Tourism and related services — Medical tourism — Service requirements

This document establishes the requirements and recommendations for facilitators and healthcare providers in medical tourism. This document intends to ensure quality service provision for tourists in order to meet the expectations of tourists travelling for medical reasons as a primary motivation. This document does not apply to thalassotherapy centres, medical spas or wellness spas.

Tourisme et services connexes — Tourisme médical — Exigences de service

General Information

Status
Published
Publication Date
14-Dec-2020
Current Stage
6060 - International Standard published
Start Date
15-Dec-2020
Completion Date
15-Dec-2020
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INTERNATIONAL ISO
STANDARD 22525
First edition
2020-12
Tourism and related services —
Medical tourism — Service
requirements
Tourisme et services connexes — Tourisme médical — Exigences de
service
Reference number
ISO 22525:2020(E)
ISO 2020
---------------------- Page: 1 ----------------------
ISO 22525:2020(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2020

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH-1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2020 – All rights reserved
---------------------- Page: 2 ----------------------
ISO 22525:2020(E)
Contents Page

Foreword ..........................................................................................................................................................................................................................................v

Introduction ................................................................................................................................................................................................................................vi

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 General requirements ..................................................................................................................................................................................... 2

4.1 General ........................................................................................................................................................................................................... 2

4.2 Visa arrangements ............................................................................................................................................................................... 3

4.3 Concierge services ............................................................................................................................................................................... 3

4.3.1 General...................................................................................................................................................................................... 3

4.3.2 Foreign languages and translation services ............................................................................................. 3

4.3.3 Transportation services ............................................................................................................................................. 4

4.3.4 Accommodation services .......................................................................................................................................... 4

4.4 Medical tourist satisfaction monitoring and action plan .................................................................................... 4

5 Requirements for facilitators .................................................................................................................................................................. 4

5.1 General ........................................................................................................................................................................................................... 4

5.2 Pre-travel and pre-treatment ..................................................................................................................................................... 5

5.3 Treatment .................................................................................................................................................................................................... 6

5.4 Post-treatment ........................................................................................................................................................................................ 6

5.4.1 General...................................................................................................................................................................................... 6

5.4.2 Return home and follow-up ................................................................................................................................... 6

6 Requirements for healthcare providers ...................................................................................................................................... 6

6.1 General ........................................................................................................................................................................................................... 6

6.2 Information ................................................................................................................................................................................................ 6

6.2.1 Information about the healthcare provider ............................................................................................. 6

6.2.2 Information about the treatments .................................................................................................................... 7

6.3 General service provision .............................................................................................................................................................. 7

6.4 Staff ................................................................................................................................................................................................................... 8

6.4.1 Staff planning and coordination ......................................................................................................................... 8

6.4.2 Qualification requirements ..................................................................................................................................... 8

6.4.3 Training .................................................................................................................................................................................... 8

6.5 Medical service provision .............................................................................................................................................................. 9

6.5.1 Admission process.......................................................................................................................................................... 9

6.5.2 Medical tourist history ............................................................................................................................................... 9

6.5.3 Informed consent ............................................................................................................................................................ 9

6.5.4 Rooms .....................................................................................................................................................................................10

6.5.5 Discharge .............................................................................................................................................................................10

6.5.6 The medical tourist’s follow-up .......................................................................................................................11

6.6 Nutrition ....................................................................................................................................................................................................11

6.7 Safety and security ...........................................................................................................................................................................12

6.7.1 General...................................................................................................................................................................................12

6.7.2 Food safety .........................................................................................................................................................................12

6.7.3 Pest control and disinfection ..............................................................................................................................12

6.7.4 Security measures and medical tourist properties .........................................................................13

6.7.5 Fire risk assessment and protection ............................................................................................................13

6.7.6 Emergency and evacuation plan .....................................................................................................................13

6.8 Cleaning, disinfection, sterilization and maintenance .......................................................................................13

6.8.1 Cleaning, disinfection and sterilization .....................................................................................................13

6.8.2 Maintenance .....................................................................................................................................................................14

Annex A (informative) Rights and duties of the medical tourist ..........................................................................................15

© ISO 2020 – All rights reserved iii
---------------------- Page: 3 ----------------------
ISO 22525:2020(E)
Annex B (normative) Minimum competency requirements and recommendations for

facilitators ................................................................................................................................................................................................................17

Bibliography .............................................................................................................................................................................................................................19

iv © ISO 2020 – All rights reserved
---------------------- Page: 4 ----------------------
ISO 22525:2020(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/ directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/ patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso .org/

iso/ foreword .html.

