While you may be unable to choose which hospital treats you in an emergency, you can usually select a facility for scheduled procedures, treatments, and ongoing care. Growing research shows significant variations in costs and the quality of care delivered between different hospitals and surgery centers. This section guides you through selecting a treatment facility.
Patient Story – (The story is true; the patient’s and provider’s names have been changed.)
Erika was told by her doctor that their hernia surgery should be performed at a local hospital. After exploring the possibility of a less invasive surgery, the patient found a surgeon and a surgery center experienced in the less invasive technique. The patient underwent surgery at a local surgery center at half the cost and was home recovering the same afternoon as the surgery.
Understand Your Options
Before you start researching facilities, understand the type of test, procedure, treatment, or care you need. Discuss this thoroughly with your doctor. If your test, procedure, or treatment requires hospitalization, check with your doctor and research if hospitalization is the only option.
Today, many tests, treatments, and procedures that used to require hospitalization are safely and effectively done in same-day surgery and specialty treatment centers. Additionally, ask your doctor if there are non-surgical alternatives available. For major illnesses or surgeries, getting a second opinion is highly recommended and sometimes required by insurance companies.
If your condition requires specialized treatment and care, ask your insurance provider what is needed to get approval for the specialty facility you want to use. Then, determine how much you would be responsible for paying out of pocket if you visit a hospital in your plan or one that is not in your plan.
Questions to Ask Before Choosing a Facility
Crucial Question: Does the facility have experience and positive outcomes with your condition, treatment, and/or surgery?
Other Questions
- Is the facility covered (in-network) by your health insurance plan? Contact your insurance provider to confirm coverage and understand out-of-pocket costs.
- What are the facility’s performance measures for infection control?
- What do they do to minimize infections?
- How often is the procedure performed at the facility? Facilities with higher volumes often have better success rates, as “practice makes perfect.”
- Is the facility highly rated by the state, consumer groups (e.g., Leapfrog Group), or other organizations?
- Is the facility accredited by a nationally recognized body, such as The Joint Commission or the American College of Surgeons (ACS)?
- Has the facility received awards from professional or recognized groups?
- Does your doctor have admitting privileges at the facility?
- What are the facility’s and your doctor’s success rates for the procedure?
- Does the facility actively work to improve its quality of care?
- Does the facility explain and respect patient rights and responsibilities? Are these available in writing?
- What is the patient-to-nurse ratio? Lower ratios may indicate more personalized care.
- Does the facility offer support services, social workers, and resources to help with financial assistance if needed?
- Is the facility conveniently located for you and your family?
Tip: You can call the billing department at the hospital or surgery center you are considering, to find out:
- What they charge for your surgery
- If they accept your insurance company’s payment as the entire payment.
- How much of the fees will you be responsible for?
- What payment options are available?
If you are using Medicare, the Medicare website offers a free guide and checklist to help you choose a hospital. It can be found online at: https://www.medicare.gov/Pubs/pdf/10181.pdf.
Medicare recommends that you take the following steps:
- Learn about the care that you need and your hospital choices.
- Consider your personal and financial needs.
- Find and compare hospitals based on their experience and success in treating your condition and addressing your specific needs.
- Discuss your hospital options and choose a hospital.
Investigating Hospital Quality and Safety
Accreditation
The Joint Commission is an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. Joint Commission accreditation and certification are recognized nationwide as symbols of quality that reflect an organization’s commitment to meeting certain performance standards. The Joint Commission also provides the public with information on selecting a treatment facility and prepares a performance report for each hospital it surveys. The report lists:
- Accreditation status (six levels—from the lowest, “Not Accredited,” to the highest, “Accredited with Commendation”).
- Date of the survey.
- Evaluation of the key areas reviewed during the survey.
- Results of any follow-up activity.
- Areas needing improvement.
- Comparison with national results.
You can order The Joint Commission’s performance reports free of charge by calling 630-792-5800. Or, online at https://www.jointcommission.org/.
Other Resources for Hospital Report Cards
- Quality Check™: Utilize their online service to verify accreditation status and review performance reports. Online at www.qualitycheck.org
- Performance Reports: Order free reports by calling 630-792-5800. These reports include accreditation status, survey dates, evaluations of key areas, and areas needing improvement.
- Medicare.gov: The official U.S. government site for Medicare offers a Hospital Compare tool with detailed information on the performance of Medicare and Medicaid-certified hospitals. Online at www.medicare.gov/hospitalcompare
- Guide and Checklist: https://www.medicare.gov/Pubs/pdf/10181.pdf
- U.S. Department of Health & Human Services: Provides information and ratings on hospitals’ care for specific medical conditions and surgical procedures. Online at www.hospitalcompare.hhs.gov
- The Leapfrog Group: A non-profit organization that focuses on patient safety. Online at www.leapfroggroup.org
- U.S. News & World Report: Publishes an annual “America’s Best Hospitals” report. Online at http://health.usnews.com/best-hospitals
- AHRQ (Agency for Healthcare Research and Quality): Provides guidance and worksheets for selecting hospitals and long-term care facilities. Online at http://archive.ahrq.gov/consumer/qnt/qnthosp.htm#sources
- The Commonwealth Fund: A private foundation that provides hospital performance data. Online at http://www.whynotthebest.org/
Has the Hospital Been Successful with My Condition?
