Standards › ASF Health Standards v10 › Standard 24
Standard 24
Medical Tourism
Medical tourism: written cost estimates, records sent home, language access, logistics, post-return tracking, travel documents, complaints, verified agents, infection risk and travel timing after procedures.
International patients receive a complete, written, all-inclusive cost estimate before travel is booked — covering the procedure, hospital stay, and commonly needed extras — not a partial quote that grows once the patient has already committed to travelling.
Why it matters. International patients who receive a low estimate and then a much larger bill abroad feel cheated and may not get the care they expected. A full written estimate before travel protects both sides.
How the surveyor verifies this criterion
Sample. Review 5 written estimates against the final bills for international patients.
1. A complete written estimate is given before travel is booked.
Method. Check each sampled patient for the estimate and its date before booking.
Evidence to show. Written all-inclusive cost estimate (MTR-FRM-001).
Pass when. Every sampled patient has the estimate before booking.
2. The estimate covers the procedure, the stay and the common extras.
Method. Check each estimate for the three items.
Evidence to show. Written all-inclusive cost estimate (MTR-FRM-001).
Pass when. Every estimate covers the three items.
3. The final bill matches the estimate.
Method. Compare each final bill against its estimate.
Evidence to show. Price transparency policy (HOS-POL-003).
Pass when. No final bill exceeds its estimate without a written agreement.
Immediate fail (any one means the criterion is not met)
- A patient is charged three times the estimate on arrival.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
A complete, usable record of the care provided is transferred to the patient’s home-country physician, in a format that physician can use — not a discharge summary that stays in the treating facility’s own system.
Why it matters. A patient who goes home needs a record that the doctor at home can use. A record that is incomplete, or in a language the doctor cannot read, causes repeated tests and missed treatment.
How the surveyor verifies this criterion
Sample. Review 5 records transfers with the consent form, anonymised.
1. A complete record of care is sent to the home-country physician.
Method. Check each sampled transfer for the record sent.
Evidence to show. Records transfer summary (MTR-FRM-002).
Pass when. Every sampled patient has a record sent to the home physician.
2. The record names the drugs and doses given.
Method. Check each summary for the drugs and doses.
Evidence to show. Records transfer summary (MTR-FRM-002).
Pass when. Every summary names the drugs and doses given.
3. The patient consents to the transfer.
Method. Check each record for the consent.
Evidence to show. Records transfer summary (MTR-FRM-002).
Pass when. Every transfer has the patient consent recorded.
Immediate fail (any one means the criterion is not met)
- A patient is sent home with a summary that names no drug or dose.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
Foreign patients have access to a competent interpreter for consent, treatment discussions, and discharge instructions — not an ad hoc arrangement using whichever staff member happens to speak some of the patient’s language.
Why it matters. A foreign patient who cannot understand the consent or the discharge instructions cannot take part in their own care. A competent interpreter is needed for these moments, not a relative or a child.
How the surveyor verifies this criterion
Sample. Review the interpreter procedure and 5 consent records showing the interpreter.
1. A competent interpreter is used for consent.
Method. Check each sampled consent record for the interpreter named.
Evidence to show. Interpreter use record (MTR-FRM-003).
Pass when. Every consent for a foreign patient uses a competent interpreter.
2. Consent is given in a language the patient reads.
Method. Check each record for the language the patient reads.
Evidence to show. Interpreter use record (MTR-FRM-003).
Pass when. Every consent is given in a language the patient reads.
3. The interpreter is used for treatment discussions and discharge.
Method. Check the records for the interpreter at each discussion.
Evidence to show. Language access and interpreters (MTR-POL-002).
Pass when. At least 95% of discussions show the interpreter used.
Immediate fail (any one means the criterion is not met)
- A patient signs consent in a language they do not read.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
The facility provides or coordinates support for travel and accommodation logistics around the procedure — not leaving an international patient, often recovering from treatment, to navigate this entirely alone in an unfamiliar country.
Why it matters. A patient who has to arrange their own travel and hotel after surgery may be left stranded. The facility does not have to do everything, but it must support the patient with the logistics.
How the surveyor verifies this criterion
Sample. Review the logistics coordination record for 5 patients.
1. Travel and accommodation are provided or coordinated for each international patient.
Method. Check each sampled patient for the arrangements recorded.
