International privacy practices and recommendations for medical tourism stakeholders

As the Medical Tourism Magazine article, Legal Issues Traveling with Privacy Protection, states, "Adding to the complexity of national variation is the fact that some countries or regions have laws that are intended to limit the transfer of personal information outside of their borders. Factors like these make the explanation of privacy protection abroad a complicated endeavor." This complexity needs awareness from all parties involved in international healthcare decisions.

How medical tourism providers address HIPAA

1. Voluntary HIPAA compliance

Some foreign healthcare facilities, particularly those targeting American patients, have voluntarily adopted HIPAA compliant practices. While not legally required to do so, these facilities implement HIPAA-like protections to reassure American patients about the security of their health information.

Voluntary compliance can include:

• Implementing robust physical, technical, and administrative safeguards
• Providing patients with privacy notices similar to those required by HIPAA
• Training staff on privacy and security protocols
• Establishing breach notification procedures

For instance, Bumrungrad International Hospital in Bangkok, Thailand, has voluntarily adopted practices aligning with HIPAA standards to protect patient health information. While not legally bound by U.S. HIPAA regulations, Bumrungrad has implemented robust physical, technical, and administrative safeguards, provides patients with privacy notices akin to those required by HIPAA, trains staff on privacy and security protocols, and has established breach notification procedures. These measures are designed to reassure American patients about the security of their health information when seeking medical care abroad.

2. International accreditation

Many foreign healthcare facilities seek accreditation from organizations such as Joint Commission International (JCI), which evaluates facilities against international standards that include privacy and security considerations. While not identical to HIPAA compliance, these accreditations signal a commitment to recognized best practices in healthcare delivery, including information protection.

3. Medical tourism facilitators as business associates

Medical tourism facilitators—companies that help patients arrange care abroad—often serve as intermediaries between American patients and foreign providers. When these facilitators are based in the United States or work with U.S. healthcare entities, they may be considered business associates under HIPAA, requiring them to comply with applicable provisions.

These facilitators can play a role in bridging the regulatory gap by:

• Implementing HIPAA compliant practices for handling patient information
• Selecting foreign providers with strong privacy protections
• Educating patients about privacy considerations
• Facilitating secure information exchange between U.S. and foreign providers

Learn more: What does it mean to be a business associate?

The economic impact of HIPAA on medical tourism

HIPAA regulations create economic implications for the medical tourism industry that affect both patients and providers:

1. Compliance costs for international providers

Foreign healthcare facilities seeking to attract American patients often invest in privacy and security measures that align with HIPAA standards. These investments include:

• Technology infrastructure for secure data management
• Staff training on privacy practices
• Development of policies and procedures
• Ongoing compliance monitoring

These costs can be substantial, particularly for facilities in developing nations. However, they represent a necessary investment for providers seeking to compete in the lucrative American patient market.

2. Market differentiation

Some international healthcare providers have turned HIPAA considerations into a competitive advantage. By prominently advertising their HIPAA-aligned practices, these facilities differentiate themselves from competitors and potentially command premium prices from privacy-conscious American patients.

This market differentiation has led to the emergence of tiers within the medical tourism industry, with some facilities specifically positioned as "HIPAA-friendly" options for American patients.

3. Patient decision-making factors

For American patients, HIPAA considerations can influence the medical tourism decision-making process. Privacy concerns may lead patients to:

• Select destinations with stronger privacy protections, even if more expensive
• Budget for additional expenses related to securing records transfer
• Limit the information shared with foreign providers
• Choose providers with U.S. affiliations or accreditations

These factors can redirect patient flows, benefiting some medical tourism destinations while disadvantaging others.

The American Medical Association (AMA) explains in its Ethical and Judicial Affairs Report that while "many medical tourists receive excellent care, issues of safety and quality can loom large. Substandard surgical care, poor infection control, inadequately screening of blood products, and falsified or outdated medications in lower income settings of care can pose greater risks than patients would face at home." These safety concerns, alongside privacy considerations, should factor into patients' decision-making processes.

Comparative privacy frameworks in popular medical tourism destinations

To better understand the privacy landscape medical tourists navigate, it's helpful to examine how various destinations approach health information protection. The Medical Tourism Magazine article provides valuable comparisons:

European Union

"The relevant law in the European Union is Directive 95/46/EC (the 'EU Data Directive') on the protection of individuals with regard to the processing of personal data and on the free movement of such data. The Directive protects a broad spectrum of information, including medical information and other types of 'personal data,' such as bank statements, credit card numbers, address, criminal record, employment and virtually any type of information that can be linked to an identified person."

