Revised 12/31/2007
Guide to Accreditation for Health Tourism
Organizations
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Healthcare tourism or the act of traveling abroad to receive healthcare is not new to our
world. But recently, we have experienced rapid global growth in the number of people
engaging in this phenomenon. With this rapid increase in scale, additional implications
have been created for the quality of service, which often cannot keep pace with the
quantity of services. The majority of the booming healthcare tourism industry has been
swept up under the jurisdiction of the Tourism Departments and Ministries in the
countries that have been reaping financial rewards in increased tourism. While HTI holds
a neutral political stance on health tourism, we do publicly support safe health tourism
practices and the safety of patients. In a globalized and patient driven healthcare
economy, no single entity and no single country can demonstrate an unbiased approach to
accreditation.
Mission Statement:
Our Mission is to uphold and improve the reputation and safety of the healthcare tourism
industry by promoting safe healthcare tourism practices among our member
organizations. We develop and employ safety, accreditation and technology solutions to
improve the health care system for those who choose the avenue of receiving health care
abroad. We maintain a neutral stance on the policy of health care tourism promotion and
health care outsourcing, but support safe and effective services for foreign patients.
Our goals are to:
Protect patient rights, quality of care and business practices in the health tourism
industry.
Protect the integrity and reputation of the health tourism industry against
companies and organizations that may jeopardize the future of the industry.
Create a "United Nations" roundtable for the health tourism industry in order to
establish health tourism standards and principles for credentialing purposes.
HealthCare Tourism International, Inc. is a non-profit organization and is currently a nonprofit 501 (c) (3) organization in the United States.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Accreditation Protocol and Guidelines
The HTI Accreditation protocol is broken down into two categories: statutes and
principles. Statutes are precise requirements in order to maintain eligibility for
accreditation. Principles are loosely defined moral and ethical standards of business and
health care. Principle assessment is based off of subjective criteria based off independent
non-paid surveyors volunteering with HTI. For an organization to be accredited, statutes
must be met exactly while principles must be upheld to a degree deemed adequate by
HTI. The HTI protocol follows a “least burdensome” approach in two ways: (1) the
organizations may claim equivalency to a certain principle in more than one way and (2)
the organizations may demonstrate equivalency to a principle in the least burdensome
manner possible to their organization, while still demonstrating reasonable equivalency to
the principle. If a response from an agency is found to be in conflict with Principles, HTI
will inform the organization and allow them to respond with corrections as required.
Privacy
HTI values Agency privacy and understands that certain trade secrets and company data
are proprietary information. We will not publish company data unless it poses a threat to
patient safety. In this circumstance, before publishing any such data, HTI will attempt to
make contact with an Agency in order to negotiate the diction of any such publication.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
I. Medical Tourism Operators/Agencies (“agency” or “agencies” or “tourism
operators”)
Definition
Healthcare tourism agencies are those whose primary purpose is not the provision of
direct healthcare services to their clients, but who engage in facilitation of health services
by acting as a liaison between patients and providers. (Ex: Hospital concierge services,
agencies that book airline flights, hotels/accommodations, hire translators, ground
transport companies, and trip coordination services for patients)
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
STATUTES:
A.1) An agency must continue support for a patient no matter what financial constraint or
debt a patient may express, after an initial act of conduct to initiate a dependence of the
patient on the agency has been established, which for this purpose construes a
relationship between patient and agency. Support for a patient is defined as providing all
those services required by the patient to successfully receive the treatment at the hospital
originally secured by the agency and clinician or service provider originally agreed. In
addition, support for a patient includes ensuring that after a patient receives treatment
they are supported with all services required to return the patient safely to their home
country via the transportation method originally offered by the agency. This does not
prevent an agency from receiving payment from a patient in full prior to establishing any
type of relationship; though if payment is accept by the agency, this can be construed as
an establishment of a relationship between patient and agency. (An example of an act that
makes a patient dependent on an agency is an agency’s booking of an airline flight for a
patient).
A.2) Agencies that have governmental or other legal actions pending or issued against
their organization should report all such incidents to HTI prior to accreditation or within
30 days of incident, whichever is earlier in time.
A.3) Agencies must not operate outside of local and international laws. In the event, that
an agency desires advice on how to proceed in certain dilemmas, accredited agencies may
request advice by mailing a written and signed request from an authorized director of the
agency to:
HealthCare Tourism International
ATTN: Agency Consulting
P.O. Box 251444
Los Angeles, CA 90025-1444
Financial Limitations:
B.1) Agencies need to disclose all partial-ownership and investments in hospitals or other
point-of-care centers, so that patients are aware of the financial interests of the healthcare
tourism provider. (Ex: If the agency has a financial interest in a certain hospital to which
it refers patients, then the agency should disclose to the patient these financial interests in
verbal or written form.) Alternately, agencies may opt to publish all financial interests via
HealthCare Tourism International and have HTI publish interests on its web sites.
B.2) Agencies agree to publish refund policies publicly on their web site or communicate
refund policies prior to entering a contract (exchange of funds) with a patient.