This document was prepared by Technical Committee ISO/TC 228, Tourism and related services.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/ members .html.
© ISO 2020 – All rights reserved v
---------------------- Page: 5 ----------------------
ISO 22525:2020(E)
Introduction

The number of people travelling from one country to another searching for healthcare has quickly

increased in recent years. Some of the reasons for this are the competitive prices that certain countries

offer, the unavailability of treatment in medical tourists' home countries and the desire of medical

tourists to skip long waiting lists. Furthermore, the growing demand within this global market has

benefited from the ease and affordability of international travel as well as technological progress and

the possibilities that the internet offers. Treatments include cosmetic surgery, dentistry, laser surgery

for eyes, spinal disc replacement, brain surgery (e.g. cerebral valve adaptation), oncologic surgery (e.g.

tumorsexeresis or complete organ removal), bariatric surgery (e.g. gastric bypass) and cardiac bypass

surgery.

Multiple stakeholders are involved in the medical tourism value chain, including facilitators, healthcare

providers (e.g. clinics and hospitals), professionals (e.g. doctors) and other interested parties (e.g.

insurance companies and consulates). The development of medical tourism faces many challenges,

such as simplifying the administrative tasks, enhancing and adapting healthcare procedures and

post-treatment care, and coordinating travel arrangements. These might present some difficulties for

healthcare providers in meeting medical tourists’ expectations.

There is an obvious need, therefore, to define, at an international level, the minimum quality

requirements for providing medical tourism services, considering the different stakeholders involved,

in order to meet the expectations of medical tourists.
vi © ISO 2020 – All rights reserved
---------------------- Page: 6 ----------------------
INTERNATIONAL STANDARD ISO 22525:2020(E)
Tourism and related services — Medical tourism — Service
requirements
1 Scope

This document establishes the requirements and recommendations for facilitators and healthcare

providers in medical tourism.

This document intends to ensure quality service provision for tourists in order to meet the expectations

of tourists travelling for medical reasons as a primary motivation.

This document does not apply to thalassotherapy centres, medical spas or wellness spas.

2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at http:// www .electropedia .org/
3.1
concierge service

service provided by the facilitator (3.2), the healthcare provider (3.4) or both to enhance the medical

tourist’s experience

EXAMPLE Pick-up or return to the airport, medical and leisure activity escort, parking services, translation

services, babysitting, cleaning staff, drivers, 24-h personal attention, accommodation rental.

3.2
facilitator

medical-tourism-specialized intermediary which aids the medical tourist in the process of contracting

medical services

Note 1 to entry: Some facilitators also completely or partly arrange concierge services, flights or accommodation

for the medical tourist.

EXAMPLE Travel agency, medical cluster, the international department of a healthcare provider.

3.3
healthcare

activities to mantain and improve the health of individuals or the general population

[SOURCE: ISO 22886:2020, 3.11.2]
© ISO 2020 – All rights reserved 1
---------------------- Page: 7 ----------------------
ISO 22525:2020(E)
3.4
healthcare provider

organisation where medical tourists (3.9) are given medical consultation, diagnosis, rehabilitation and

medical or surgical treatment
EXAMPLE Clinic, hospital, rehabilitation centre.
3.5
healthcare staff
qualified staff who provide clinical services to medical tourists (3.9)

EXAMPLE Nurse practitioner, physician’s assistant, emergency medical technician, radiography staff,

dietician.
3.6
medical procedure
action intended to deliver healthcare (3.3)
EXAMPLE Diagnosis, treatment, therapeutics and tests.
3.7
medical staff

graduates in medicine who meet the legal requirements for the practice of the profession

3.8
medical tourism

international or national travel which has healthcare (3.3) as a primary motivation

3.9
medical tourist
person travelling for healthcare (3.3)

Note 1 to entry: The reasons for such travel include medical consultation, diagnosis, rehabilitation and medical

or surgical treatment.
3.10
temporary exit allowance

permission given to the medical tourist (3.9) to leave the healthcare provider (3.4) and continue the

treatment (3.11) afterwards, when the treatment is carried out in several stages

Note 1 to entry: In some treatments, such as oncology, the treatment is carried out over several periods.

