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Costa Rica has 2 of Top 20 Latin American Hospitals for Medical Tourism

By Keith Macartney / May 21st, 2013 / No Comments


Airport lounges in the United States, Canada and other countries are filling-up with a new type of traveler: the medical tourist. Increasingly more people with and without health insurance or socialized medicine are grabbing their bags and traveling to other countries for medical treatment that better fits their budgets. Many travel thousands of miles to Asia and Europe as their destinations of choice. Let’s face it, medical tourism is on the rise, and besides the patient, Costa Rica is one of the major benefactors.

1But why have such a few, in terms of total percentages of medical tourism, not even considered Latin America over some of these other higher-cost, further distance destinations?
It pretty much comes down to a lack of good information and lingering misconceptions.
Too many foreigners still think of Central and South America as just a source for dengue fever or malaria. Many still have the perception that Latin American health care is not as good as that of their own country.

So América Economia Intelligence launched an in-depth and scientific investigation on getting to know the major hospitals in Latin America and to understand which ones offer the best quality standards in their management, facilities, specialties and medical services to their patients. The result is the first comprehensive study on the quality of clinics and hospitals in Latin America based on International standards and qualify of healthcare.

2America Economia worked for several months with a panel of experts to design a methodology to assess the quality of medical facilities, specifically those designated multipurpose high complexity -or- those best suited for the medical vacation tourist due to an infrastructure for several medical specialties under one roof. With information provided by ministries of health of 10 countries in the region, together with other international institutions, a sample of 180 hospitals and clinics were invited to participate by opening the secrets of their internal management teams to America Economia researchers.

The final list of 20 best Latin American hospitals and clinics were each evaluated in several different dimensions.

One of the most important dimensions was hospital safety. According to experts; the quality models discussed and the ability of an institution at minimizing risk within the complexity of its operations is the basis for quality management.

3Clinica Biblica of CostaRica was ranked #5 in 2009 Top Latin America Hospitals & Clinics.. Also relevant was a hospital’s processes that reduce risks such as; existence of proper procedures for registration, management and transparency of health information and the perception of patients (such as satisfaction surveys). The systematic application of good practices and the availability of professionals in emergency shifts along with the measured presence and frequency of meetings of ethics committees are also important deciding factors being as such entities are responsible for ensuring the dignity of patients.

Another dimension analyzed for each hospital was the human factor. It is no mystery that many patients choose a doctor rather than the institution where they will meet, because they understand the importance of occupational health in the care they receive.

5That is why America Economia Intelligence decided to include training of doctors in each hospital or clinic in the ratings. This was no easy task in that this type of data not readily available at a majority of Latin American hospitals and clinics.

However, information obtained did show: 91.4% of physicians of the 20 top Latin American hospitals and clinics have at least one specialty, 32.4% have a sub-specialty and 1.9% have two or more sub-specialties.

When it comes to Latin American doctors who practice specialized medicine; 9% of physicians with a sub-specialty, 15.7% of those with two specialties, and 84% of those with three or more specialties studied in the most prestigious medical universities in the United States and Europe.

Methodology of Ranking Hospitals and Clinics

In order to make a first selection of hospitals and clinics to be studied, América Economia consulted with the Ministries of Health of nine countries (Argentina, Brazil, Colombia, Costa Rica, Cuba, Chile, Mexico, Peru and Venezuela) regarding which facilities, through their quality characteristics, local prestige and variety of medical benefits, should be seen as the best in each country.

6Hospital San Rafael de Alajuela of CostaRica was ranked #20 in 2009 Top Latin America Hospitals & Clinics.

America Economia then contrasted the preliminary list with various sources of classified information, such as Joint Commission International (JCI), in addition to accreditation schemes or national quality studies in Argentina, Brazil, Colombia and Chile.

A sample of over 180 hospitals and clinics where sent a questionnaire requesting specific data for comparison. After which, a second questionnaire was sent to 31 institutions with more specific questions.

Nearly 700 professionals voted regarding the prestige of the hospitals and clinics, the prestige of the health systems of the nine countries and their views about the factors that affect hospital quality.

This process received the support of an international panel of leading experts in hospital management and public health specialists who made contributions in the preparation of the conceptual framework, methodological design and performance analysis strategy of this ranking. Their work did not affect the outcome of the study, nor had access to the information provided by hospitals and clinics.

The final ranking was defined through the weighted sum of seven dimensions:

  1. Patient Safety and Dignity: 20%
  2. Human Capital: 20%
  3. Knowledge Management: 15%
  4. Capacity: 15%
  5. Efficiency: 10%
  6. Prestige: 20%

1) Patient Safety and Dignity: The set of conditions which encompasses a hospital or clinic that can provide guarantees that their patients receive the best attention, care and respect possible.

