THE PRINCIPLES OF MEDICAL TOURISM INDUSTRY – OUTBOUND – INBOUND- INTRABOUND / USA DR.AYŞE TURAN MD, MA DR.AYŞE TURAN MD, MA

FROM SPAS TO COGNITIVE COMPUTING SUMERIAN POOLS ST.MORITZ DRINKING SPRINGS ASCLEPIUM AYURVEDA ROMAN BATHS JAPANESE SPAS MANSURI HOSPITAL VILLE D’EAUX ********************** INDUSTRIALIZATION 1720 BATH ENGLAND TBC ENGLAND-USA 1933 ABMS-The American Board of Medical Specialists-standards 1958 UEMS 1960 YOGA dental/eye/cosmetic/heart SUMERIAN POOLS ST.MORITZ DRINKING SPRINGS ASCLEPIUM AYURVEDA ROMAN BATHS JAPANESE SPAS MANSURI HOSPITAL VILLE D’EAUX ********************** INDUSTRIALIZATION 1720 BATH ENGLAND TBC ENGLAND-USA 1933 ABMS-The American Board of Medical Specialists-standards 1958 UEMS 1960 YOGA dental/eye/cosmetic/heart

GLOBAL MEDICAL TOURISM ERA 1997 JCA-I –SE ASIA & LATIN AMERICA DENTISTRY AND COSMETIC SURGERY PARTNERSHIPS WITH THE US BASED HEALTH PROVIDERS BABY BOOMERS- OUTSOURCING- NONEMERGENY PROCEDURES 1997 JCA-I –SE ASIA & LATIN AMERICA DENTISTRY AND COSMETIC SURGERY PARTNERSHIPS WITH THE US BASED HEALTH PROVIDERS BABY BOOMERS- OUTSOURCING- NONEMERGENY PROCEDURES

TRANSATLANTIC STORY OF AN ARTIFICIAL HIP 112,317 dollar / 13,660 dollar Intermediaries St.Rembert’s Belgium 1000 USA orthopedists-200 million dollars million settlement billion dollars joint replacement --- USA 1/6 military budget 112,317 dollar / 13,660 dollar Intermediaries St.Rembert’s Belgium 1000 USA orthopedists-200 million dollars million settlement billion dollars joint replacement --- USA 1/6 military budget

USA MEDICAL TOURISM GUIDELINES AMA- OUTBOUND Voluntary Diagnostic and therapeutic alternatives Recognized İnternational Accrediting Follow –up care Travel costs included Patients rights and legal recourse Doctors licensing and outcomes data Facility accreditation and outcomes data HIPAA Guidelines for patient data transfer Surgical procedures / travel/ vacation risks Voluntary Diagnostic and therapeutic alternatives Recognized İnternational Accrediting Follow –up care Travel costs included Patients rights and legal recourse Doctors licensing and outcomes data Facility accreditation and outcomes data HIPAA Guidelines for patient data transfer Surgical procedures / travel/ vacation risks

INTRABOUND & INBOUND MEDICAL TOURISM STANDARDS / USA - 1 Doctors recommendation AHA American Hospital Association Annual Survey- reputational survey of physicians IHQ Index of Hospital Quality-hard data Structure X Process X Outcomes Doctors recommendation AHA American Hospital Association Annual Survey- reputational survey of physicians IHQ Index of Hospital Quality-hard data Structure X Process X Outcomes

STRUCTURE Resources for patient care: nurse/bed Technology Patient services Recognized designation : Nurse Magnet /National Institute/Center of Excellence /Reference Center Discharge number – inpatient data Resources for patient care: nurse/bed Technology Patient services Recognized designation : Nurse Magnet /National Institute/Center of Excellence /Reference Center Discharge number – inpatient data

PROCESS Delivery of Care Patient safety quality indicators Reputation survey Diagnosis-treatment-prevention-patient education Delivery of Care Patient safety quality indicators Reputation survey Diagnosis-treatment-prevention-patient education

OUTCOMES STRUCTURE-PROCESS:OUTCOMES Mortality rate Risk adjustment Complexity of cases-severity of illness Readmissions Patient safety Infection rates STRUCTURE-PROCESS:OUTCOMES Mortality rate Risk adjustment Complexity of cases-severity of illness Readmissions Patient safety Infection rates

INDEX OF HOSPITAL QUALITY ELIGIBILITY 1- Teaching Hospital-OR-Medical School Affiliation –OR-200 beds set up and staffed-OR at least 100 beds and 4/8 key technologies 2-Minimum severity of illness complex care experience treating discharge volume ELIGIBILITY 1- Teaching Hospital-OR-Medical School Affiliation –OR-200 beds set up and staffed-OR at least 100 beds and 4/8 key technologies 2-Minimum severity of illness complex care experience treating discharge volume

EXAMPLE TECHNOLOGIES -Ablation of Barret’s esophagus -Cardiac intensive care unit -Computer assisted orthopedic surgery -Diagnostic Radioisotope services -ERCP -Endoscopic Ultrasound -Full Field Digital Mammography -Imageguided radiation therapy -CT -PET/CT -Robotic surgery -Shaped beam Radiation -Single Photon emission CT -Stereotactic radiosurgery -Transplant services -Ablation of Barret’s esophagus -Cardiac intensive care unit -Computer assisted orthopedic surgery -Diagnostic Radioisotope services -ERCP -Endoscopic Ultrasound -Full Field Digital Mammography -Imageguided radiation therapy -CT -PET/CT -Robotic surgery -Shaped beam Radiation -Single Photon emission CT -Stereotactic radiosurgery -Transplant services

PATIENT SERVICES Alzheimer’s center Arthritis treatment center Cardiac rehabilitation Fertility clinic Genetic testing /counseling Hospice Infection isolation room Pain management program Palliative care Patient controlled analgesia Psychiatric geriatric service Translators Wound Management services Alzheimer’s center Arthritis treatment center Cardiac rehabilitation Fertility clinic Genetic testing /counseling Hospice Infection isolation room Pain management program Palliative care Patient controlled analgesia Psychiatric geriatric service Translators Wound Management services

METHODOLOGY MULTIDISCIPLINARY INTERDISCIPLINARY TRANS DICIPLINARY

SAĞLIK BAKANLIĞI SAĞLIK TURİZMİ DAİRESİ BAŞKANLIĞI