We’re not ready for medical tourism

Last Tuesday, I saw a television commercial, under the Incredible India campaign, that promotes medical tourism. It featured satisfied Western patients who had good words for the quality of Indian medical care. It also featured impressive looking medical facilities, similar to those we expect in the top medical centers of America. To the Indians, medical tourism is serious business.

By serious business, I mean more than press releases and speeches. The Indians have invested in expensive infrastructure like those modern medical centers with the latest in technology before they launched their program. India’s medical tourism industry could generate revenues of $2.1 billion a year by 2012, according to a report by McKinsey Consultants and the Confederation of Indian Industry, a business group.

As in our budding attempt at medical tourism, the Indian version’s main appeal is low-cost treatment by world class trained and certified doctors. Most estimates claim treatment costs in India start at around a tenth of the price of comparable treatment in America or Britain.

And they are not only talking of complicated heart surgeries but also simple procedures such as diagnostic services we know in our country as "executive check-up." According to a 2003 article at the Financial Times, one that includes blood tests, electro-cardiogram tests, chest x-rays, lung tests and abdominal ultrasound costs just $84 (or P4,200) at a Delhi-based healthcare company geared for medical tourism. Hmm. That’s a lot cheaper than here. The one I had here last year cost P40,000 for almost the same things.

I guess that raises the competitiveness issue right away. In the eagerness of Health Secretary Duque to produce a press release about a functioning medical tourism industry here, he may have neglected to check this matter of pricing competitiveness with India. His estimate of some $200 million earned by medical tourism last year is suspect. Dr. Vicki Belo couldn’t have performed that many tummy tucks on foreigners.

While I am very much in favor of a program that would put the Philippines in the map as a world class provider of health care, I think we ought to do our homework first before we put out the "open for business" sign. As in the case of regular tourism, let us put up the infrastructure first.

If you have gotten sick lately that was serious enough to require hospital stay, you would know that getting a room or even a bed requires a lot of prayers. It is a fact that we do not have enough hospital beds in this country, even in Metro Manila. And I do not mean just charity beds. The big hospitals here are almost always fully occupied.

Coming from a family of doctors, I will be the first to say that I believe Filipino doctors are among the world’s best. But we may not have enough qualified, world class certified health professionals in town if we are honestly going to pursue this program. Many of these certified world’s best doctors who happen to be Filipinos are working abroad. Or if they are here, they are already terribly busy with their local patients as it is.

Anyone who has waited hours to see his doctor know what I am saying. Just look at the long lines of patients in the waiting rooms of doctors. There was a time I had to wait three hours to see my cardiologist. It seems they have too many patients in too many hospitals and given the difficulty of negotiating Manila’s traffic between Makati and Ortigas or Alabang and Quezon City, one can understand the demands on the time of our doctors. Yet, these are the very same doctors who would most likely be called upon to see the medical tourists.

Unlike India, we have not been sending our young doctors for training abroad in the last 20 years or so. We no longer have as many doctors certified by foreign specialty boards. And the ones who are I have talked to say they are discouraged to return home because of the inhospitable reception of our local specialty boards. Purely local trained doctors may be as good as the foreign trained ones but medical tourists and their HMOs will want foreign specialty board certified ones or they will go to India.

With nurses, I get the impression the best of them almost immediately leave for work abroad. The phenomenal growth in the number of sub standard nursing schools that are unable to provide the proper in-hospital training for their students means nursing care can’t be that good. High turnover means the hospitals are forever on training mode for their nurses.

The worst part of Secretary Duque’s plan is the part that calls for the conversion of the government owned specialty hospitals like the Heart Center and Kidney Center for medical tourism. The part about upgrading their facilities is welcome. But I am worried that after these facilities start catering to foreign exchange paying patients, ordinary Filipinos would have lost the chance to avail of reasonably priced medical services they are now able to access.

You can see even now how bad this purely for profit orientation of the medical tourism business can be. Look at that St. Luke’s Hospital they are trying to build at Fort Bonifacio. They refuse to pay taxes on the ground that they are a foundation but they also refuse to provide for charity beds. I fully support Taguig Mayor Tinga for standing his ground that St Luke’s can’t have it both ways.

Making money out of the medical profession is alright. I can understand why doctors who invested a lot of time and money sharpening their skills must be given the proper payback. But when businessmen (who are not doctors), such as those in the St Luke’s board, start putting money ahead of humanity, the noble profession of medicine loses its luster.

Even in India, the International Herald Tribune reports, many Indian doctors are growing angry at the government’s focus on medical tourism while the health of a large portion of India’s population is neglected. "This has prompted an argument between those who assert that medical tourism benefits the Indian health-care system by improving its standards and those who say the practice worsens disparities in the distribution of health care that are already critical."

Doctors in India are now divided on the issue. Many take pride in the rising standards at the top end of the profession and see the arrival of medical tourists as an endorsement of health care excellence. Advocates of medical tourism, the IHT reports, say it pushes up standards within the Indian medical profession and contend that there will be a trickle-down effect to local services from the high-class medical centers being built to cater to the elite of India and to foreigners.

But the class divide is serious so that IHT reports the Health Ministry is now reluctant to publicize its work in this area out of worries over inequality of access. "In India, all rich people now go private, so there is no pressure on the government to improve the public health system," an Indian doctor observed. We can say pretty much the same thing happening here and that would be aggravated by medical tourism.

A few kilometers from a medical tourism facility is the All-India Institute of Medical Sciences, considered the best public hospital in India. It underscores the divisions within the Indian health care system. Corridors are grimy and rooms are poorly lighted, patients crowd the waiting rooms and the staff looks harassed. Wow. Sounds like the PGH, the best public hospital in our country.

It is unlikely that the money brought in by foreigners would raise standards and cross-subsidize the public sector, as our current experience with the St Luke’s Fort Bonifacio project is proving. What’s also happening is that our health secretary’s attention is being distracted by this very "photogenic" project to the detriment of his real duty to raise the standards in our public hospitals.

When health department investigators chose to file charges against government doctors running the Rizal Medical Center for the death of infants from what could have been hospital acquired infection, they should have included the health secretary’s name as well. In my mind, the health secretary is more culpable for the break down of standards in poorly funded public hospitals than the poor resident doctors who are just making do with the little they are given.

Medical tourism is a great idea. But before we jump into the bandwagon, let us first make sure we do not aggravate present problems in domestic health care delivery and that we have the stamina and the determination to be good at it for the long term. To Secretary Duque, a student of my father at UST College of Medicine, a nice press release earns you transient pogi points with Ate Glue but don’t forget the basics that underline it.

Pre-flight inspection

Got this one from Pinky Diokno.

A flight attendant was stationed at the departure gate to check tickets. As a man approached, she extended her hand for the ticket and he opened his trench coat and flashed her.

Without missing a beat, she said, "Sir, I need to see your ticket… not your stub."

Boo Chanco’s e-mail address is [email protected]