Medical Limitations:
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
C.1) Agencies agree to receive medical clearance from a patient’s physician before
critically sick or injured patients are allowed to travel on airplanes and other modes of
transportation. The definition of ‘critically sick’ depends on the medical opinion of the
physician. Agencies must post a message on their web site or other public notice area that
claims that medical tourism operators should not be used in the event that emergency
healthcare treatment is needed. In the event of an emergency, patients should be referred
to their local healthcare facility. If, however, a medical tourism company does provide
services for “critically sick” patients, the onus is on the company to explain for
accreditation purposes how it intends to evaluate patients and ensure logistical safety for
its patients.
C.2) Agencies agree to operate under medical, dental and health laws of their local
municipality and acquire all licenses and documentation required prior to engaging in
business.
C.3) Agencies that directly employ a clinician (i.e. doctor, nurse, physical therapist) must
communicate to the patient that the clinician is employed by the Agency prior to entering
into an agency-patient contract.
C.4) Agencies must attempt to follow-up on patient’s health and satisfaction status after
patient returns to their home country at least two times during the period of eighteen
months following date of health treatment. An attempt is construed as making a
reasonable attempt to contact to a patient after they have returned to their home country.
Advertising Limitations:
D.1) Healthcare tourism operators/agencies must not falsely advertise about the quality of
healthcare received with their agency.
D.2) Healthcare tourism operators/agencies cannot coerce a patient into healthcare
treatment with a certain provider. Patients always have the right to refuse treatment and
cancel their trip. If this happens, patients are subsequently entitled to a pro-rated refund
for services not used minus expenses occurred by the agency.
D.3) Agencies should not advertise the quality of health service as being superior to
another entity unless an independent study reference is cited on advertisement.
Data & Record Keeping:
E.1) Agencies must keep records of full patient details for 5 years after the completion of
the patient’s healthcare treatment in case these are needed to help resolve patient postoperative complications and other unforeseen incidents arising from the health tourism
experience.
E.2) Agencies that transfer patient records electronically to providers overseas must use
industry standard encryption services in order to uphold patient privacy.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
E.3) Agencies agree to maintain current licenses required to operate their business as
required by both local and international businesses.
E.4) All patient data and information must be kept in a secure, fire-proof and locked file
cabinet. In the event that patient data is stolen or lost, patients must be notified within 15
days. Annually, agencies must create an electronic or physical backup of all patient files
and store this separately in a different secured location of similar security standards.
Conflict of Interest:
F.1) All employees of an agency must sign a conflict of interest statement which affirms
that the employee or his/her immediate family does not have any financial or political
interest in vendors used by the agency. If a financial or political interest does exist, all
conflicts must be reported to HealthCare Tourism International for full disclosure.
Risk Management:
G.1) Patients must have 24 hour access to a live operator or other appointed
representative from Agency while abroad in country where health service is to be
delivered.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
PRINCIPLES
Name of Organization:
Mailing Address:
Main Telephone Number
Organization’s Web Site:
Ownership:
Staff:
CEO Name:
Telephone Number
Fax Number
Accreditation Company Representative Name:
Telephone Number:
Fax Number:
Email Address:
What year was your company established?
What countries do you serve?
Organization Overview:
2.A) Is your business a for-profit, non-profit/NGO or government organization?
What is your organization’s mission statement or purpose?
What business services does your company provide. Please be specific.
How long has your company been in business or operating as a health tourism facilitator?
What other businesses or services has your company provided in the past besides health
tourism-related services? What other services does your company engage in now other
than health tourism-related services?
Please provide a list of health tourism investments in for-profit or non-profit companies
your business has made currently? Health tourism investments are defined as investments
in an entity that provides either direct or support services to the participants within the
health tourism industry in any respect.
How do your company’s investments influence the vendors you choose to employ and
how do you ensure use of equal evaluation of vendors during selection of your vendors?
Does your company have any government actions or liens against it currently? If so,
please provide full details.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Does your company have any pending or past legal lawsuits against it? If so, please
provide full details.
Management Overview:
2.B) Describe your team’s management structure organization’s governance. Who are
your key employees?
What type of liability or responsibility does your management team have for the
individual client or patient using your services?
Describe your staffing and ability to manage requests for medical travel. What assurances
can you make that a patient who uses your service will not have service disruption due to
staffing issues, staffing availability or financial issues?
Describe, to the extent possible, your initial funding/financial backing.
Please describe the sources of your revenue and % breakdown.
What financial resources are available to your company and how long will these
resources last given your company makes no revenues starting now?
History/Experience Overview:
2.C) Describe your company’s experience in clinical health care services, if any?
How will you be able to promote medical treatment procedures? Does anyone in your
country have the capacity to promote certain medical treatment procedures? If so, who
and what qualifications allow this person(s) to make such promotions?
How do you intend to respond to clinical-related questions from patients referrals?
By what method did you find the hospitals/clinics that you have chosen to refer patients
to for health services?
What other governmental or NGO accreditation agencies or health tourism associations
in your country should HealthCare Tourism International exist?
What are certifications or accreditations does your company currently possess?
