For an Administration which sometimes seems chronically under fire and a step behind its Asian neighbors, the Philippines' nascent Medical Tourism Program could possibly be the cure for many ills, despite some criticism and yet-unanswered questions about its long-term benefits.

Under a program authorized by Executive Order 372 in October 2004, the Philippines has begun to tap into the rapidly growing medical tourism industry. A task force of public agencies and private health industry interests under the joint direction of the Department of Health, the Department of Tourism, and the Department of Trade and Industry, was formally introduced in January 2006, and then again in a splashy 'Grand Launch'� last November. According to the PMTP's official website, the initiative is 'aimed at attracting foreign clients to the Philippines for needed medical care as well as health and wellness services coupled with sightseeing tours, vacation, and shopping packages.'� According to Secretary of Health Francisco Duque III, the benefits to this, apart from a potentially huge influx of foreign money, are cheaper costs of medical services in the country, expansion of services for poor and underprivileged Filipinos, and slowing, if not stopping entirely, the migration of doctors and nurses to other countries. Critics of the program, however, are concerned that the benefits might not actually trickle down into the lower levels of the Philippines' public health system, and might in fact cause entirely new problems.

No one is arguing that the opportunity isn't there. Estimates of the total value of the medical tourism industry range from $10 billion to $40 billion per year between now and 2010, and the International Trade Commission in Geneva has made the staggering prediction of $188 billion per year by 2013. Thailand, the regional front-runner in the medical tourist trade, is seeing about $1 billion per year from the industry, with 55,000 patient visitors from the United States alone in 2006.
Affordability is perhaps the major factor driving the industry. For an aging population in the United States faced with ever-increasing health care costs, a savings of 40 to 70 percent on medical procedures is an attractive prospect. In other countries such as the United Kingdom and Canada, availability of treatment is a consideration; waiting periods for non-emergency procedures are routinely 18 months or longer.
But according to Rudy Rupak, President of PlanetHospital, a California-based medical tourism facilitator, price is not just the only consideration. 'Healthcare outsourcing used to be about cost savings,'� he says, 'Now it is about getting value for money also, and finding doctors who are willing to perform techniques that most doctors in the western countries would not.'� PlanetHospital currently sends patients to six countries, among them India, Singapore, and Thailand. Rupak, who says his company's sales are increasing by 50 percent each month, was recently visited by a 19-member delegation from the Philippines. To date very few clients have inquired about the Philippines, but he believes things are about to change. 'I expect to visit soon and promote the Philippines widely,'� he says.

Good news for the PMTP, but is the Philippines ready to set out the welcome mat for ailing visitors? Assistant Secretary Cynthia Carrion and Director Cynthia Lazo of the Department of Tourism certainly think so. As the leaders of the program for the DOT, Carrion and Lazo lay claim to most of the responsibility of making medical tourism work, and their enthusiasm for the project is unquestionable. They take exception to what they see as critics' overemphasis on the public health issues. 'I would rather call it Wellness Tourism,'� Secretary Carrion says. 'It really is more than just hospitals and doctors.'�
Lazo explains, 'This is really a culture-based program. We have a culture of healing and caring, whether through traditional medicine like our hilots, our culture of caring for our elderly parents and grandparents, or in our health care people, who are known for their compassion and resourcefulness.'� As Carrion and Lazo see it, all the elements to a complete wellness culture, involving not only doctors and hospitals, but also spas and retirement services, are already in place. All they have to do is to figure out how to get visitors to come and take advantage of them.
Hardly anyone can argue that increasing tourism is a bad thing, so most of the criticism centers on the public health issue. Dr. Salvador S. Geluz, an Internist in Cavite, scoffs at the notion that medical tourism will do anything but widen the gap between those who can afford proper medical care and those who cannot. For starters, he has little faith that Philippine hospitals ' public or otherwise ' can meet the standards foreign patients will expect to see. 'Hospitals here are so inefficient and corrupt,'� he says, relating a story about a friend and patient who was unable to have a scheduled angiogram due to a lack of supply of lab materials. The hospital where this slightly-embarrassing mix-up occurred was not some distant provincial hospital, but supposedly at St. Luke's, the flagship of the PMTP. (Officials at St. Luke's would not comment on the incident, citing
patient confidentiality.) When he needs medical treatment, Dr. Geluz travels to the United States. 'I want to be safe,'� he says simply.
Dr. Geluz is convinced that providing more hospital beds for patients in the NCR is not a solution to the problems of affordable medical care for most Filipinos. In private practice for 32 years, the 70-year-old spends one day a week treating patients free of charge in a squatter area in General Trias, Cavite, sometimes even providing food for those in need. And he estimates that about 40 percent of his regular patients cannot afford to pay him. 'What can I do? My patients need me,'� he says. 'I do what I can.'�
The real problem, he says, is getting sufficient supplies of medicines and equipment to the people who need it most. With so many private and political interests involved, he fears that not only will the increased revenues not find their way into programs to help the disadvantaged, but that attention to public health at large will be further diverted to prestigious money-making programs, worsening an already difficult situation for most of the population.
Secretary Carrion notes that some of the concerns are understandable, but feels that critics are getting ahead of themselves. 'We are in our infancy,'� she says. 'It took Thailand 12 years of dedicated work to get to where they are now.'� And as for those who complain that areas outside Metro Manila are being ignored, she says, 'We have to start somewhere. We just can't throw open the doors to the whole country. That's what India did, and they ran into a lot of problems. Yes, in some cases we are slowing things down. But we want to do this right.'�
Director Lazo points out that even at this early stage, development of the program in places like Davao and Cagayan de Oro is already underway. 'We really are driven by what the market wants,'� she explains. 'Now, for example, many foreign tour companies and medical
facilitators are expressing an interest in Cebu. So we expect to have something in place there in the next couple months.'�
One objective of the program does seem to meet with wide approval. Dr. Geluz agrees that if the program works, it could help slow or stop the 'brain drain'� of Filipino medical talent. 'Sometimes when I am in the U.S., my friends there ask me why I don't work there. But I am a Filipino,'� he explains. 'It's a simple matter of money for many doctors. They would also stay, if they can earn enough here.'�

To PlanetHospital's Rudy Rupak, doctors are the most important part of the equation. 'My belief is that patients do not go to a hospital, they go to a doctor,'� he says. 'And a good doctor, it stands to reason, will be at a great hospital.'� The people involved in the PMTP are betting he's right. But will the gamble pay off?

The Philippines may have arrived late at the medical tourism party, but the experiences of patients in other Asian nations may help the country break a few stereotypes and present a better alternative. Rudy Rupak explains, 'One problem I witnessed was in Thailand where I encountered racist pricing ' whereby Thais were paying one price, Americans another price, and Arabs yet another. I think this is wrong.'� Sound familiar? If the leadership of the PMTP is willing to put a stop to petty corruption of this sort, the program has a good chance of succeeding. The potential rewards are fantastic ' for the country on the whole, for medical professionals, and for thousands of people who could be put to work in the hospitality and service industries to serve a huge influx of foreign visitors. But only if the personalities involved are willing to take the long view that using the profits to improve the lives and health of all Filipinos will only make the country more desirable as a
medical tourist destination. The real benefit to countries like the Philippines, according to Rudy Rupak, is that 'countries that were once thought of as third world are being looked upon as world class as far as healthcare is concerned.'� If it's handled right, medical tourism could put the Philippines into the world class in many other ways as well.

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