Since the article's publication, the EU has implemented the even more comprehensive General Data Protection Regulation (GDPR), which builds upon these principles with additional protections and more severe penalties for violations.

A key consideration for medical tourists involves international data transfers: "One key component of the EU Data Directive is that it prohibits the transfer of data from the EU to a recipient outside of the EU unless the recipient country (referred to as the 'third country') provides protection that is comparable to the EU's."

This creates potential complications for Americans receiving care in Europe who later need their records transferred back to U.S. providers: "The United States is not considered a safe repository for EU data, which means that additional measures, such as obtaining the 'unambiguous' informed consent of the subject of the information, are required before data may be transferred. This means that a medical professional providing follow-up medical care in the United States may not be able to obtain the patient's treatment history from the European health care provider unless that provider has an unambiguous consent of the patient."

Canada

Canada represents another popular destination for American medical tourists, with its own distinct privacy framework: "Canada has two federal privacy laws, the Privacy Act and the Personal Information Protection and Electronic Documents Act (or 'PIPEDA'). The Privacy Act applies to Canadian government agencies and places limitations on their ability to collect, use and disclose personal information. PIPEDA applies to the private sector and similarly regulates the collection, use or disclosure of personal information in connection with commercial activities."

The article highlights that PIPEDA's scope extends beyond HIPAA's focus: "Personal information that is protected under PIPEDA includes the type of information that is protected under HIPAA, but is broader than health or medical information. For example, income, purchasing and spending habits, marital status and religion, education, genetic make up and ethnic origin are all protected when the information identifies the individual."

Understanding these differences becomes essential for patients navigating cross-border healthcare.

Recommendations for stakeholders

Based on the current landscape of HIPAA and medical tourism, several recommendations emerge for key stakeholders:

For healthcare providers:

• Develop clear policies for handling patient information in medical tourism scenarios, including secure methods for transferring records internationally.
• Establish relationships with foreign healthcare facilities that demonstrate commitment to privacy and security standards compatible with HIPAA.
• Educate patients about privacy implications before they pursue medical tourism, ensuring they can make informed decisions.
• Document all information exchanges with foreign providers, maintaining records of patient authorizations and information transfers.

The AMA recommends that physicians "seek to familiarize themselves with issues in medical tourism to enable them to support informed decision making when patients approach them about getting care abroad." This professional preparation helps ensure patients receive appropriate guidance regarding their medical tourism decisions.

For medical tourism facilitators:

• Clarify your role under HIPAA, determining whether you qualify as a business associate and implementing appropriate compliance measures.
• Vet foreign healthcare providers thoroughly regarding their privacy and security practices before recommending them to American patients.
• Develop standardized processes for secure information exchange between U.S. and foreign providers.
• Provide transparency to patients about how their information will be protected throughout the medical tourism journey.

For foreign healthcare providers:

• Consider voluntary HIPAA alignment if targeting American patients by implementing privacy and security measures that address their expectations.
• Clearly communicate your privacy practices to potential patients, highlighting areas where your approach may differ from HIPAA.
• Invest in staff training on privacy considerations, particularly for those who interact directly with international patients.
• Pursue relevant accreditations that include privacy and security components, demonstrating a commitment to internationally recognized standards.

The AMA report emphasizes that "local follow-up care and financing be coordinated prior to travel and that coverage include costs of necessary follow-up care in the U.S. Patients should be informed about their rights and legal recourse and should have access to information about the foreign facility and health care professionals, the potential risks of combining surgical procedures with travel, and outcomes data for the procedure(s) they will undergo."

As medical tourism continues to grow, stakeholders must balance the opportunities it presents with the responsibilities of protecting sensitive health information. Through thoughtful policies, transparent communication, and proactive measures, the industry can address HIPAA considerations while continuing to provide patients with valuable healthcare options beyond their home borders.

FAQs

Are international healthcare providers legally required to follow HIPAA?

No, foreign healthcare providers are not legally required to comply with HIPAA unless they have a direct connection to the U.S. healthcare system.

Can medical tourists request their records in a HIPAA-compliant format?

Patients can request this, but compliance depends on the foreign provider's data management policies and their willingness to align with HIPAA standards.

What role do medical tourism facilitators play in data privacy?

Facilitators can help bridge privacy gaps by selecting partners with strong data protections and implementing secure data exchange protocols.

How do international data transfer laws affect medical tourists?

Some regions, like the EU, have strict rules limiting the transfer of personal data to countries with weaker privacy protections, including the U.S.

Why do some foreign healthcare facilities voluntarily follow HIPAA-like standards?

Offering familiar privacy protections can build trust and attract American customers.