By Alma Anonas-Carpio

Despite having built the first specialty hospitals in Southeast Asia and having been a medical tourism destination since the 1970s, way before the term "medical tourism" had even been coined, the Philippines lags behind its Asian neighbors who also offer healthcare services to foreign visitors.

A Department of Health (DOH) official told the Philippines Graphic in an interview that while the Philippines still has good chances of making it as a medical tourism hub, there are some problems that need solving and misconceptions that must be cleared up before this can happen.

DOH medical tourism program manager Dr. Anthony Calibo said the Philippines has been a destination for balikbayan and foreign visitors who seek the expertise and skill of Filipino medical professionals. Calibo has been handling the government’s medical tourism program for one year now.

"Even before the term medical tourism was coined, many Filipinos who had migrated overseas and many foreigners would come here to seek treatment at the government’s specialty hospitals—the National Kidney and Transplant Institute, Philippine Heart Center, Lung Center of the Philippines, the Philippine Children’s Medical Center and the East Avenue Medical Center, as well as at the country’s private tertiary hospitals," Calibo said. "We have been a destination for patients seeking expert medical care since the 1970s."

"Our number one clients are Filipinos based abroad—our OFWs (Overseas Filipino workers), migrant Filipinos who married foreigners but still prefer treatment by Filipino doctors and at Filipino hospitals—they are our natural market. We are improving (medical) facilities for these balikbayan as well as for foreigners," Calibo said. "Mainly, we want to provide a medical balikbayan welcome."

As of now, tertiary hospitals, specialty clinics and spas make up the bulk of service providers for the medical tourism industry in the Philippines, he said, adding that this new industry does not serve a "purely cosmetic" purpose, but offers "a balance of services available in hospitals" as well.

In the future, he added, the government is aiming to encourage the growth of "medical tourism ecozones"—medical complexes that integrate everything, such as the one St. Luke’s Medical Center (SLMC) is building at the Fort Bonifacio Global City and the oncology—centric St. Francis Cabrini Medical Center under construction in the town of Sto. Tomas, Batangas. These types of facilities, Calibo said, "will receive income tax holidays and enjoy duty-free importation of medical equipment."

Singapore has been particularly aggressive in promoting its medical tourism industry and officials of the Singapore Tourism Board and Singapore’s hospitals have been making annual sorties to Manila to promote their brand of medical tourism.

No take-off

"The story about how good the Philippines is in delivering medical services has not taken off," Calibo said, despite concerted efforts by the government and various private sector groups to promote the Philippines as a medical tourism hub.

He cited labor problems at the top of a list of ailments that plague the growth of the country’s medical tourism industry—including the migration of medical professionals to greener pastures, poor incentives and pay for the medical professionals who do stay and an imbalance in the number of medical professionals in given specializations vis-a-vis the demand for such specialized professionals.

He underscored the need to improve infrastructure and practices among the locals to support medical tourism. "We need to improve our airport facilities and our roads, as well as provide a clean, attractive environment for tourists in general and medical tourists in particular. In a general sense, (the Philippines) has to be a good tourism destination," Calibo said.

"We already have good healthcare facilities and that alone will lure foreigners to come here," he noted. "These (medical) facilities should be complemented by good tourism facilities—good roads, good environmental sanitation, peace and order, road discipline, good airports. Our environs are clearly interrelated—and our environs and tourist facilities could stand improvement."

Calibo said that, while medical tourism is seen as one way of stanching the country’s brain drain of doctors, nurses and paramedical support staff, "health human resources has been one of the critical issues involved in medical tourism. The lack of healthcare professionals like doctors, nurses and paramedical staff is a very important issue here."

Many private hospitals, he added, need to improve the pay scales for these medical professionals "who have studied long and hard to train for their professions" and to provide incentives that will persuade them to stay in the country instead of migrating to countries where they can earn better.

Medical access gap

The perception of a "medical access" gap—one where poor and indigent Filipinos are unable to gain access to vital healthcare services while "rich foreigners" are able to fly into the Philippines, get quality medical and VIP treatment and fly back out again—is a negative view that hampers the government’s efforts to promote medical tourism to the Philippines, Calibo said.