Evidence to show. Logistics coordination register (MTR-REG-001).
Pass when. Every sampled patient has arrangements recorded.
2. Transport home is confirmed before discharge.
Method. Check each record for the transport home and its date.
Evidence to show. Logistics coordination register (MTR-REG-001).
Pass when. Every patient has transport home confirmed before discharge.
3. The arrangements are recorded with who arranged them.
Method. Check each record for the arranger.
Evidence to show. Logistics coordination register (MTR-REG-001).
Pass when. Every arrangement has the arranger recorded.
Immediate fail (any one means the criterion is not met)
- A patient is discharged with no transport home.
Documents
E-learning
References
- World Health Organization. Framework on integrated people-centred health services. Geneva: WHO; 2016.
The facility actively tracks what happens to international patients after they return home — including complications discovered by a home-country physician — not just relying on a generic follow-up call that a satisfied patient may not bother answering.
Why it matters. A complication that appears after the patient flies home may never reach the clinic that treated them. Tracking what happens after return is how the clinic learns, and how the patient is helped.
How the surveyor verifies this criterion
Sample. Review the post-return follow-up log for 5 patients, with complications recorded.
1. Each international patient is tracked after return home.
Method. Check each sampled patient for follow-up contacts after return.
Evidence to show. Post-return follow-up log (MTR-REG-002).
Pass when. Every sampled patient has follow-up recorded after return.
2. Complications found by a home-country physician are recorded.
Method. Check the log for any complication reported by the home physician.
Evidence to show. Post-return follow-up log (MTR-REG-002).
Pass when. Every complication reported is recorded.
3. The action taken is recorded.
Method. Check each complication for the action and who was told.
Evidence to show. Post-return follow-up log (MTR-REG-002).
Pass when. Every complication has an action recorded.
Immediate fail (any one means the criterion is not met)
- A patient has a wound infection after return and no record at the clinic.
Documents
E-learning
References
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705
The facility provides the specific documentation international patients need to support their travel, correctly and promptly — not generic paperwork that leaves the patient to figure out what is required themselves.
Why it matters. An international patient often needs letters and forms to travel, such as a fitness-to-fly letter. Wrong or missing documents can stop them from flying home.
How the surveyor verifies this criterion
Sample. Review the travel document list by destination and 5 issued documents, anonymised.
1. The document list is kept by destination.
Method. Check the list for each destination the clinic serves.
Evidence to show. Travel documentation by destination (MTR-POL-003).
Pass when. Every destination served has a document list.
2. The documents needed are issued correctly and in time.
Method. Check each sampled patient for the documents issued before travel.
Evidence to show. Travel document issued record (MTR-FRM-004).
Pass when. Every sampled patient has documents issued in time.
3. A fitness letter is issued where the patient needs one to fly.
Method. Check each flying patient for the fitness letter.
Evidence to show. Travel document issued record (MTR-FRM-004).
Pass when. Every flying patient who needs one has a fitness letter.
Immediate fail (any one means the criterion is not met)
- A patient is unable to fly because the fitness letter was missing.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
International patients have access to a complaint and redress process reachable from their home country, with evidence complaints are addressed — not a process that functionally only works for a patient still physically present in the country.
Why it matters. A foreign patient who is harmed has no easy way to complain from home, and may have no route to redress. A complaint process reachable from abroad closes that gap.
How the surveyor verifies this criterion
Sample. Review the international complaint log for the last 12 months, with the route and the response time.
1. An international complaint route is available from the patient’s home country.
Method. Check the route published, with contact details and response time.
Evidence to show. International complaint log (MTR-REG-003).
Pass when. The route is published with contact details and a response time.
2. Each complaint from abroad is logged and responded to within the set time.
Method. Check each complaint for the response date.
Evidence to show. International complaint log (MTR-REG-003).
Pass when. At least 95% of complaints are responded to within the set time.
3. The complaint is addressed, with the outcome recorded.
Method. Check each complaint for the outcome.
Evidence to show. Complaints and feedback (INC-POL-002, existing, reused).
Pass when. Every complaint has an outcome recorded.
Immediate fail (any one means the criterion is not met)
- A complaint from abroad is left unanswered for months.