3.11
treatment

healthcare (3.3) given to the medical tourist (3.9) for an illness, injury or disease in order to make them

healthy or to improve their quality of life
4 General requirements
4.1 General

This clause establishes the requirements for quality service in medical tourism and applies to both the

facilitator and the healthcare provider.
The facilitator and the healthcare provider shall:

a) provide the medical tourist with documented information about their specialties, the services

offered and their field of expertise;

b) cooperate with each other and with the medical tourist to facilitate the process, providing the

medical tourist with the required information regarding both the travel and the medical procedure;

2 © ISO 2020 – All rights reserved
---------------------- Page: 8 ----------------------
ISO 22525:2020(E)
c) have appropriate insurance for their activities;

d) identify the legal requirements that apply to them (e.g. operating licence, authorization of the

health authority, health transport, food safety, hazardous waste management, X-ray facilities) and

ensure that these are taken into account when offering and providing the services;

e) define and implement a documented procedure to identify the different job profiles of the

organization managing the personal and clinical data of medical tourists and establish the level of

permissions necessary to access that information for each job profile;

f) ensure confidentiality and data protection for medical tourists (e.g. separate records for clinical

data and administrative data); it is highly recommended that software systems are implemented

which allow the management of and control the access to this information (e.g. tests, results,

diagnostics);

g) recommend contracting an insurance policy to cover possible complications of the treatment

when this is not included in the given quotation, considering also other expenses for death and

repatriation (for the medical tourist and their companions);

h) implement a management system that evidences quality service provision and appropriate internal

management.
4.2 Visa arrangements

The facilitator, the healthcare provider or both should identify and document the visa requirements for

international medical tourists, where applicable and at least for those countries of origin where most of

their medical tourists come from.

In some cases, the healthcare provider can write an invitation letter when requested by the medical

tourist.
4.3 Concierge services
4.3.1 General

Concierge services can be offered either by the facilitator or the healthcare provider.

The facilitator or healthcare provider shall define the services offered for their medical tourists’

convenience. For that purpose, it should analyse, for example:
a) the treatments offered;
b) the average stay of the medical tourists;
c) the origin of the medical tourists;
d) the languages and other cultural issues related to the medical tourists.
4.3.2 Foreign languages and translation services

The facilitator and the healthcare provider shall communicate and provide their services in at least

one foreign language, which shall be determined considering the countries of origin of their medical

tourists. When translation services are required, these services shall be provided.

The facilitator and healthcare provider shall have a list or access to contact details related to translation

service providers.
© ISO 2020 – All rights reserved 3
---------------------- Page: 9 ----------------------
ISO 22525:2020(E)
4.3.3 Transportation services

Transportation services from from the main destination entrance points (e.g. airports) shall be offered.

Appropriate vehicles and facilities for medical tourists with physical disabilities should be provided.

The medical tourists shall be informed of applicable conditions in advance.

Transportation to the accommodation facilities at the destination shall be provided by the healthcare

provider or the facilitator (upon request, if applicable). The transportation should be appropriate to the

medical condition of the medical tourists.
4.3.4 Accommodation services

When, due to the type of treatments carried out by the healthcare provider (i.e. follow-up activities and

recovery), an accommodation service outside the healthcare provider is needed, the facilitator and the

healthcare provider shall cooperate with accommodation providers and other service companies at the

destination in order to offer practical information. The accommodation should account for the needs

and requirements of people with disabilities.

NOTE For additional information about accessibility requirements see ISO 21902 .

The opportunity to book those services together with the treatment as a package should be available.

4.4 Medical tourist satisfaction monitoring and action plan

Both the healthcare provider and the facilitator shall measure and monitor medical tourist satisfaction

with their own service. Also, concierge services, when applicable, shall be measured and monitored.

The results obtained from this evaluation shall be available for the staff involved so that the healthcare

provider, the facilitator or both implement an action plan to improve medical tourist satisfaction. They

shall also handle medical tourists’ complaints.

The results obtained from the monitoring plan of medical tourist satisfaction as well as the actions

taken to improve medical tourist satisfaction shall be recorded.
5 Requirements for facilitators
5.1 General
Medical tourism is divided into three major processes:
— pre-travel and pre-treatment;
— treatment;
— post-treatment, including return home and follow-up.
The facilitator shall:
a) have specific knowledge of the healthcare sector;

b) document its relationship with the healthcare provider through a contract, which includes the

procedure to be followed by both parties; this contract shall also ensure the data protection of the

medical tourists;
c) keep documented information of the medical procedure.
The minimum competencies for facilitators shall be as specified in Annex B.
1) Under preparation. Stage at the time of publication: ISO/DIS 21902:2020.
4 © ISO 2020 – All rights reserved
---------------------- Page: 10 ----------------------
ISO 22525:2020(E)
5.2 Pre-travel and pre-treatment
The facilitator shall:

a) collect general information from the medical tourist so the appropriate treatment can be offered by

the healthcare provider and, when requested by the medical doctor, submit a form to be completed

by the medical tourist to inform the medical doctor of his or her medical history;

b) provide the medical tourist with the information needed regarding the medical doctor, healthcare

provider and/or its own services and expertise;

c) ensure that an application form is completed by the medical tourist; the application form shall

include at least the medical tourist’s contact details, language preference and submission of privacy

policy, and shall allow the medical tourist to explain his or her needs or case;

d) contact the medical tourist in order to get additional information to that previously provided

through the application form, regarding his or her special needs, concerns and expectations,

quotation and requested time frame for the treatment;

e) request from the healthcare provider information regarding, for example, the medical staff,

treatment, test benefits, possible general risks and complications of the treatment, length of stay

and estimated time to discharge and recovery time, and inform the patient accordingly, referring

the medical tourist to the healthcare provider for a medical process explanation;

f) provide the medical tourist with general information regarding the travel arrangements offer (e.g.

general visa information when needed, transfer information);

g) ensure that the medical tourist has given formal consent for their personal information to be

collected and disseminated to the medical staff;

h) ensure that the requested medical data and tests (e.g. magnetic resonance imaging, X-rays, photos,

clinical laboratory test results) are provided by the medical tourist when needed for the medical

procedure;
i) agree with the medical tourist about the most convenient travel dates;

j) agree with the medical tourist about the accommodation facilities and other concierge services

needed; the facilitator should suggest an accommodation provider which meets the medical

tourist’s needs (i.e. in terms of accessibility, nutrition and a companion person);

k) request from the healthcare provider a quotation for the treatment;
l) inform the medical tourist about the following:

— the necessary travel documents, such as passport and visa acquisition and their estimated costs;

— the possibility that the treatment might be cancelled for medical reasons once the medical

tourist is at the healthcare provider;

— the possibility that the selected doctor will not be not available due to unforeseen circumstance;

in this case, an alternative shall be determined in consultation with the medical tourist;

— the payment policy;

— the responsibility of every party in the process (facilitator and healthcare provider);

— the applicable legislation, which is the one in the country where the treatment is carried out;

m) after receiving all the information (including the medical process as well as the concierge services),

send a final quotation of all services to the medical tourist for approval; this quotation shall be clear

enough to allow them to identify what is included and what is not; coverage in case of complications

(if any) shall be determined;
© ISO 2020 – All rights reserved 5
---------------------- Page: 11 ----------------------
ISO 22525:2020(E)
n) book the treatment with the healthcare provider;

o) arrange concierge services, taking into account the medical tourist’s special needs and requests;

p) send in advance the complete travel information to the medical tourist, above all departure and

arrival dates at destination;

q) ensure that administrative personnel of the facilitator have no access to clinical data.

5.3 Treatment

The facilitator shall stay in contact with the healthcare provider to monitor and ensure the correct

fulfilment of the agreement during the whole treatment and assist the medical tourist in case of

unsatisfactory results.
5.4 Post-treatment
5.4.1 General

The facilitator shall stay in contact with the healthcare provider to monitor and ensure the correct

development of the agreement during the post-treatment and act as a mediator in case of complications

or unsatisfactory results.

Specifically, during the recovery period at the destination (if any), the facilitator, as mediator, shall

ensure the medical tourist receives from the healthcare provider the necessary post-treatment follow-

up, according to the medical procedure.

The facilitator shall ensure that the accommodation is adapted to the medical tourist's specific needs.

5.4.2 Return home and follow-up

If the facilitator is responsible for the medical tourist’s return home process, he shall plan this process

according to the specific needs of the medical tourist.

The facilitator should ensure a follow-up service once the medical tourist is back home.

6 Requirements for healthcare providers
6.1 General
The healthcare provider shall:
a) define and communicate its insurance policy for medical tourists;
b) ensure effective communication with the medical tourist;
c) inform the medical tourist of their ri
...