Research indicates that hospitals that perform a wide range of similar procedures tend to achieve better outcomes with them. In other words, “practice makes perfect.” Ask your doctor and the hospital:
- The frequency of procedures, treatments, or tests performed at the treatment facility each month or year.
- The facility’s success rate.
- The number of procedures your doctor has done at the facility.
- The doctor’s success rates.
Financial and Insurance Considerations
Contact your health insurance provider to get a list of in-network hospitals. Understand your out-of-pocket costs, including co-pays, deductibles, and co-insurance, for both in-network and out-of-network facilities. When you require specialized treatment at a facility outside your network, inquire with your insurance provider about the approval process. Ensure your insurance covers more than just the hospital, including doctors, emergency rooms, emergency room specialists, and ambulances.
Hospital Billing Department
Contact the billing departments of the hospitals you are considering to learn the costs of your recommended tests and procedures. Confirm whether the hospital accepts your insurance company’s payment as full payment and inquire about payment options if needed.
Ambulatory Surgery and Specialty Centers (ASCs)
Many tests, treatments, and procedures that once required hospitalization can now be safely and effectively performed in these settings. ASCs provide same-day surgery where you stay for a few hours or up to one night.
Important Questions
- Is the facility licensed and accredited? You can also check accreditation for SCs through The Joint Commission or the Accreditation Association for Ambulatory Health Care (AAAHC). Online at www.jointcommission.org
- Is the facility’s clinical and administrative staff well-trained and experienced?
- How many procedures like yours has the facility performed in the last 12 months?
- If the center is not affiliated with a hospital, how will they handle emergencies?
- Does your health insurance include the facility in its network?
Getting Treatment Overseas
Medical tourism has become increasingly popular as patients seek high-quality, affordable healthcare options abroad. This guide provides recent information on overseas medical treatment, highlighting key points for patients and caregivers to consider.
Cost Savings
The primary driver for medical tourism is significant cost savings, often ranging from 20% to over 50% compared to U.S. prices. For example:
- Angioplasty costs approximately $55,000 to $57,000 in the U.S., compared to $2,500 to $3,500 in Malaysia.
- Heart bypass surgery costs approximately $10,000 in India, compared to $94,277 (insured cost) or $210,842 (retail price) in the U.S.
- Knee replacement costs approximately $8,500 in India, compared to $30,358 (insured cost) or $69,991 (retail price) in the United States.
Popular Destinations
Leading countries for American medical tourists include:
- Mexico (most common)
- Canada (most common)
- Thailand
- India
- Singapore
- Brazil and Argentina (especially for cosmetic procedures)
- Panama (emerging destination with U.S.-affiliated hospitals)
Quality of Care
Many overseas hospitals offer high-quality care comparable to or exceeding U.S. standards. For example:
- Bumrungrad International Hospital in Thailand treats over 400,000 foreigners annually.
- Apollo Hospitals and Wockhardt Hospitals in India often surpass the average U.S. community hospital in quality.
- Some facilities are affiliated with renowned U.S. institutions, such as Johns Hopkins International’s partnership with Hospital Punta Pacifica in Panama.
Famous U.S. Hospitals with Foreign Affiliates
- The Cleveland Clinic owns facilities in Canada, Vienna, Austria, & Abu Dhabi.
- Johns Hopkins International is affiliated with Punta Pacifica in Panama City.
- Johns Hopkins International is affiliated with the International Medical Center in Singapore.
- International Hospital Corp. (Dallas) is building several hospitals in Mexico.
Accreditation and Quality Assurance
To ensure quality, look for hospitals accredited by the Joint Commission International (JCI). They have accredited over 120 foreign hospitals. The International Organization for Standardization (ISO) can also be a good resource.
Risks and Considerations
Before pursuing medical tourism, consider the following:
- Legal recourse may be limited in case of malpractice.
- Follow-up care and potential complications should be planned for in advance.
- Communication barriers may exist if you do not speak the local language.
Planning Your Medical Tourism Trip
Research everything thoroughly and take the following steps:
- Investigate the qualifications of your chosen clinician and the hospital or facility credentials.
- Obtain international travel health insurance that includes coverage for medical evacuation.
- Schedule a pre-travel consultation with your healthcare provider or a travel medicine specialist.
- Arrange for follow-up care before traveling.
- Consider using a medical travel intermediary to help with research and arrangements.
Medical tourism can offer significant cost savings and access to high-quality care for many procedures. However, careful planning and consideration of potential risks are essential. By thoroughly researching options and preparing adequately, patients can make informed decisions about seeking treatment overseas.
For additional information about choosing a hospital, you can use the Guide to Choosing a Hospital by the Centers for Medicare & Medicaid Services at https://www.medicare.gov/Pubs/pdf/10181.pdf, or any of the following articles:
Dr. You 
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