One of the government’s newest revenue-raising schemes is medical tourism, but many health experts and activists remain skeptical.

by AVIGAIL M. OLARTE

	MEDICAL TOURIST. Zoe de la Torre, a permanent resident of Italy, took a 16-hour flight to Manila to undergo operation for her cervical spine arthritis. [PCIJ photo]

ZOE DE la Torre didn't mind that her surgery at the plush, marble-floored St. Luke's Medical Center in Quezon City cost P700,000. Not even if she could have had the procedure in one of Italy's government hospitals for free. As a permanent resident of Italy, where she has worked selling medical instruments for the last 25 years, she enjoys that privilege. But she says she would be undergoing a "very delicate" procedure, and she wanted to make sure she was comfortable.

A private facility in Italy was out; being uninsured, she says there was no way she could afford a bill that would be nearly twice that of St. Luke's. Besides, the 55-year-old widow liked the charming St. Luke's doctor better than the one she consulted in Bologna.

Both had diagnosed her as having cervical spine arthritis. But when de la Torre finally decided to proceed with the operation they said she needed, she opted to take a 16-hour flight to have it done by her U.S.-trained Filipino orthopedic surgeon at the private hospital that recently had President Gloria Macapagal-Arroyo among its patients.

"They have excellent and very caring doctors here," said a happy and satisfied de la Torre on the bright August morning that she was discharged from St. Luke's. "The hospital took care of me the moment I stepped through their doors."

She added, "I'll definitely tell my Filipino and Italian friends to come have their treatments here."

Philippine officials certainly hope so. After all, they launched a medical-tourism program last January, and are set to have a bigger launch this November. The plan is to have as many tourists — and balikbayans like de la Torre — coming not only to see the sights, but also to have medical treatments that could range from cosmetic nips and tucks to major surgeries like that undergone by de la Torre.

For government officials and some hospital administrators, medical tourism is a win-win industry. Tourists would be able to enjoy medical services at a fraction of the price they would pay at home. (See table on comparative costs.) The Philippines would earn millions of dollars in revenue from a business that would also generate thousands of jobs. Even the International Trade Commission in Geneva says medical tourism could grow into a $188-billion global business by 2013.

Table 1: Comparative Cost of Treatments (in US$) Source: PIDS
TREATMENT	USA	SINGAPORE	MALAYSIA	THAILAND	PHILIPPINES
Cataract surgery	2,500-3,000	1,749	1,014	950	1,424
Total knee replacement	5,000	6,207	4,342	5,500	5,639
Liposuction	2,800-5,700	3,221	1,711	1,365	1,400

TREATMENT	USA	PHILIPPINES
General medical check-up	5,000	500
Coronary bypass surgery	50,000	25,000
Kidney transplantation	150,000	25,000
Lasik eye surgery	3,000	1,000
Breast augmentation	5,000	2,000

Proponents of the medical-tourism program say it could only revitalize the country's weak healthcare system, in large part through outright financial infusions. The problem is that with a framework and other vital components for the program still missing, it's not clear how such infusions will be done.

That isn't exactly comforting to those already wary about the program. Health activists and experts alike fear that with medical tourism, hospitals — government ones, most especially — could start shifting most of its attention, and most of its beds, to foreign patients. They also find it incongruous for the country to offer medical services to foreigners when thousands of Filipinos die each year because they could not afford treatment or lived too far from a health facility. And there is the nagging worry that organ-selling by the poor would escalate as tourists sign up for transplant operations.

Former health secretary Alberto Romualdez Jr. himself remarks, "The state of our public health is so inequitable. Unless we achieve a level of healthcare like that in Thailand, I don't think we should be even catering to the needs of these tourists."

Thailand is Asia's forerunner in medical tourism, which has also attracted India and even Singapore and Malaysia. Last year, Thailand earned over a billion dollars from one million medical tourists. Its government, however, has also spent considerable sums on its citizens' health. According to a 2006 World Health Organization report, Thailand's government shouldered 60 percent of the country's total health expenditure in 2003; of its total government expenditure, 13.6 percent went to health.

In comparison, health's share of the Philippines' total government expenditure was only 5.9 percent. Today barely three percent of the country's GDP is being spent for health, even as the rising cost of healthcare has more and more Filipinos electing not to seek treatment for their illnesses.