FINAL
INTERNATIONAL ISO/FDIS
DRAFT
STANDARD 22525
ISO/TC 228
Tourism and related services —
Secretariat: UNE
Medical tourism — Service
Voting begins on:
2020­09­17 requirements
Voting terminates on:
Tourisme et services connexes — Tourisme médical — Exigences de
2020­11­12
service
RECIPIENTS OF THIS DRAFT ARE INVITED TO
SUBMIT, WITH THEIR COMMENTS, NOTIFICATION
OF ANY RELEVANT PATENT RIGHTS OF WHICH
THEY ARE AWARE AND TO PROVIDE SUPPOR TING
DOCUMENTATION.
IN ADDITION TO THEIR EVALUATION AS
Reference number
BEING ACCEPTABLE FOR INDUSTRIAL, TECHNO­
ISO/FDIS 22525:2020(E)
LOGICAL, COMMERCIAL AND USER PURPOSES,
DRAFT INTERNATIONAL STANDARDS MAY ON
OCCASION HAVE TO BE CONSIDERED IN THE
LIGHT OF THEIR POTENTIAL TO BECOME STAN­
DARDS TO WHICH REFERENCE MAY BE MADE IN
NATIONAL REGULATIONS. ISO 2020
---------------------- Page: 1 ----------------------
ISO/FDIS 22525:2020(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2020

All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may

be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting

on the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address

below or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH­1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii © ISO 2020 – All rights reserved
---------------------- Page: 2 ----------------------
ISO/FDIS 22525:2020(E)
Contents Page

Foreword ..........................................................................................................................................................................................................................................v

Introduction ................................................................................................................................................................................................................................vi

1 Scope ................................................................................................................................................................................................................................. 1

2 Normative references ...................................................................................................................................................................................... 1

3 Terms and definitions ..................................................................................................................................................................................... 1

4 General requirements ..................................................................................................................................................................................... 2

4.1 General ........................................................................................................................................................................................................... 2

4.2 Visa arrangements ............................................................................................................................................................................... 3

4.3 Concierge services ............................................................................................................................................................................... 3

4.3.1 General...................................................................................................................................................................................... 3

4.3.2 Foreign languages and translation services ............................................................................................. 3

4.3.3 Transportation services ............................................................................................................................................. 4

4.3.4 Accommodation services .......................................................................................................................................... 4

4.4 Medical tourist satisfaction monitoring and action plan .................................................................................... 4

5 Requirements for facilitators .................................................................................................................................................................. 4

5.1 General ........................................................................................................................................................................................................... 4

5.2 Pre­travel and pre­treatment ..................................................................................................................................................... 5

5.3 Treatment .................................................................................................................................................................................................... 6

5.4 Post­treatment ........................................................................................................................................................................................ 6

5.4.1 General...................................................................................................................................................................................... 6

5.4.2 Return home and follow­up ................................................................................................................................... 6

6 Requirements for healthcare providers ...................................................................................................................................... 6

6.1 General ........................................................................................................................................................................................................... 6

6.2 Information ................................................................................................................................................................................................ 6

6.2.1 Information about the healthcare provider ............................................................................................. 6

6.2.2 Information about the treatments .................................................................................................................... 7

6.3 General service provision .............................................................................................................................................................. 7

6.4 Staff ................................................................................................................................................................................................................... 8

6.4.1 Staff planning and coordination ......................................................................................................................... 8

6.4.2 Qualification requirements ..................................................................................................................................... 8

6.4.3 Training .................................................................................................................................................................................... 8

6.5 Medical service provision .............................................................................................................................................................. 9

6.5.1 Admission process.......................................................................................................................................................... 9

6.5.2 Medical tourist history ............................................................................................................................................... 9

6.5.3 Informed consent ............................................................................................................................................................ 9

6.5.4 Rooms .....................................................................................................................................................................................10

6.5.5 Discharge .............................................................................................................................................................................10

6.5.6 The medical tourist’s follow­up .......................................................................................................................11

6.6 Nutrition ....................................................................................................................................................................................................11

6.7 Safety and security ...........................................................................................................................................................................12

6.7.1 General...................................................................................................................................................................................12

6.7.2 Food safety .........................................................................................................................................................................12

6.7.3 Pest control and disinfection ..............................................................................................................................12

6.7.4 Security measures and medical tourist properties .........................................................................13

6.7.5 Fire risk assessment and protection ............................................................................................................13

6.7.6 Emergency and evacuation plan .....................................................................................................................13

6.8 Cleaning, disinfection, sterilization and maintenance .......................................................................................13

6.8.1 Cleaning, disinfection and sterilization .....................................................................................................13

6.8.2 Maintenance .....................................................................................................................................................................14

Annex A (informative) Rights and duties of the medical tourist ..........................................................................................15

© ISO 2020 – All rights reserved iii
---------------------- Page: 3 ----------------------
ISO/FDIS 22525:2020(E)
Annex B (normative) Minimum competency requirements and recommendations for

facilitators ................................................................................................................................................................................................................17

Bibliography .............................................................................................................................................................................................................................19

iv © ISO 2020 – All rights reserved
---------------------- Page: 4 ----------------------
ISO/FDIS 22525:2020(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards

bodies (ISO member bodies). The work of preparing International Standards is normally carried out

through ISO technical committees. Each member body interested in a subject for which a technical

committee has been established has the right to be represented on that committee. International

organizations, governmental and non­governmental, in liaison with ISO, also take part in the work.

ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of

electrotechnical standardization.

The procedures used to develop this document and those intended for its further maintenance are

described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the

different types of ISO documents should be noted. This document was drafted in accordance with the

editorial rules of the ISO/IEC Directives, Part 2 (see www .iso .org/ directives).

Attention is drawn to the possibility that some of the elements of this document may be the subject of

patent rights. ISO shall not be held responsible for identifying any or all such patent rights. Details of

any patent rights identified during the development of the document will be in the Introduction and/or

on the ISO list of patent declarations received (see www .iso .org/ patents).

Any trade name used in this document is information given for the convenience of users and does not

constitute an endorsement.

For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and

expressions related to conformity assessment, as well as information about ISO's adherence to the

World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see www .iso .org/

iso/ foreword .html.

This document was prepared by Technical Committee ISO/TC 228, Tourism and related services.

Any feedback or questions on this document should be directed to the user’s national standards body. A

complete listing of these bodies can be found at www .iso .org/ members .html.
© ISO 2020 – All rights reserved v
---------------------- Page: 5 ----------------------
ISO/FDIS 22525:2020(E)
Introduction

The number of people travelling from one country to another searching for healthcare has quickly

increased in recent years. Some of the reasons for this are the competitive prices that certain countries

offer, the unavailability of treatment in medical tourists' home countries and the desire of medical

tourists to skip long waiting lists. Furthermore, the growing demand within this global market has

benefited from the ease and affordability of international travel as well as technological progress and

the possibilities that the internet offers. Treatments include cosmetic surgery, dentistry, laser surgery

for eyes, spinal disc replacement, brain surgery (e.g. cerebral valve adaptation), oncologic surgery (e.g.

tumorsexeresis or complete organ removal), bariatric surgery (e.g. gastric bypass) and cardiac bypass

surgery.

Multiple stakeholders are involved in the medical tourism value chain, including facilitators, healthcare

providers (e.g. clinics and hospitals), professionals (e.g. doctors) and other interested parties (e.g.

insurance companies and consulates). The development of medical tourism faces many challenges,

such as simplifying the administrative tasks, enhancing and adapting healthcare procedures and

post-treatment care, and coordinating travel arrangements. These might present some difficulties for

healthcare providers in meeting medical tourists’ expectations.

There is an obvious need, therefore, to define, at an international level, the minimum quality

requirements for providing medical tourism services, considering the different stakeholders involved,

in order to meet the expectations of medical tourists.
vi © ISO 2020 – All rights reserved
---------------------- Page: 6 ----------------------
FINAL DRAFT INTERNATIONAL STANDARD ISO/FDIS 22525:2020(E)
Tourism and related services — Medical tourism — Service
requirements
1 Scope

This document establishes the requirements and recommendations for facilitators and healthcare

providers in medical tourism.

This document intends to ensure quality service provision for tourists in order to meet the expectations

of tourists travelling for medical reasons as a primary motivation.

This document does not apply to thalassotherapy centres, medical spas or wellness spas.

2 Normative references
There are no normative references in this document.
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.

ISO and IEC maintain terminological databases for use in standardization at the following addresses:

— ISO Online browsing platform: available at https:// www .iso .org/ obp
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3.1
concierge service

service provided by the facilitator (3.2), the healthcare provider (3.4) or both to enhance the medical

tourist’s experience

EXAMPLE Pick-up or return to the airport, medical and leisure activity escort, parking services, translation

services, babysitting, cleaning staff, drivers, 24-h personal attention, accommodation rental.

3.2
facilitator

medical- tourism- specialized intermediary which aids the medical tourist in the process of contracting

medical services

Note 1 to entry: some facilitators also completely or partly arrange concierge services, flights or accommodation

for the medical tourist.

EXAMPLE Travel agency, medical cluster, the international department of a healthcare provider.

