RP: A new medical tourism haven

Medical tourism has been defined as the act of traveling to other countries to obtain medical, dental, and surgical care.

According to Wikipedia, it is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care. Medical tourism has become so popular that over 50 countries, including the Philippines, have identified medical tourism as a national industry.

The reason why people travel to other countries to get medical care is simple: cost. Offshore medical procedures can be performed for as little as one-tenth the cost of what would normally be charged in western countries like the United States. And yet the facilities offshore are state of the art, at least most of them. Many hospitals and clinics in the Philippines for instance are newer and have much better technology and equipment than hospitals in the United States. They are typically staffed by doctors and surgeons trained in Western medicine, and they provide equal or greater quality surgical care than US hospitals. These surgical procedures are performed with the same technology and expertise, yet cost a fraction of the price.

For example, a knee replacement surgery in a high-tech hospital in the Philippines performed by Western trained surgeons might only cost $6,000. In the United States you’re probably looking at $50,000. Heart bypass surgery in Asia costs around $10,000. In the US, it’s $60,000 to $80,000. Gastric bypass surgery in the US can cost $10,000 to $20,000. Overseas it can be done for well under $5,000.

According to an article by the University of Delaware publication, Udaily, the cost of surgery in India, Thailand or South Africa can be one-tenth of what it is in the US or Western Europe, and sometimes even less. A heart-valve replacement that would cost $200,000 or more in the US, for example, goes for $10,000 in India—and that includes round-trip airfare and a brief vacation package. Similarly, a metal-free dental bridge worth $5,500 in the US costs $500 in India, a knee replacement in Thailand with six days of physical therapy costs about one-fifth of what it would in the States, and Lasik eye surgery worth $3,700 in the US is available in many other countries for only $730. Cosmetic surgery savings are even greater: A full facelift that would cost $20,000 in the US runs about $1,250 in South Africa.

A combination of many factors has lead to the recent increase in popularity of medical tourism: exorbitant costs of healthcare in industrialized nations, ease and affordability of international travel, favorable currency exchange rates in the global economy, rapidly improving technology and standards of care in many countries of the world.

The Philippines has been growing as a tourist destination of choice for health and vacation because of its world class physicians, modern technology, and uniquely Filipino brand of caring and compassion at great values for money at a fraction of the cost in developed countries. It is home to some of the best hospitals and stand alone specialty clinics, offering world-class expertise, state-of-the-art facilities, and the distinct warmth of the Filipino hospitality. And of course, it has some of the world’s best spa retreat resorts and tour destination as added attractions.

A growing industry

Medical tourists can come from anywhere in the world, including Europe, the UK, Middle East, Japan, the US, and Canada. This is because of their large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care. An authority at the Harvard Business School recently stated that “medical tourism is promoted much more heavily in the UK than in the US.”

A forecast by Deloitte Consulting published in August 2008 projected that medical tourism originating in the US could jump by a factor of 10 over the next decade. An estimated 750,000 Americans went abroad for health care in 2007, and the report estimated that a million and a half would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.

A large draw to medical travel is convenience and speed. Countries that operate public health-care systems are often so taxed that it can take considerable time to get non-urgent medical care. The time spent waiting for a procedure such as a hip replacement can be a year or more in Britain and Canada; however, in Costa Rica, Singapore, Hong Kong, Thailand, Cuba, Colombia, Philippines or India, a patient could feasibly have an operation the day after their arrival. In Canada, the number of procedures in 2005 for which people were waiting was 782,936.

Popular medical travel worldwide destinations include Argentina, Brunei, Cuba, Colombia, Costa Rica, Hongkong, Hungary, India, Jordan, Lithuana, Malaysia, Philippines, Singapore, South Africa, Thailand, and recently, Saudi Arabia, UAE, Tunisia, and New Zealand.

In Europe, Belgium, Poland, and Slovakia are also breaking into the business. South Africa is taking the term “medical tourism” literally by promoting their medical safaris.

Not all good news

However, perceptions of medical tourism are not always positive. In places like the US, which has high standards of quality, medical tourism is viewed as risky. In some parts of the world, wider political issues can influence where medical tourists will choose to seek out health care.

Medical tourism carries some risks. Some countries, such as India, Malaysia, Costa Rica, or Thailand have very different infectious disease-related epidemiology to Europe and North America. Exposure to diseases without having built up natural immunity can be a hazard for weakened individuals, specifically with respect to gastrointestinal diseases (e.g Hepatitis A, amoebic dysentery, paratyphoid) which could weaken progress, mosquito-transmitted diseases, influenza, and tuberculosis. However, because in poor tropical nations diseases run the gamut, doctors seem to be more open to the possibility of considering any infectious disease, including HIV, TB, and typhoid, while there are cases in the West where patients were consistently misdiagnosed for years because such diseases are perceived to be “rare” in the West.

RP as a destination

The Philippines has been growing as a destination for medical tourism. The US Medical Tourism Association magazine reported that this services sub-sector grew eight percent in 2007. The Philippines is one of a few countries that sends qualified physicians and dentists to the US, a testament to its quality of medical education.

But how big an industry is medical tourism in the country? The local Department of Tourism and the Taylor, Nelson, and Sofres (TNS) research group are jointly undertaking a study on medical and health/wellness tourism in the Philippines. The study aims to gather baseline data on the gross receipts, number of medical tourists, and their average confinement period in DOT-accredited medical tourism facilities.