  • Ethics Committee: weighted according to the existence and operation of an agency dedicated to thinking and deciding about cases where disputes arise regarding ethical medical treatment of patients.
  • Accreditation of hospital quality: the organizations were evaluated under the possession of accreditation, weighted according to their prestige, being the order: JCI, ISO and other international and national accreditations.
  • Best practices and protocols: a weighted sum of an index of best practice, including a relevant set of actions undertaken systematically by a hospital or clinic, and an index of protocols for inpatient care, aimed at establishing security processes of patients.
  • Registration and medical information management: a weighted sum of the information management practices that help minimize errors and improve knowledge of the activities in each hospital or clinic, such as hospital records, error logs, medical records and others.
  • Emergencies: systems were weighted according to the treating clinician, assessing their composition (doctors, nurses and assistants) in different shifts: morning, afternoon, evening and watch.
  • Nosocomial infections: a weighted sum according to the existence and operation of a dedicated body to control and minimize hospital-acquired infections, along with infection rates provided by the institutions and corrected in relation to the average rates of those hospitals and clinics in the study accredited by Joint Commission International (JCI).
  • Transparency: weighted sum associated with the publication, on websites or institutional memory of key information from hospitals and clinics, such as adverse clinical events, financial data and costs and prices.

2) Human Capital: This includes readiness by a hospital or clinic qualified health professionals and excellence for hospital compliance with the task. That they are understanding and applying the right skills for diagnosis and treatment of patients.

  • Medical education: considering the medical education campus, both undergraduate majors and/or graduate degree, as lifelong learning.
  • Percentage of full time doctors: those working days of 6 or more hours.
  • Percentage of full time nurses: those working days of 6 or more hours and the prevalence of registered nurses in different shifts (morning, afternoon, evening and watch).

3) Knowledge Management: Includes activities a hospital or clinic utilizes to both generate or obtain medical knowledge from outside the facility for continued education of the staff.

  • Generating knowledge: weighted sum of data such as availability and budget of a department of teaching and research, the number of ISI publications or the existence of a genetic counseling department.
  • Obtaining knowledge: weighted sum of the existence of affiliations to universities and other mechanisms for obtaining knowledge.
  • Dissemination of knowledge: weighted sum of the services by which the hospital or clinic provides medical knowledge to their roster, such as printed media or intranet, in addition to many titles and subscriptions gotten by the library of each institution.bigstock-Medical-still-life-with-stetho-21186317

4) Capacity: Applies to those features that make a hospital or clinic work such as amplitude, load, number of specialties and its ability to handle complexity. This also includes the ability of care and hospitality for international patients.

  • Size: sum weighted index numbers that show the relative bearing of each hospital or clinic, such as total discharges, average length of hospitalization and other parameters of the general infrastructure.
  • Medical Diversity: weighted sum of the amounts of specialties offered by a hospital or clinic.
  • Operating Room: Measuring the ratio between operating rooms and expenditures since surgery.
  • Laboratories: sum of all laboratory tests provided by the institutions.
  • Emergencies: weighted sum of the number of surgical discharges, according to emergency unit: Adult, Pediatric and Neonatal.
  • Medical support services: a weighted sum of the existence of units such as Dialysis, Nutrition, Psychology, Oncology, Transplant, Pharmacies, Laboratories.
  • Attention: weighted sum relationship such as medical care expenditures or nurse expenses.
  • Other services: weighted sum of the aspects that make the stay more comfortable for the patient and their attendants, for example; room extras, bed booking service, travel medical unit, or staff with language skills and other services.

5) Efficiency: It is for this aspect of managing a hospital or clinic, which aims to adopt practices that ensure a quality hospital makes rational use of resources. This also includes basic financial assessment of these entities, regarded as enterprises.

  • Hospital efficiency: a weighted sum of basic indicators such as cost per discharge, existence and operation of a quality management department, percentage bed occupancy and operating rooms, and development of medicine by evidence.
  • Good management practices and digital development: including developments in these areas over the past 5 years.
  • Financial Efficiency: weighted sum of results: average return (2007-2008), increased liquidity (2007 and 2008), variation in sales (2007-2008), debt reduction (2007-2008), variation of EBITDA (2007 — 2008), and profitability per employee (2008).

6) Prestige: Survey results of physicians on the most prestigious hospitals and clinics. These are both internationally ranked and ranked as Latin America facilities weighted by the country of origin of the survey participant.

  • Survey of international prestige
  • Survey of Latin American prestige
  • Country Factor

Costa Rica obtained the distinction of having two hospitals make the 2009 Top 20 Latin American Hospitals and Clinics list … private Hospital Clinica Biblica in San José and public CCSS Hospital San Rafael in Alajuela, near the Juan Santamaria International Airport.