - Medical records: X-Rays, MRI’s, medical histories, photographs, immunization records, prescriptions and any other health records relevant to your surgery. Carry all these medical reports and any medicines in your carry-on luggage so there is no chance of them getting lost. Write in large letters what is inside each separate folder. - Map of the locations and telephone numbers of your home embassy in your destination country, the hospital where you will receive medical treatment, and the hotel where you will be staying. Keep all these items close to hand, so you’ll have them when you leave the airport. - Cash, credit cards, debit cards and travelers checks. Bring enough cash to cover all travel expenses, as well as unforeseen expenses. You can change your home currency into local currency at the airport upon arrival in most countries, or at any banks and foreign exchange services in country. You’ll also be able to withdraw money at most ATM’s located in your destination. - Driver’s license. Carry your driver’s license and make sure it will remain valid throughout your trip and long beyond. Keep this in a prominent place along with your passport, as these will serve as important identification documents and be useful in case of emergencies. Step 10. Visit your treatment facility and receive a pre-treatment assessment Once you’re settled in, call your treatment center and schedule a meeting with them. Above all, you want to have a good luck at where you’ll be receiving your treatment, and get an idea of their standards and professionalism in person. Depending on your individual operation or procedure, you will have a pre-operative assessment performed before your treatment. Be sure to schedule time for this and ask your treatment facility what all will be involved before going. If possible, give yourself plenty of time in-country before your scheduled treatment, both to adapt to the new environment, and to confirm that everything is in order according to your planning and schedule. Meet and talk with your doctor. Step 11. Get your operation or receive your treatment By now, you’ve done all that you can do, and you’re in the hands of the medical professionals who you’ve chosen. By being well-informed and prepared, you can now relax and simply follow the instructions that they will be providing you. If you have a companion with you, be sure they know your schedule and what to expect following your treatment. The more major the surgery, the more you’ll want your partner to check on you and make sure that everything has gone normally and according to plan. Step 12. After your surgery or treatment In most cases, you’ll be spending at least some time in hospital. Be sure to check the details of this beforehand so you know what to expect and can plan accordingly. Then, you will be released. Chances are you’ll need to come back for a check-up after a given number of days, so you may have some time to take a tour, visit a spa perhaps or see some sights, depending on your condition. You will have planned this already if you’ve been following the checklist above. So take it easy and try to enjoy your medical holiday before your final check-up and eventual departure. Be sure to get as much information as possible before leaving home, as communications will obviously be more difficult from abroad. You should know the answers to common questions such as: What are the possible complications of my procedure, and how common are they? How much pain will I have, and how long will it last after my procedure? How soon can I have visitors after my treatment? Will I need physical therapy, and if so, for how long? How long should I wait after my treatment before flying home? How long should I wait before returning to work? What restrictions should I observe after my procedure, and for how long? What medications will I need, where are they available, and how long will I need to take them? What should my home physician know? And what should I give my doctor in the form of files, x-rays, or documents from you? What about insurance paperwork? Will you assist me with this? What needs to be done in-country? Will there be follow-up options with my doctor from home, such as telephone calls, emails, or online chats? Step 13. Calculate the total cost of your international medical vacation Although the cost of your treatment will certainly be less than at home, be sure to take into account all costs of your medical holiday when planning and budgeting for your trip. Don’t forget to include the following: Passports, visas, and any supplementary paperwork needed, including copies and translations if needed; International flights and extra (hidden) fees such as excess baggage, airport expenses and meals, etc.; Immigration and emigration fees, airport taxes, and tips; Transportation costs from your home to your hotel – and back; Accommodation; Food and beverages; Taxes and gratuities; Communication costs: telephone, internet and phone cards; Medical equipment, if needed (wheelchairs, crutches, bandages, etc.); Medication and related supplies or devices; Travelers insurance; Post-operative treatment and recovery expenses; Shopping, entertainment and recreation; Tours; Transportation; Impulse buys; Donations; Gifts; Contingency funds – do not cut your expenses too close. You do not want to find yourself in a situation where you do not have immediate access to needed funds; Step 14. Prepare for the unexpected Although often more expensive, it is a good idea to get air tickets without too many conditions. Your post-operative treatment may take more, or possibly even less, time than projected. Do not make your schedule too tight and inflexible, as it’s not unusual for changes to occur, be it the hospital or doctor, or unforeseen natural, cultural, or political events. Check your host country’s national holidays, something often overlooked, as it could well affect your schedule. Step 15. For those who decide to work with a medical tourism company or agent As we mentioned at the beginning of this guide, you can arrange medical treatment yourself or you can use a medical tourism agent, of which there are now many available. This will depend completely on your situation, state of health, and level of comfort and proficiency in handling things yourself. If you’ve been to your destination before and feel comfortable communicating with clinics or hospitals there, you might want to consider arranging everything yourself. If you run into trouble, you can always seek professional assistance later. If you have friends or relatives living in your destination, you’re probably better off having them assist you if they are willing to do so. They will certainly have your best interests at heart and be familiar with the local medical scene. They may be able to negotiate discounts for you, and you won’t need to pay a broker. On the other hand, if you have never been to the country before and don’t know anyone living in the country, you may want to seek the help of professionals, especially if you’re elderly, disabled or an inexperienced traveler. You will quickly learn whether language is going to be an issue or not as you begin contacting the facilities you are considering. You should take this factor into serious consideration before deciding on a particular destination. There are potential obstacles along the way, and if you are not in the best of health, you’re well advised to let a medical tourism agency handle everything for you. If you choose carefully, they may not cost much more, if anything, as they will receive their payments while handling your case and arranging all logistics. The truth is that a professional medical tourism provider can take care of virtually everything for you, including some things you may not have expected. They are well worth looking into depending on the complexity of your case and the host country, even if you eventually decide to handle things yourself. Among their services are providing you with detailed information about various procedures, detailed hospital – and surgeon – profiles, medical records transfer, free surgery quotes, pre- and post-consultation with the hospital, feedback and testimonials from previous patients, medical and dental loan financing, passport and visa advice, airport pick-up and drop-off, travel insurance, hotel booking, tourism services in country and more. The bottom line is that due diligence and advance research are critical to a safe, successful and healthy medical holiday. Whether you end up handling it yourself or using a broker or provider, think ahead, plan your trip wisely and remain open and flexible. If you follow all the advice above, you’re sure to have a successful medical holiday and an exciting cultural adventure at the same time.