It is highly doubted however that the study will be able to capture the real extent of medical tourism in the Philippines, considering that there are very few DOT-accredited medical tourism facilities in the country. Also, due to the oftentimes highly confidential nature of the procedures done as well as doctor-patient confidentiality not to mention the tax implications of divulging a doctor’s real income, it is expected that the data that will be gathered by the study will be grossly understated.

The Philippines is no different from other medical tourism destinations – it can over the best and it can offer the worst. Botched medical procedures, sometimes causing deaths, have been reported but unfortunately, medical malpractice suits hardly prosper here.

The importance of regulation cannot be overemphasized. The DOT has a process of accrediting medical facilities. There is a law against illegal practice of medicine. Doctors face cancellation of their medical license for violations of the Medical Act. Unfortunately, there are many non-doctors who perform even complex procedures such as liposuction, rhinoplasty, to name a few. In some cases, these procedures are performed in small rooms at the back of beauty salons. They, therefore, cannot be regulated and this is where the problem often lies.

Check your doctor

But the fact that a doctor performs the procedure is not assurance of safety. Dr. Alex de Leon, an officer of the Philippine Association of Plastic Reconstructive and Aesthetic Surgeons (PAPRAS) and Dr. Reena Corona-Rosales, a fellow of the Philippine Dermatological Society (PDS), explain that not all doctors are board-certified. In order to be board-certified, a doctor has to undergo studies or trainings in hospitals or schools accredited by the Philippine Medical Association (PMA) in order to be eligible for tests conducted by PMA associations such as PAPRAS and PDS. PAPRAS is under the Philippine College of Surgeons and is the only recognized association of plastic reconstructive and aesthetic surgeons in the country. PDS on the one hand, is the only association recognized by the Philippine College of Physicians for dermatology practitioners.

De Leon and Corona, who have put up La Nouvelle Image, the first of its kind to be accredited both by the DOT and the Department of Health under the country’s medical tourism program as an ambulatory surgical clinic, advise those who plan to undergo surgery and even simple dermatological and beauty procedures to check whether their doctors are members in good standing of PMA-accredited associations, or in other words, board-certified.

The country’s best

The two used to work as a team while in private practice at the SM Megamall-based Clinica Manila until Reena decided to put up her own clinic in 2006 and tapped Alex as her business partner.

The partners scouted around for a suitable location for a clinic. They found it in The Linden Suites, a full service hotel along San Miguel Avenue in Pasig City. La Nouvelle Image, which formally inaugurated last year, is the very first skin and plastic surgery clinic in the Philippines manned by board-certified specialists and situated within a first-class hotel.

What eventually convinced Linden management, which at first was concerned about the administrative risks of having a clinic with an operating room within the hotel premises, was the fact that the two are specialty board-certified practitioners who have between them a total of 22 years of successful private practice to back them up as well as the idea of promoting medical tourism in the country.

Their proposal to The Linden Suites was based on a concept where the clinic would be part of a medical tourism package for visitors to the Philippines. “Our proposal revolved around the idea that within the next five years, the Philippines would become a focal center for medical tourism. It will have a very sizeable clientele base, a significant percentage of which would be our own balikbayans and foreign-based Filipinos,” Dr. Reena explains.

The idea of a hotel-based aesthetic clinic is not new. Dr. Reena notes that in other countries, they do it the other way around. They set up hotels for the clinics of the plastic surgeons and dermatologists.

Dr. Reena was immediately right in her choice of a location for the clinic. The past two Decembers have seen La Nouvelle Image receiving a very heartening number of balikbayan patients. A good number of them availed of the clinic’s packaged offerings that cover both the clinic’s aesthetic procedures and accommodations at The Linden Suites.

In running La Nouvelle Image, the two doctors have always kept in mind that their business activities should not compromise their primary calling as professional medical practitioners. This is probably the reason why they are adverse to the idea of advertising themselves, which is against medical ethics.

“We don’t render our services just for monetary considerations. Over and above business, we give primary to the integrity of our private practice. In fact, we do turn down some patients, such as when we see that they are not medically fit nor ready for the procedures they are asking for. We also refuse patients when we see that they are not psychologically fit for the procedure, based on the pre-operative consultation or assessment. The fact is that some patients want to have aesthetic procedures done on them for the wrong reasons,” Dr. Alex was quoted as saying.

Dr. Reena adds that they do not offer their services shotgun-style just for the sake of promoting the business side of it. “In fact, we are honest to a fault with our patients. We tell them what we can and cannot do for them and what their best options are, if any. And then we let them decide,” she said.

Dr. Alex and Dr. Reena are confident that the Philippines is well on its way to becoming one of the foremost medical tourism destinations. “But a lot remains to be done. Many prospective patients do not know where to go. Many are still concerned about the peace and order situation in the country and some still think that we are still a backward country. We feel that the country is not being promoted enough abroad as a medical tourism destination.”

But more importantly, the two people behind the highly successful La Nouvelle Image suggests that it is time that all government offices concerned step in and start looking into the unregulated practice of non-board certified doctors and worse, non-doctors. “They are giving medical tourism in the country a bad name,” they emphasized.