"Medical tourism, it's like buying jewelry," says Romualdez. "You don't need it to survive as long as you can provide for your needs. Before you buy your jewelry, you should be able to provide for your basic needs first."

A less poetic way of putting Romualdez's argument is this: before lavishing attention on medical tourism, the government should strengthen the country's basic health services first.

BUT IT'S not as if the government is actually pouring money into the program, says Dr. Paul Reganit, medical tourism officer of the Department of Health (DOH). He says the government's role is only to create an environment where medical tourism can thrive.

"It's really the hospitals who will develop themselves," says Reganit. "All you need to do is to encourage these hospitals to improve their facilities. We're only trying to organize the hospitals and other groups so that we can have a unified program."

Perhaps if the program were a private-sector initiative, there would be few creased foreheads among the likes of Romualdez. But the Philippine Medical Tourism Program is not only a project spearheaded by the government, it also has government health facilities among its participants. In fact, of the 20 hospitals named as being part of the program's first phase, nine are government-owned. (See Table 2)

Table 2: List of Health Facilities Included in Phase 1 TOP* 17 HOSPITALS AD CLINICS Philippine Heart Center National Kidney and Transplant Institute Lung Center of the Philippines Philippine Children's Medical Center East Avenue Medical Center St. Luke's Medical Center Asian Hospital and Medical Center The Medical City Capitol Medical Center Makati Medical Center Eye Republic American Eye Center Asian Eye Institute Makati Eye Laser Center Belo Medical Group Calayan SurgiCenter AT Reyes Dermatology and Laser Center OTHER FACILITIES Cardinal Santos Medical Center Manila Doctors Hospital San Juan de Dios Hospital UST Hospital Medical Center Manila Tagaytay Health System Amang Rodriguez Memorial Hospital Quirino Memorial Medical Center Pasig Medical Center Jose Reyes Memorial Medical Center *per DOH classification Source: DOH

Reganit concedes that while the health department would not be giving these state hospitals extra money for the program, they are expected to spend on facility improvement. That could mean realigning hospital budgets. Theoretically, though, improved facilities would mean better services even for local patients who would continue to make up the bulk of the government hospitals' clientele. According to Reganit, participating state hospitals are to allot a maximum of only 10 percent of their bed capacity to foreigners. Private hospitals — among them St. Luke's — have been asked to increase their bed allotment to accommodate Filipino charity patients by 10 percent.

Reganit admits that they are still looking for ways to ensure that such rules would be strictly implemented. But he has said in a paper he wrote on the program: "The DOH remains committed to the delivery of public health services and would ensure that a possible two-tiered medical provision system between local and international patients is ideally avoided or realistically minimized. Any incident of discrimination against Filipino patients may affect the accreditation of partner hospitals and clinics."

The DOH is one of the Philippine Medical Tourism Program's lead agencies, along with the Department of Tourism and Department of Trade and Industry. The health department says medical tourism is a "multi-agency, multi-sectoral initiative" and a "public-private partnership" that requires collaborative work among government and private hospitals, specialty and wellness clinics, tourism associations, hotels and restaurants, retailers, transport and communication groups.

Created in 2004 through Executive Order 372, the program involves medical, surgical, and dental services; spa and wellness; traditional and alternative healthcare; and drug abuse treatment and rehabilitation. There will be "international medical zones" and "international retirement health zones." And if Thailand has the likes of Phuket for recuperating medical tourists, the Philippines offers picturesque places such as Boracay, Palawan, and Batanes.

"Our regional competitors — India, Thailand, Singapore, and Malaysia — are way ahead of us," says Reganit. "(But) the difference will be in the packages that we will offer (because) we do have exotic locales. So, once they had the surgery and they're ready to be discharged, they can recuperate in our best tourist spots."

Besides, despite a debilitating brain drain in the health sector, Reganit says the country can still boast of having some of the "best and the brightest" medical specialists who have had extensive training abroad.

De la Torre would probably agree; she says it was her doctor at St. Luke's who had first diagnosed her illness, which had given her aches and pains in her neck, back, and arms for a decade. When she sent St. Luke's findings to a friend in Cuba, which is known for its excellent healthcare system, the Cuban doctor who saw the hospital's name on the papers told her friend, "You shouldn't ask us anymore. They're one of the best."