He also said that "it would be unfair to say medical tourism causes an increase in hospital fees," though the new, hotel-like look of many refurbished hospital lobbies may point in that direction. Calibo said it is mainly "economic factors that dictate inflation and cost of operation, which will dictate any increase in hospital rates per day, not just the redecoration investments by hospitals that seek to follow the medical tourism trend."

According to DOH estimates, he said, balikbayans and foreigners visiting the Philippines for medical treatment make up "less than one percent of total (patient occupancy) in private hospitals," so there is no danger that the growth of the medical tourism industry will deprive Filipinos of access to quality healthcare.

The natives’ lack of access to adequate healthcare services at medical facilities and from medical professionals may also not be a "brain drain problem" as much as a distribution problem, he noted.

"There is no readily accessible database that I can use, but I can share my observation that the problem in terms of professionals able to render medical services is mostly geographic in nature—the lack of doctors in some areas is a problem, but this is not just because we do not have enough doctors," Calibo said.

"It may be because we do not have enough medical professionals who meet the needs of a given community in one area and too many practitioners in another."

He said the DOH is working to address the problems of poor medical personnel deployment through the health Human Resource Development Bureau headed by Dr. Kenneth Ronquillo. "This bureau is working to put together a database of medical professionals and their specializations and locations so we can determine where the gaps that need filling are."

Calibo added that "once this project is complete, we will know where the surpluses are and in which areas we need to train more doctors, nurses and paramedical staff. Right now, we just have the PRC to monitor license renewals and issuances of new licenses for medical professionals, but that will not tell us conclusively what we need to know to solve this labor problem."

He also called for an increase in the national budget allocation for healthcare services "to improve the healthcare situation in the Philippines. We need to address public health issues side by side with any improvements we make to existing medical and clinical practices here—including medical tourism."

Local government units and communities can also help improve their own access to healthcare and medical professionals by "making it more attractive for doctors, dentists, nurses and other health services professionals to open up shop in their communities by offering quick business permit processing and, where possible, tax incentives."

Kidney problems

Another negative perception about medical tourism in the Philippines is that this is a country where kidneys for transplant are sold on the black market by poor Filipinos who receive but a fraction of the price charged by black market middlemen for their kidneys.

News articles and photos capturing images of the black market sale of kidneys triggered a DOH clampdown earlier this year, when Health Secretary Francisco Duque III issued a moratorium on kidney transplants to foreigners in the Philippines.

"Clearly, from the inception of the medical tourism program, we never advertised kidney transplants as part of the program," Calibo said. "Kidney transplantation has been one of the problems that hounded the healthcare system even before the government began working to promote medical tourism. The problem is the underground people operating illegal transactions brokering the sale of kidneys for transplant."

He also praised DOH Secretary Duque’s move suspending kidney transplants for foreigners, adding that government agencies and private entities that are working to promote medical tourism "are not involved in this heinous activity." He said the black market trade in kidneys "has made RP health professionals less worthy in the global arena."

Competition

The Philippines also faces stiff competition from its Asian neighbors, particularly Singapore, Malaysia, Thailand and India, which, he said indicates the need to "improve how the (Philippines) is being projected and how the Department of Tourism (DOT) is able to market the Philippines as a medical tourism hub.

Singapore has been particularly aggressive in promoting its medical tourism industry and officials of the Singapore Tourism Board and Singapore’s hospitals have been making annual sorties to Manila to promote their brand of medical tourism. Calibo also suspects that the Singaporeans "are here to head-hunt for Filipino medical professionals who can work there."

Calibo recalled a statement made by his immediate superior, Health Undersecretary Jade del Mundo, at the Medical Tourism Asia 2008 conference at Sentosa island in Singapore, where del Mundo noted that majority of hospitals worldwide are "staffed by Filipino health professionals. Without Filipino health professionals, these hospitals will collapse."

He said "Singapore promotes its hospital-based services as being ‘higher than Level III healthcare,’ whereas the Philippines offers health and wellness services that cover hospitals, the ambulatory medical (outpatient) sector, wellness with spas and resorts and retirement services." The island-state’s main selling point for its medical tourism marketing thrust is that Chinese traditional medicine therapies are offered in a scientific and modern way.

India is marketing its ayurvedic and homeopathic traditions as part of its medical tourism offerings and Thailand has found its niche as a cosmetic surgery, gender reassignment surgery and spa service hub.

