Medical tourism is touted by the government as an avenue for arresting and, possibly reversing, the brain drain that has Filipino doctors training to be nurses so they can seek greener pastures overseas.

This is also the reason why many private tertiary hospitals like the St. Luke’s Medical Center, Asian Hospital and Medical City are starting to look and feel more like five-star hotels, from the improved food served to patients to the huge floral arrangements and elegant interior décor of their lobbies.

Medical tourism is also seen as a way to boost the country’s tourism earnings by leveraging on both the country’s scenic spots and world-renowned hospitality as well as on the famed excellence of Filipino doctors, nurses and medical support staff which have made the Philippines a favorite recruiting spot for foreign hospital headhunters over the last two decades.

For Department of Health (DOH) medical tourism program manager Dr. Anthony Calibo, however, medical tourism is but one component needed in a larger strategy to stanch the brain drain.

Calibo advocates that local medical centers and clinics should "offer doctors a good living back home (as) a possible means of luring our health professionals back in a brain gain strategy."

Better opportunities: A good start

Offering better revenue opportunities for medical professionals through medical tourism "cannot purely answer the issue of brain drain because our present healthcare system should adequately address compensation to the healthcare professional. The income should be transferred equitably to medical residents and fellows, nurses and paramedical professionals—because they are not adequately compensated," especially since medical professionals must undergo "long years of study and pay high matriculation fees just to qualify for their chosen professions."

According to Calibo, most medical professionals who are just beginning their careers in private hospitals often get paid minimum wage or lower. "In terms of government hospitals, it is different because of the DOH plantilla," which dictates slightly higher starting pay grades. "For private hospitals, I have yet to see the income earned by hospitals being felt by the doctors and medical professionals who work there. I would not say (these hospitals) are underpaying their people, but the salaries can be improved. The income overseas is still more attractive."

Besides improving compensation, Calibo said there is a need to "improve training systems and to provide opportunities for medical personnel to establish their practices in areas where their specialized skills are needed" through tax breaks and other incentives that local government units and communities can provide.

He also noted that the Medical Act of 1959 "needs to be overhauled" to benefit the workers in the healthcare industry and ensure that ongoing professional training for these practitioners is institutionalized.

He said progress in the country’s medical tourism industry "should translate into improving financial compensation for hospital employees. There should be a concept of reintegration for technology and technology transfer back home" so Filipino medical professionals working overseas will want to return home.

Calibo said the country’s five specialty hospitals and some private tertiary medical facilities and specialty clinics are already DOH-certified as centers for medical tourism, with more such institutions awaiting certification.

Basic requirements

Calibo outlined the requirements each specialty clinic and tertiary medical care facility must meet to gain the DOH stamp of approval to operate as facilities for medical tourism. Each facility must send a letter of intent addressed to Health Undersecretary Dr. Jade F. Del Mundo, as well as already hold the appropriate government licenses and permits—such as the DOH licenses to operate, environmental clearance certificates, SEC registration, articles of incorporation, a listing of corporate officers and business entity as well as bank certificates and assets.

The application to the DOH must also be accompanied by a vicinity map, physical description of the land, buildings and facilities—with photographs of these facilities and location.

The facility seeking the DOH stamp of approval also needs to furnish Del Mundo with a list and brief description of the services they intend to offer, including treatment modalities, system of applications, therapies and the rationales, philosophies and bases for special therapies they seek to offer.

These medical facilities must also include a list of their other amenities—i.e. inter-national patient assistance center, restaurants, gift shops, spa facilities, specialty stores, flower shops and the like, as well as provide a database of professional medical staff with their complete resumés.

To qualify as medical tourism centers, these hospitals and specialty clinics should also have certificates of compliance with Department of Tourism guidelines and have a Certificate of Need for Medical Tourism Facility (from DOH-CHD), in the case of institutions located in tourism areas.

Pleasant surroundings

The DOH also requires medical facilities seeking inclusion on the government list of medical tourism facilities to be located "in a place with a pleasant environment suitable for a tertiary hospital and that "the facade, architectural features and general construction of the building shall have the distinctive qualities of a tertiary hospital."

Medical tourism facilities should have private and suite rooms with bathrooms "equipped with fittings of the highest quality, with 24-hour service of hot and cold running water; showers and bathroom essentials." The floors and walls of such rooms should also be "covered with impervious material of good design and high quality workmanship."

These facilities should also have telephones "with DDD and IDD lines in each private and suite room" and "cable television in each private and suite room." Hot and cold drinking water and glasses should also be provided for each room, as well as a refrigerator and 24-hour room service "including provisions for snacks, light refreshments and special diet based on guest’s/patient’s specific request."

"All suite rooms shall have adequate furniture of good quality and design; lighting arrangements and fixtures in the room and bathroom shall be so designed to ensure aesthetic as well as functional excellence," the DOH list of requirements adds.

The DOH also requires that hospital services and information "shall be prominently displayed in each bedroom including food and beverage outlets and hours of operation, fire exit guidelines and house rules for guests" and that "there shall be a reception, information counter, and/or guest relation office providing a 24-hour service and attended by highly qualified, trained and experienced staff."