3.3
healthcare

activities to mantain and improve the health of individuals or the general population

[SOURCE: ISO 22886:2020, 3.11.2]
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3.4
healthcare provider

organisation where medical tourists (3.9) are given medical consultation, diagnosis, rehabilitation and

medical or surgical treatment
EXAMPLE Clinic, hospital, rehabilitation centre.
3.5
healthcare staff
qualified staff who provide clinical services to medical tourists (3.9)

EXAMPLE Nurse practitioner, physician’s assistant, emergency medical technician, radiography staff,

dietician.
3.6
medical procedure
action intended to deliver healthcare (3.3)
EXAMPLE Diagnosis, treatment, therapeutics and tests.
3.7
medical staff

graduates in medicine who meet the legal requirements for the practice of the profession

3.8
medical tourism

international or national travel which has healthcare (3.3) as a primary motivation

3.9
medical tourist
person travelling for healthcare (3.3)

Note 1 to entry: The reasons for such travel include medical consultation, diagnosis, rehabilitation and medical

or surgical treatment.
3.10
temporary exit allowance

permission given to the medical tourist (3.9) to leave the healthcare provider (3.4) and continue the

treatment (3.11) afterwards, when the treatment is carried out in several stages

Note 1 to entry: In some treatments, such as oncology, the treatment is carried out over several periods.

3.11
treatment

healthcare (3.3) given to the medical tourist (3.9) for an illness, injury or disease in order to make them

healthy or to improve their quality of life
4 General requirements
4.1 General

This clause establishes the requirements for quality service in medical tourism and applies to both the

facilitator and the healthcare provider.
The facilitator and the healthcare provider shall:

a) provide the medical tourist with documented information about their specialties, the services

offered and their field of expertise;

b) cooperate with each other and with the medical tourist to facilitate the process, providing the

medical tourist with the required information regarding both the travel and the medical procedure;

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c) have appropriate insurance for their activities;

d) identify the legal requirements that apply to them (e.g. operating licence, authorization of the

health authority, health transport, food safety, hazardous waste management, X-ray facilities) and

ensure that these are taken into account when offering and providing the services;

e) define and implement a documented procedure to identify the different job profiles of the

organization managing the personal and clinical data of medical tourists and establish the level of

permissions necessary to access that information for each job profile;

f) ensure confidentiality and data protection for medical tourists (e.g. separate records for clinical

data and administrative data); it is highly recommended that software systems are implemented

which allow the management of and control the access to this information (e.g. tests, results,

diagnostics);

g) recommend contracting an insurance policy to cover possible complications of the treatment

when this is not included in the given quotation, considering also other expenses for death and

repatriation (for the medical tourist and their companions);

h) implement a management system that evidences quality service provision and appropriate internal

management.
4.2 Visa arrangements

The facilitator, the healthcare provider or both should identify and document the visa requirements for

international medical tourists, where applicable and at least for those countries of origin where most of

their medical tourists come from.

In some cases, the healthcare provider can write an invitation letter when requested by the medical

tourist.
4.3 Concierge services
4.3.1 General

Concierge services can be offered either by the facilitator or the healthcare provider.

The facilitator or healthcare provider shall define the services offered for their medical tourists’

convenience. For that purpose, it should analyse, for example:
a) the treatments offered;
b) the average stay of the medical tourists;
c) the origin of the medical tourists;
d) the languages and other cultural issues related to the medical tourists.
4.3.2 Foreign languages and translation services

The facilitator and the healthcare provider shall communicate and provide their services in at least

one foreign language, which shall be determined considering the countries of origin of their medical

tourists. When translation services are required, these services shall be provided.

The facilitator and healthcare provider shall have a list or access to contact details related to translation

service providers.
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4.3.3 Transportation services

Transportation services from from the main destination entrance points (e.g. airports) shall be offered.

Appropriate vehicles and facilities for medical tourists with physical disabilities should be provided.

The medical tourists shall be informed of applicable conditions in advance.

Transportation to the accommodation facilities at the destination shall be provided by the healthcare

provider or the facilitator (upon request, if applicable). The transportation should be appropriate to the

medical condition of the medical tourists.
4.3.4 Accommodation services

When, due to the type of treatments carried out by the healthcare provider (i.e. follow-up activities and

recovery), an accommodation service outside the healthcare provider is needed, the facilitator and the

healthcare provider shall cooperate with accommodation providers and other service companies at the

destination in order to offer practical information. The accommodation should account for the needs

and requirements of people with disabilities.

NOTE For additional information about accessibility requirements see ISO 21902 .

The opportunity to book those services together with the treatment as a package should be available.