Neither Singapore nor Thailand, however, offers the scope and breadth of medical services, spa and wellness services and retirement services that the Philippines does, Calibo said.

According to him, the Philippines is "looking at delivering the whole spectrum of services—our hilot is part of our wellness services in a relaxing and non-therapeutic modality. This is how different the Philippines is, how it is able to compete with other countries right now. We are covering more ground than these countries, which often offer only their hospital-based services, with a few spa services on the side."

The services offered by Philippine hospitals participating in the medical tourism industry "depend on hospital’s capability and on what the foreign clientele want," Calibo said. Many balikbayan and foreign patients seek services in "hypertension and ischemic heart disease management, diabetes control, oncology, treatment for degenerative diseases like arthritis—particularly joint replacement and spinal surgery, diet management and urogynecology."

Outpatient offerings include cosmetic procedures like dermatologic surgery, oral surgery and aesthetic dentistry, as well as and ophthalmologic procedures like LASIK eye surgery, he said.

As far as costs are concerned, Calibo said that while the DOH and DOT "don’t use the term ‘cheap’ or ‘lower rates,’ we say there is value for money services and we are competitive enough against Singapore, India, Thailand and Malaysia.

Four gateways, with more on the way

Problems aside, the Philippines is in the competition and will not waver, Calibo said adding that the country offers more than one "gateway for health and fitness." He also said "Metro Manila, Cebu City, Subic and Clark and Davao City are all international access points, thanks to their own international airports."

Of the four existing medical tourism hubs, he said, "the Central Visayas (Cebu) has been very aggressive and very dynamic in their efforts to concretize plans for the area, plus there is the Cebu Health and Wellness Council which meets regularly to address issues on health and wellness tourism."

It is this dynamism, he added, that makes Cebu stand out as one of the Philippines’s medical tourism hubs, though medical tourism is "not a monopoly of Cebu. In late 2007, the Central Luzon area’s DOH Center for Health Development, through Regional Director Dr. Rio Magpantay, convened government agencies and the private sector on plans to also maximize the potential of Central Luzon as a medical tourism hub, primarily because of Subic and Clark."

In Metro Manila, private hospitals like SLMC, Makati Medical Center, Medical City and Asian Hospital have already taken the initiative to branch out into medical tourism by upgrading their equipment, refurbishing their premises and offering medical procedures that will attract tourists seeking healthcare services.

SLMC and Medical City have both gained accreditation from the US-based Joint Commission International, which evaluates the quality of healthcare services in hospitals located outside the US. As far as marketing efforts are concerned, Calibo said SLMC has been marketing its services to Micronesia and to Filipino-Americans who may want to come home for treatment and a vacation—a move replicated by Medical City and Asian Hospital.

While the government’s five specialty hospitals are included in the roster of facilities where foreigners can receive the best possible treatment, Calibo said other government hospitals must be brought up to speed if they are to contribute to the government’s efforts to turn the Philippines into a medical tourism haven.

He noted that del Mundo "sees that it is equally important to improve the technology, healthcare delivery, services and quality of healthcare in government hospitals" adding that "initiatives to reorient healthcare delivery for these hospitals" are now underway through a public-private cooperation between hospitals which has the medical professionals in private hospitals sharing expertise with their counterparts in DOH-run facilities.

Improvements in the DOH-run hospitals’ management and service delivery, he added, "will benefit local residents as well as tourists seeking medical treatment. They will also enable the Philippines to compete globally in the medical tourism arena."

While the road to successfully promoting the Philippines as the place to go for medical tourism is still long, there are many people and things that make the effort the government is putting behind this push worthwhile. Calibo said: "We have a very beautiful country, very hospitable people and highly-skilled medical professionals who are world-renowned for their skill and capacity for caring."

What remains is to remove the obstacles that make competing with the world’s other medical tourism hubs that much more difficult. He added: "Build or improve the infrastructure that greets our visitors, offer tertiary hospitals and specialty clinics good incentives to offer top-notch medical tourism services, offer medical professionals competitive compensation and make sure that the world remembers that the Philippines is a place where they can find excellent and caring healers." G

* I researched, interviewed people for and wrote this piece which came out in the latest issue of the Philippines Graphic Magazine. I also did the sidebar story, which will be posted shortly.