Medical and medical support staff at these facilities should also be "professionally qualified, highly trained, experienced, efficient and courteous."

The DOH minimum requirements list includes provisions that "there shall be a well-designed lounge with seating facilities, the size of which is commensurate with the size of the hospital" and 24-hour porter service as well as a "foreign exchange counter within the hospital premises" and "IDD and DDD public phone facilities" located strategically on each floor of the hospital.

Tourist facilities, high standards, good food

The health agency also requires that "there shall be a secured left-luggage room and safety deposit box within the hospital" and "a business center equipped with office equipment (e.g. fax machine, computer, telephone, etc.) and providing secretarial service and mailing services."

Housekeeping in these facilities should be "of the highest possible standard" with adequate supplies of linen, blankets and towels "of the highest quality and shall be spotlessly clean." These linens and towels must be changed "daily and as needed" and laundry and dry-cleaning services should also be available to patients and guests.

Besides offering the highest quality rooms, furnishings, linens and services, tertiary hospitals seeking to offer medical tourism services should also have "a well-equipped, well-furnished and well-maintained, restaurant in the hospital serving both international and Filipino cuisine"—not just the nutritious but bland affair that is ordinary hospital food.

To qualify for inclusion in the local list of medical tourism facilities, a tertiary hospital must have a professionally designed kitchen, pantry and cold storage that is "well-equipped, well-maintained, clean and hygienic." The kitchen "shall have an adequate floor area with non-slip flooring and tiled walls and adequate light and ventilation" as well as an "ample supply of kitchen pots and utensils." These utensils and wares should not be "chipped, cracked or grazed" and "the dining and silverware shall be kept well-plated and polished at all times."

The DOH also requires the kitchen staff on duty in these hospitals to "wear hair nets/caps while preparing food; and room service food staff shall wear hair nets/caps while serving."

Hospital maintenance

To qualify for inclusion on the medical tourism list, tertiary hospitals should ensure that all sections of their hospitals are "properly maintained at all times" and have "efficient and adequate ventilation in all areas of the hospital."

There should also be "adequate lighting in all public and private areas" and "a high-powered stand-by generator capable of providing full automatic power in all service areas of the hospital."

Each room of these hospitals are required to have "three garbage receptacles—one each room for biodegradable, non biodegradable and infectious wastes."

These hospitals should also have an elevator "designated for the exclusive use of patients; guests and staff; and for service purposes of the hospital." They should also have "an adequate and secured parking area. If necessary, a valet service shall be provided," as well as "a sundries shop in the hospital."

Security at these facilities should be adequate and maintained "on a 24-hour basis" at "all entrances and exits of the hospital premises. Likewise, a central circuit television shall be installed in each floor of the hospital."

"Limousine service, airport transfers and air ambulance service" should also be made "available upon request." Interpreters "fluent in Nihonggo, Mandarin, Korean, Cantonese and other foreign languages should also be available upon request.

The DOH also requires that hospitals seeking inclusion on the medical tourism list have computerized billing and payment processes and credit card payment capability."

There should also be "clean and presentable public washrooms with running water in every floor of the hospital" and a waiting lounge for all service units.

Once all these requirements have been complied with, Calibo said, "an inspection of the institution will be scheduled."

Because the Philippines is looking at creating several medical tourism hubs, Calibo also furnished the Philippines Graphic with the requirements for endorsement to the Philippine Economic Zone Authority given areas may register as medical tourism economic zones if they secure a DOH license to operate and PhilHealth accreditation, as well as an endorsement from the DOT, over and above the requirements that tertiary hospitals and specialty clinics in this vicinity may already have obtained.

Noting that industrialists like Manny Pangilinan and Lucio Tan have begun investing in private hospitals like the Makati Medical Center (MMC) and Cardinal Santos Medical Center, Calibo said the "major advantage of businessmen taking over medical facilities "is that they can infuse investment and money to pump-prime these hospitals to improve management and operations."

SLMC, he added, "came out of bank-ruptcy through the efforts of (lawyer) William Quasha." In Calibo’s opinion, "hospital administration requires more than just the brilliance of a hospital administration... hospitals should be transformed into a corporation-like entity so it is managed with the efficiency of corporation. There is a tremendous shift in making hospitals this way."

"It is noteworthy that, despite the impact of these hospitals transforming into mini-financial institutions, so to speak, these hospitals should be reminded of their corporate social responsibility—they should still be able to allocate a portion of their income to social service delivery for indigent patients and those who can ill-afford the rising cost of healthcare," Calibo added, noting that "SLMC has a social service department where patients can be admitted to the ward and the quality of service is not diminished though they pay a minimal fee," and that the MMC still provides high-quality treatment for the yellow card patients of Makati City.

Queries about the Philippine Medical Tourism Program may be directed to the DOH Office for Special Concerns. Interested parties may call the following telephone numbers: 781-4353; 743-8301 local 1142 · 1145; telefax 711-6075. They may also contact Calibo at (0927) 336-2127 or send their questions by email to apcalibo@doh.gov.ph. (Alma Anonas-Carpio) G

* This is the sidebar to Philippines Graphic's cover story this week (also written by me). :)