The Definitive Guide to International Hospital Accreditation
i.e. How do I know that the hospital or clinic that I'm going to is safe?
I. What is Hospital Accreditation and Why Does it Matter?
There are many great hospitals and health care facilities all over the world. Unfortunately there is no large dataset of success and failure statistics that we can use to compare them to each other (although there have been efforts to compare hospitals within the US as well as compare international medical systems to each other), so for now, one of the next-best ways to know that you're going to a a safe, modern, health care facility with good hospital standards and a proven record of patient safety, is to look at their accreditation.
What is accreditation?
Accreditation is a form of external quality assessment carried out by a third-party, involving both a self-assessment and a peer review by an external group of surveyors. It is important to note that accreditation is based on the processes and procedures a hospital has in place, not its outcomes. Harvard Professor of Law, I. Glenn Cohen, writes:
"Are those procedures aimed at improving quality? Absolutely. But they are insufficient to ensure high quality care... accreditation is very expensive to achieve, but that tells us only that a particular foreign facility has the finances and/ or support of its home government necessary to achieve that accreditation, not necessarily that its quality is very high. To be sure, when friends and colleagues ask me for advice on foreign hospitals I always ask if they have received JCI or another well-regarded accreditation, and this information is useful, but it is not sufficient as a guide for quality."1
In other words, hospital accreditation is a good guide when selecting a health care facility, but it is only a guide. Additionally, it's important to note that there is not strong evidence that hospital accreditation leads to better care.2, 3, 4 In fact, in most European countries accreditation is completely optional, and many European countries do not have any sort of hospital accreditation system at all.5 To help people understand European healthcare accreditation, The Belgian Health Care Knowledge Centre has produced a very detailed report comparing Europe's accreditation systems.
In the cases in which a country has optional or non-existent health care accreditation, your best bet is to research whether that country is known for a good health care before making your medical travel plans. You should also remember this when comparing hospitals across the world; an un-accredited hospital in a country that does not require accreditation but nonetheless has very high standards for their health care, like Germany, might have better outcomes than a locally-accredited facility in a country not so renowned for their medical care. Less-developed nations are the cases in which acreditation becomes most important, in order to make sure you are choosing a facility that provides care to the high standards you would expect. A well-accredited medical facility in an otherwise less-developed nation may provide equivalent or even superior care, when compared to a medical facility in a more economically advanced nation; but an unaccredited medical facility in a less-developed nation could be a dangerous disappointment.
Looking at hospital accreditation—while not completely foolproof—is one of the best and easiest ways to choose a health care facility that has made maintaining high, international, hospital standards a high priority.
II. What is the Difference Between Different Accreditations?
The main differences come down to: international versus local accreditation agencies, and general versus specific.
There are international accreditation agencies, like the Joint Commission International (JCI), which accredits hundreds of medical facilities across the world, and there are local accreditation agencies like the Malaysian Society for Quality in Health, which only accredits in Malaysia. Many countries, especially those interested in signaling quality to medical tourists, have developed their own local accreditation agencies.
Local Healthcare Accreditors
|Care Quality Commisison||The United Kingdom|
|Malaysian Society for Quality in Health||Malaysia|
|National Accreditation Board for Hospitals & Healthcare Providers||India|
There is also a difference between very general accreditors such as JCI, which mainly looks at hospitals, and very specific accreditors such as the American Association for Accreditation of Ambulatory Surgery Facilities which only accredits outpatient facilities.
Specialized Healthcare Accreditors
|American Association for Accreditation of Ambulatory Surgery Facilities International||Outpatient facilities|
|Verified Internet Pharmacy Practice Sites||Online pharmacies|
III. Major International Hospital and Health Care Facility Accreditors
There are a few major international hospital accreditors which are frequently mentioned in medical journals or other professional medical publications, all of which can be used to filter a medical facility search on Well Traveled.
Major International Health Care Accreditors
|Australian Council of Healthcare Standards|
|Joint Commission International|
While they are not the same, the four above accrediting bodies above do tend to be somewhat interchangeable, as they are all stringent and highly respected accreditors from medically advanced nations. The Joint Comittee International is generally regarded as the most prestigious international hospital accreditation, but it is not clear if that leads to superior outcomes, or is merely a matter of branding. JCI is also a very expensive accreditation, with a declared average fee of $46,000.00 USD (in 2010).6
If you find of the details of accreditaion almost too boring to bear, and you just want a quick and simple guideline, the most acceptable shortcut is to look for a place accredited by one of the major international accreditors.
IV. Irrelevant Accreditation
There is one accreditations that is frequently advertised on medical travel sites which Well Traveled does not consider relevant to good medical care.
The International Organization for Standardization (ISO)
With respect to hospital work, ISO is often mistakenly considered to be an international healthcare accreditation scheme, however it is not. In Patients Beyond Borders: Everybody's Guide to Affordable, World-Class Medical Travel, author Josef Woodman remarks that, "ISO mostly oversees facilities and administration, not healthcare procedures, practices, and methods. That’s of limited value in terms of your treatment."
Nonetheless, you will from time to time see ISO accreditation advertised on healthcare facility or medical tourism websites as if it were a relevant distinction. We advise skepticism when dealing with any person or company that treats ISO as a relevant qualification in terms of health care; it absolutely is not, and we can't think of a valid reason to treat it as if it were.
V. Leave the Accrediting to the Accreditors
On medical tourism websites you will, from time to time, see claims that they hand-pick only the most "trusted hospitals and clinics." Unless they explain their selection criteria in detail and offer evidence, statements like this are not really about safety, just marketing and branding. The professional medical community, even accreditors, preferably one accredited by the The International Society for Quality in Health Care (ISQua) (yes, that's an accreditor that accredits accreditors. Try to say that five times fast!) have difficulties judging medical facilities—and they are the ones who are professionally trained to do exactly this!
What's certain is, no startups, no blogs, no one but the accreditors are qualified to make quality assessments about medical facilities, and any that claims that they are should be met with heavy skepticism. At Well Traveled, our aim is to clear up the confusion, to educate medical travelers and to help them to make informed, choices— not develop a dependence on us.
Our recommendation is to understand what accreditation is and what it is not, and factor it into your decision of where to receive care, but allow it to be one of many factors in a well-researched treatment plan.
More Information About Hospital and Health Care Accreditation Around the World
1. Cohen, I.G., 2014. Patients with passports: medical tourism, law, and ethics. Oxford University Press.
2. Chen, J., Rathore, S.S., Radford, M.J. and Krumholz, H.M., 2003. JCAHO accreditation and quality of care for acute myocardial infarction. Health Affairs, 22(2), pp.243-254.
3. Miller, M.R., Pronovost, P., Donithan, M., Zeger, S., Zhan, C., Morlock, L. and Meyer, G.S., 2005. Relationship between performance measurement and accreditation: implications for quality of care and patient safety. American Journal of Medical Quality, 20(5), pp.239-252.
4. Sack, C., Lütkes, P., Günther, W., Erbel, R., Jöckel, K.H. and Holtmann, G.J., 2010. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology. BMC health services research, 10(1), p.120.
5. Scrivens, E., 2002.Accreditation and the regulation of quality in health services. Regulating entrepreneurial behaviour in European health care systems. pp 91—105.
6. Joint Commission International. Cost of Accreditation.Archived from the original on October 16, 2011. Retrieved May 4, 2017.