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The continuum of care (e.g., ongoing communication between a primary care physician and a specialist or another primary care provider in another location) is an important aspect of healthcare that is not well researched when a patient travels across an international border. Interventions to attempt to reduce the lack of fidelity in communication and standards between regional providers have often resulted in positive outcomes for patients including: 1) reductions in emergency department visits; 2) reductions in hospitalizations; and 3) reductions in readmission rates (Anonymous, 2013). In addition, the American Hospital Association (AHA, 2018) found better care coordination across a state could increase the percentage of acute stroke patients who received correct and timely care protocols by 50 percent over a four (4) year period. However, more data is needed to either support the positive results from using proper & systematized cross border communication, reporting, and protocols; or support that there is a negative impact on health outcomes resulting from the lack of these standards.
A fairly common example of the problems with discontinuity in communication and reporting between pre-and-post movement health communications is when a medical tourist (roughly defined as a person traveling for ‘value’ by going outside of their region or country for a health procedure) travels for care. Often, these patients may be seeking access to a specific healthcare procedure, which will deliver acceptable medical standards/protocols/measures, and is offered at what a patient perceives is a reasonable price (Vequist & Valdez, 2009). There is very little evidence, in the literature, about what type of impact these behaviors had on patients’ healthcare outcomes or how the travel effected their health status.
Another example of problems with the continuum of care is when an immigrant enters a new country and receives healthcare in the destination from a doctor who is not familiar with their individual medical history. Obviously this could have a significant disruptive impact on the patient’s overall health. As Lunt and colleagues (2011) suggest “When medical treatment is sought from abroad, the normal continuum of care may be interrupted.” Therefore it is important to analyze empirical information on how this movement across borders impacts patient health outcomes. For example, a small sample size (n = 24) study analyzing English patients (WHO, 2011), who were treated in Germany, showed a “somewhat mixed picture of the quality of follow-up care” with ten (10 or 41.6 percent) of the patients rating their after-care as “unsatisfactory” and four (4 or 16 percent) who reportedly did not receive any after-care at all (Wismar, et al., 2011).
This research will look at the role that cross border movement plays on healthcare by analyzing a large data set of potential patients who traveled from one country to another and how this behavior impacted their health. This will add to the body of knowledge on this subject, which is little understood. For example, Lunt and colleagues (2011) stated that “There is scant evidence on long- or short-term follow-up of medical tourists who return to their home countries following treatments at a range of destinations.” In an article evaluating domestic patients, of which 40 percent traveled outside of a region for medical treatments, an article in Rand Health Quarterly by Price et al. (2013) found that “More attention needs to be given to understanding the regional burden of disease, patient flows across geographic borders, and regional capacity for cancer care.” Finally, according to Durham and Blondell (2017), in an analysis of 57 academic papers on medical tourism, they found that “There was very limited evidence… in what circumstances this cross-border patient movement impacts the health and the continuum of care of those who travel and the broader health systems.”