Documents
E-learning
References
- World Health Organization Regional Office for Europe. Declaration on the Promotion of Patients’ Rights in Europe. Copenhagen: WHO Regional Office for Europe; 1994.
Any third-party medical tourism facilitator or agent the facility works with is verified and held to a defined standard of conduct — not an unregulated intermediary operating without any accountability to the facility or the patient.
Why it matters. A facilitator or agent who brings patients to a clinic may promise things the clinic cannot deliver, or take money without a service. The clinic is responsible for who it works with.
How the surveyor verifies this criterion
Sample. Review the list of verified agents with their written agreements and the yearly verification record.
1. Each facilitator or agent is verified before referrals.
Method. Check each agent for the verification date before the first referral.
Evidence to show. Verified agents register (MTR-REG-004).
Pass when. Every agent is verified before its first referral.
2. Each agent works under a written agreement with a standard of conduct.
Method. Check each agent for the signed agreement.
Evidence to show. Facilitator and agent standard (MTR-POL-004).
Pass when. Every agent has a signed agreement.
3. Each agent is verified again each year.
Method. Check each agent for the yearly verification.
Evidence to show. Verified agents register (MTR-REG-004).
Pass when. Every agent has a current yearly verification.
Immediate fail (any one means the criterion is not met)
- An agent charges patients a fee the clinic never agreed.
Documents
E-learning
References
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705
International patients are assessed for travel-associated infection risk specific to their journey and country of origin, with appropriate screening and precautions applied — not treated identically to a local patient with no recent travel history.
Why it matters. Patients who travel from another country can bring infections, such as measles or TB, and can catch some from the clinic. Assessing the risk for their journey and country protects both them and the local patients.
How the surveyor verifies this criterion
Sample. Review 5 completed travel infection risk assessments, anonymised.
1. Each international patient is assessed for travel-associated infection risk.
Method. Check each sampled patient for the completed assessment.
Evidence to show. Travel infection risk assessment (MTR-FRM-005).
Pass when. Every sampled international patient has an assessment.
2. The screening and precautions match the journey and the country of origin.
Method. Check each assessment for the screening and precautions against the journey.
Evidence to show. Travel infection risk assessment (MTR-FRM-005).
Pass when. Every assessment has screening and precautions matched to the journey.
3. The precautions are applied and recorded.
Method. Check each assessment for the precautions recorded as applied.
Evidence to show. Travel infection risk assessment (MTR-FRM-005).
Pass when. Every assessment records the precautions applied.
Immediate fail (any one means the criterion is not met)
- A patient with active TB is admitted with no assessment.
Documents
E-learning
References
- World Health Organization. WHO consolidated guidelines on tuberculosis: module 2, screening. Geneva: WHO; 2021.
- World Health Organization (2016). Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level. Geneva: WHO. https://www.who.int/publications/i/item/guidelines-on-core-components-of-infection-prevention-and-control-programmes-at-the-national-and-acute-health-care-facility-level
Every international patient receives a specific, documented discussion of safe travel timing after their procedure — including the elevated blood clot risk from combining recent surgery with air travel — not a general assumption that the patient will figure out when it is safe to fly home.
Why it matters. After some procedures, a long flight raises the risk of a blood clot. A patient who is not told when it is safe to fly can travel too soon and be harmed.
How the surveyor verifies this criterion
Sample. Review 5 written travel timing discussions after a procedure, anonymised.
1. Each international patient has a documented discussion of safe travel timing.
Method. Check each sampled patient for the timing discussion recorded.
Evidence to show. Post-procedure travel timing record (MTR-FRM-006).
Pass when. Every sampled international patient has the discussion recorded.
2. The blood clot risk from surgery combined with air travel is explained.
Method. Check each record for the explanation.
Evidence to show. Post-procedure travel timing record (MTR-FRM-006).
Pass when. Every record shows the blood clot risk explained.
3. The advice is given in writing.
Method. Check each record for the written advice.
Evidence to show. Post-procedure travel timing record (MTR-FRM-006).
Pass when. Every patient is given the advice in writing.
Immediate fail (any one means the criterion is not met)
- A patient flies the day after surgery with no advice.
Documents
E-learning
References
- National Institute for Health and Care Excellence (NICE). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. NG158. London: NICE; 2020.
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