Medical tourism?

NOTICE how in both English and Tagalog we use innocuous words to describe "HOSPITAL sets sights on Manila," read the headline.

I wouldn't have given the article too much attention except that it appeared in The Nation, an English-language daily newspaper in Bangkok. The article, which came out last week, disclosed that Bumrungrad, one of the largest hospitals in Thailand, was planning to invest some $9.2 million in Asian Hospital and Medical Center in Manila's Alabang suburb, representing a 40-percent stake in the Filipino hospital.

Because of frequent trips to Thailand, the name Bumrungrad was familiar. I knew it was a major player in Thai medical tourism, offering all kinds of medical packages for foreigners. Could Bumrungrad's move with the Asian Hospital be part of an expansion of its medical tourism package into the Southeast Asian region?

What does this mean for the Philippines' own plans for medical tourism? Maybe even more crucially, do we want to compete for this emerging niche in the global market?

Executive health packages

Let's look first at what medical tourism is all about.

Until fairly recently, people looked at Third World countries and its hospitals as inferior imitations of those in developed countries. Western expatriates as well as wealthier Third World "natives" would fly to the United States for something as simple as an executive check-up, having very little trust in local hospitals or doctors.

In the past 30 years or so, the costs of health care have soared in developed countries, especially the United States. Americans and, to some extent, the British, Canadians, Australians began to look for ways to reduce these expenses. Certain services and procedures in American hospitals are now being contracted out to Third World countries, from transcriptions of medical records to the reading of X-rays.

With medical tourism, the patient is literally "outsourced" -- packed off and sent to countries like Thailand on executive packages that offer, besides the medical services, all kinds of services. Bumrungrad's website offers perks like "roundtrip airport transport, welcome massage, cell phone, half-day Bangkok orientation tour, two round trips to hospital with hospital outpatient registration and process orientation plus 24/7 assistance for your entire stay in Thailand"!

The Bumrungrad website lists rates for some medical services. Need a coronary angiogram? That's about $3,000, including two nights in a single room. An elective Caesarean section? That's about $1,000, including four nights in a single room. Breast augmentation with smooth saline implant costs about $2,000, including one night in a single room.

Plastic surgery is actually quite big in Thailand. When you land in Bangkok's airport, the free maps carry many ads of clinics offering these procedures. One map I got, for example, had an ad from Bangmod Hospital offering breast implants, abdominoplasty (tummy tucks), liposuction, face lift, double eyelid surgery, nose implant, laser skin resurfacing and... sex reassignment surgery.

These rates are very low compared to what you'd pay in the United States, Europe or Australia. As Bumrungrad's hard sell goes, the savings from one root canal performed in Thailand actually gives you extra money for a luxury vacation. Their website has this blurb that pretty much summarizes the business of medical tourism: "We can schedule shopping excursions, river tours, ancient site tours, trips to nearby beaches... all around your medical appointment schedule."

Faith healers

The Philippines probably beat other countries to this idea of medical tourism bit many years ago. I recall how in the 1970s, faith healers like Tony Agpaoa were already offering tour packages for people coming in from Europe and Japan who wanted the faith healers' services. Agpaoa even had his own little hotel in Baguio City so patients didn't have to look for their own accommodations. The faith healing packages eventually went into decline, and last I heard, it was our faith healers who were going to Eastern European countries to do their road-show healing.

Earlier this year, then secretary of tourism Roberto Pagdanganan announced that the Department of Tourism was teaming up with the Department of Health, specifically the Philippine Institute of Traditional and Alternative Health Care, to promote medical tourism. At that time, he said only the St. Luke's hospital had been accredited for their program but Asian Hospital, Capitol Medical Center, and Medical City had also applied.

So, do we want to pursue this medical tourism track?

I think there's potential here. Some of our hospitals, and health professionals, can match those in the United States; after all, we've been exporting our doctors and nurses there for 50 years now. Our medical and nursing curricula are certainly tougher than many of our neighbors' in Southeast Asia. Who knows, maybe medical tourism can convince a few more Filipino health professionals to stay rather than migrate.

On the "tourism" side, we do have a long way to go. It's hard to compete with our neighboring countries' tourist attractions, given their edge of a few hundred years with temples and palaces. On the other hand, we do have lots of untapped potential, with our nature spots and, of course, we do have an edge in terms of greater fluency in English, which is so important for a service industry of this type.

Reservations

I do have my reservations about medical tourism. My main concern is that it might distort our priorities. Just look at our flight attendants and the way they smile and kowtow to foreign flyers, constantly asking them if they need anything. Compare that to the scowl that greets you, a mere fellow Filipino, if you have the temerity to ask for water.
Bring that kind of discrimination into our entire health care system and you can imagine what could happen.

I worry, too, about the bandwagon effect of every hospital trying to get into the act. If quality is not maintained, our medical tourism program could be shot down even before it takes off. All you need is a few well-publicized complaints of botched medical procedures from the visitors and we're finished.

Remember, too, there's the "tourism" angle to this. A foreign patient may be totally pleased with the medical services, but if he or she is mugged while out on a shopping trip or overcharged at some tourist trap, then they're likely to discourage friends from coming here.

We should be realistic though. Medical tourism isn't going to bring in huge revenues. Neither will it save our health care system from its present dismal state. But if we get our priorities right, medical tourism could help somewhat to serve the needs of Filipinos, with revenues derived from it going back into improving equipment and services and, in a sense, subsidizing costs for indigent patients.