Marketing/Advertising:
2.D) Does your company have a web site that is currently operational? If not, when (if
ever) does it plan to operate a web site?
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Does your website include information on treatment procedures? If so, what is your
source of information? How do you determine the source of information to use?
Does your website have links to contracted providers? Physicians/dentists/other
clinicians?
Does your website explain the health travel process for the consumer? If so, are there
certain details that you omit for one reason or another?
Is your web site set up for consumers to send electronic messages to clinical providers, or
must all communications go through you, so that the consumer is blind to the contact
information with the clinical provider?
What marketing materials does your company currently have?
What information is included about contracted providers?
Define your markets and patient customers: What is your target market?
Describe your strategy for reaching your target market both domestically and
internationally. How will you promote your relationship with contracted providers?
What other business development and promotional strategies do you intend to employ?
What are your projections for health travel referrals from your organization for 2008?
(Where will your patients be traveling for their health services?)
 What percent is projected for Asia Pacific?
 What percent is projected for Central/South America/Caribbean?
 What percent is projected for North America?
 What percent is projected for Europe?
 What percent is projected for Middle East?
 What percent is projected for Australia/Oceania?
 What percent is projected for Africa?
What barriers do you foresee referring patients to providers in each of the preceding areas
(answer only those applicable to where you will or already place patients for clinical
services)?
What are the best and worst months to travel? What months do you serve the most
clients?
Please name nearby attractions and leisure activities that you recommend to patients who
receive health care services in the countries you facilitate healthcare in. If so, how do
these activities affect the post-operative care and recovery of patients.
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Do you provide or facilitate any other “tourism” based services to patients who receive
health care? If so, do you recommend patients engage in these activities before or after
receiving health care?
Services/Fees Overview:
2.E) Describe how your organization will provide the following patient-related
services: If your company does not provide certain services, please indicate this as well.
 Travel including transport, hotel
 Obtaining visas
 Transferring patient medical records
 Coordination of scheduling with provider
 Maintaining communication with patient, provider and other parties involved
 Arranging for personal assistant/concierge
Fee Structure/Payment mechanism
 Describe your proposed fee structure. How do you propose to be paid for the
services you provide?
 Will the amount or mechanism by which you are paid affect the hospital or
clinical provider or other vendor you will choose? Please explain.
 If your decision to use certain vendors is not dependent on the fee structure or
payment methods used by the vendor, please explain how you ensure this?
Coordination of medical care among patient, insurer, domestic and international
physician and medical providers (this represents the entire process flow from referral
intake to post-procedure care).
Provide a detailed step by step analysis and detail of how you will manage the overall
patient experience.
Do you offer transportation to and from the airport? (if applicable) If yes, explain how
you choose your transportation vendors and what criteria you use to ensure reliable and
safe transportation.
Do you have any signed contracts or agreements with insurers, employers and third party
payers for international referrals
 Do you have agreements in place with any of the above?
 Describe your approach to securing agreements with any of the parties above and
promoting providers with which you contract
What forms of payment do you accept from your patients and physician/dental/health
provider clients?
___ Visa
___ Mastercard
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
___ American Express
___ Diner’s Club
___ Paypal
___ Cash
___ Money Order
___ Personal Check
___ Wire transfer
___ Other (specify) _______________________________________________
Risk Management Overview
2.F) Describe your company’s strategy/policy of managing risks from the actions and
lack of action from the following stakeholders:
 Traveling Patient
 Provider
 Vendors
Explain what contingency plans your company has installed in order to mitigate risk for
patients/customers? If no contingency plans are in place, please provide a rationale.
Outcomes/Metrics Overview
IIG) Measures of success
How do you evaluate potential providers with which you contract (accreditation,
certification, or other requirements in other to contract with them)?
 How will you evaluate the benefit of your agreements with these providers?
 By what criteria do you judge the commitment to quality of your
providers/vendors?
Do vendors or clinical providers that you use both non-clinical and clinical require
any certifications in order to be eligible to partner with your company? If so, which
certifications or accreditations to you require from potential partners?
What metrics do you use to self-evaluate improvements for your company over time?
Please address:
Patient complaints
Patient post-op, travel, logistical complications
Adverse events including reporting of patient data errors, logistical errors.
Please make any additional comments you’d like our accreditation body to know about
your organization:
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org
Revised 12/31/2007
Attachments / Appendices
Please answer the questions fully on separate unlined paper. Any modification to your
application must be submitted before the review process has been generated
Please attach all documents and appendices to this document.
Please attach all appendices and attachments to the end of this document.
Document may be submitted either by:
1) Scanned / Emailed to health@healthcaretrip.org
2) Mailed to
HealthCare Tourism International
PO Box 251444
Los Angeles, CA 90025-1444
United States of America
I hereby declare under penalty of perjury that the information contained in this
application is truthful, complete and contains no omissions. I have voluntarily completed
this application for purposes of accreditation from HealthCare Tourism International.
Date:
HealthCare Tourism International - A 501 (c) (3) non-profit organization
(310) 928-3611 · www.healthcaretrip.org