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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 text-normals 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.

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

Name Focus
American Association for Accreditation of Ambulatory Surgery Facilities International AAAASFI American Association for Accreditation of Ambulatory Surgery Facilities International Outpatient facilities
Temos Temos Temos Medical Tourism
Verified Internet Pharmacy Practice Sites VIPPS 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

Name
Accreditation Canada ACANADA Accreditation Canada
Australian Council of Healthcare Standards ACSHI Australian Council of Healthcare Standards
Joint Commission International JCI Joint Commission International
QHA Trent QHA QHA Trent

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 text-normals 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

Name International or Local General or Specific About
International General Independant and not-for-profit. Accredits a wide range of medical facilities, from large hospitals to small clinics. Mostly accredits within Canada, but accredits many international facilities as well.
International Outpatient facilities Not-for-profit accrediting organization for outpatient facilities. US-based, but accredits facilities worldwide.
International General Ensures facilities conform to Australian National Safety and Quality Health Service (NSQHS) Standards.
The United Kingdom General Mandatory for all hospitals and healthcare providers in the UK, both public and private.
International General UK-based specialist provider of healthcare accreditation and certification programmes working in the UK and across Europe; accredited to ISQua and ISO 17021 standards. Accreditation programs are tailored for all types of healthcare provision from acute hospitals and their specific services such as radiotherapy and maternity to care homes and hospices.
International General By far the most well-known, prestigious, and expensive international accreditation agency. Based out of the United States but accredits hundreds of facilities across the world.
Germany General KTQ is a German accreditation system which is optional in Germany, and has recently (since 2013) started to branch outside to facilities in Austria, China, and the Republic of Georgia.
Malaysia General Non-profit NGO responsible for advocating, promoting, and supporting continuous quality improvements and safety in Malaysian healthcare arena.
India General Accredits a wide range of health care facilities in India.
International General Based in the United Kingdom, mission is to provide an expert-led, evidence-based, reasonably priced and transparent accreditation scheme.
International Medical Tourism Accepts facilities that have already been accredited by a major agency and focuses on their medical tourism specific services and procedures.
The United States of America Online pharmacies Optional accreditation for US American pharmacies that sell prescription drugs online.

References:


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.