4.4 Medical tourist satisfaction monitoring and action plan

Both the healthcare provider and the facilitator shall measure and monitor medical tourist satisfaction

with their own service. Also, concierge services, when applicable, shall be measured and monitored.

The results obtained from this evaluation shall be available for the staff involved so that the healthcare

provider, the facilitator or both implement an action plan to improve medical tourist satisfaction. They

shall also handle medical tourists’ complaints.

The results obtained from the monitoring plan of medical tourist satisfaction as well as the actions

taken to improve medical tourist satisfaction shall be recorded.
5 Requirements for facilitators
5.1 General
Medical tourism is divided into three major processes:
— pre-travel and pre-treatment;
— treatment;
— post­treatment, including return home and follow­up.
The facilitator shall:
a) have specific knowledge of the healthcare sector;

b) document its relationship with the healthcare provider through a contract, which includes the

procedure to be followed by both parties; this contract shall also ensure the data protection of the

medical tourists;
c) keep documented information of the medical procedure.
The minimum competencies for facilitators shall be as specified in Annex B.
1) Under preparation. Stage at the time of publication: ISO/DIS 21902:2020.
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5.2 Pre-travel and pre-treatment
The facilitator shall:

a) collect general information from the medical tourist so the appropriate treatment can be offered by

the healthcare provider and, when requested by the medical doctor, submit a form to be completed

by the medical tourist to inform the medical doctor of his or her medical history;

b) provide the medical tourist with the information needed regarding the medical doctor, healthcare

provider and/or its own services and expertise;

c) ensure that an application form is completed by the medical tourist; the application form shall

include at least the medical tourist’s contact details, language preference and submission of privacy

policy, and shall allow the medical tourist to explain his or her needs or case;

d) contact the medical tourist in order to get additional information to that previously provided

through the application form, regarding his or her special needs, concerns and expectations,

quotation and requested time frame for the treatment;

e) request from the healthcare provider information regarding, for example, the medical staff,

treatment, test benefits, possible general risks and complications of the treatment, length of stay

and estimated time to discharge and recovery time, and inform the patient accordingly, referring

the medical tourist to the healthcare provider for a medical process explanation;

f) provide the medical tourist with general information regarding the travel arrangements offer (e.g.

general visa information when needed, transfer information);

g) ensure that the medical tourist has given formal consent for their personal information to be

collected and disseminated to the medical staff;

h) ensure that the requested medical data and tests (e.g. magnetic resonance imaging, X-rays, photos,

clinical laboratory test results) are provided by the medical tourist when needed for the medical

procedure;
i) agree with the medical tourist about the most convenient travel dates;

j) agree with the medical tourist about the accommodation facilities and other concierge services

needed; the facilitator should suggest an accommodation provider which meets the medical

tourist’s needs (i.e. in terms of accessibility, nutrition and a companion person);

k) request from the healthcare provider a quotation for the treatment;
l) inform the medical tourist about the following:

— the necessary travel documents, such as passport and visa acquisition and their estimated costs;

— the possibility that the treatment might be cancelled for medical reasons once the medical

tourist is at the healthcare provider;

— the possibility that the selected doctor will not be not available due to unforeseen circumstance;

in this case, an alternative shall be determined in consultation with the medical tourist;

— the payment policy;

— the responsibility of every party in the process (facilitator and healthcare provider);

— the applicable legislation, which is the one in the country where the treatment is carried out;

m) after receiving all the information (including the medical process as well as the concierge services),

send a final quotation of all services to the medical tourist for approval; this quotation shall be clear

enough to allow them to identify what is included and what is not; coverage in case of complications

(if any) shall be determined;
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n) book the treatment with the healthcare provider;

o) arrange concierge services, taking into account the medical tourist’s special needs and requests;

p) send in advance the complete travel information to the medical tourist, above all departure and

arrival dates at destination;

q) ensure that administrative personnel of the facilitator have no access to clinical data.

5.3 Treatment

The facilitator shall stay in contact with the healthcare provider to monitor and ensure the correct

fulfilment of the agreement during the whole treatment and assist the medical tourist in case of

unsatisfactory results.
5.4 Post-treatment
5.4.1 General

The facilitator shall stay in contact with the healthcare provider to monitor and ensure the correct

development of the agreement during the post­treatment and act as a mediator in case of complications

or unsatisfactory results.

Specifically, during the recovery period at the destination (if any), the facilitator, as mediator, shall

ensure the medical tourist receives from the healthcare provider the necessary post-treatment follow-

up, according to the medical procedure.
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