Continuity of Care Remains a Top Concern

Rick Johnson, for HealthLeaders Media , January 27, 2009

Like most writers, when I'm assigned a long-form article I try to craft it in a way that doesn't just report on current happenings, but points out a few trends that might take hold in the near future. So it was with this month's cover story, Flat-World Healthcare.

In the article, I presented some key events that could perpetuate the medical travel movement. For instance, the increased pressure of U.S. businesses to pass along healthcare costs to employees will likely continue. So this could be an opportunity for businesses to add a medical travel benefit to let employees get the most cost-effective care since they will be shouldering more of the burden.

But with my lens so honed on the future, perhaps I didn't spell out bluntly enough a few of the big challenges facing medical travel today. With so much coverage on the topic over the past calendar year, I might have assumed this was well-treaded ground. However, recently a couple of readers e-mailed me to ask: What happens when the knee-replacement patient returns home to the U.S. and has a post-operative infection?

The good news is that after a year of reporting on global healthcare, I haven't yet heard of a post-operative complication that wasn't resolved. As we know, however, even in hospitals with outstanding complication rates, surgeries can go wrong.

I point out in HealthLeaders magazine that if employers push payers toward medical travel benefits, some of these continuity of care issues go away—for insured patients anyway. Post-op infections and other complications are things that global healthcare providers are actively addressing now, but I haven't yet seen a single best practice. Here are a few strategies I've heard of:

Some medical travel facilitators have agreements with local providers to accept their patients for post-op care. This could give the patient the comfort of knowing that there's a U.S. provider in place to assist in the case of complications. However, if this provider is in Florida, for instance, it wouldn't likely do much good for a patient in Spokane, WA.

I've also heard of global providers, such as Medtral New Zealand, that offer contingency insurance to cover the risk of major surgical complications.

Some global providers and facilitators are acting carefully and deliberately when it comes to continuity of care. Luke B. Johnson, director of international business development for Christus Health, tells me that Christus Muguerza won't accept a U.S. medical traveler who doesn't document a local physician for follow-up care.

Even though global providers and medical travel facilitators have rightly identified ways to deal with the continuity of care issue, the opportunity remains for an uninsured patient to fall between the gaps in care. That's why I'm interested in seeing how partnerships between U.S. and global providers might take shape in the coming years to create a true network solution of local and distant care providers.

Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at
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