Health Care is for All

By Joyce Socao-Alumno and Ramil Gulle

ONE FREQUENTLY ASKED QUESTION when discussing Global Healthcare Travel also known as Medical Travel or Medical Tourism is this: Will the country’s public healthcare be compromised once the Philippines becomes a global healthcare hub? The short answer, based on the experience of India and other more established medical tourism destinations is: No, as long as we do it right.

Universal Healthcare or “Kalusugang Pangkalahatan” is a priority program of the Aquino administration. The Department of Health (DOH) will never lose sight of that. The thrust of the DOH is to make healthcare available to all Filipinos, especially for some 5.2 million families that have been identified as belonging to the poorest of the poor. That said, however, it does not mean that global healthcare travel is right away at cross-purposes with Kalusugang Pangkalahatan.

“Global healthcare travel brings its own benefits for the country’s economy, for our healthcare professionals and for our health and tourism sector. Universal healthcare vis-à-vis global healthcare need not be a choice between one or the other—both can benefit the country in each their own way,” explained Health Secretary Enrique Ona at the 1^st Philippine Global Healthcare Forum held at the National Kidney Institute Auditorium on November 2011.

Global Healthcare Travel: Addressing a worldwide need

What needs to be stated at the outset is this: the goal of “universal healthcare for Filipinos” is not necessarily opposed to what Medical Travel is, which is essentially seeking after universal healthcare but on a worldwide scale. Healthcare is a right not of individual nations but of all persons—this is precisely why everyone has the right to seek the best care possible and seek treatment anywhere deemed appropriate for one’s illness.

This is an activity that, based on existing studies and trends, will become even more prevalent. Why? There are several factors, including: 1) The rapidly aging population in many countries including the United States, Japan and Western European nations; an aging population means more age-related illnesses and ailments; 2) The rising costs of healthcare in the United States, Canada, Australia and Western Europe; 3) The rising number of patients in these countries who have no health insurance and thus, would not be able to afford their home country’s healthcare. 4) The overburdened social healthcare systems of these countries that can no longer effectively serve their populations.

The other factors are: 5) The availability of medical tourism destinations like India, Singapore, Thailand, Malaysia, the Philippines, and others in Asia; Mexico; South American nations like Colombia, Brazil and Costa Rica; some Eastern European destinations like Hungary, Poland, Slovenia, etc.; and Middle Eastern nations including Israel, Iran, etc.; 6) These medical tourism destinations provide healthcare that is of comparable, if not better, quality as the healthcare in patients’ home countries, at lower cost; and 7) The relative ease of global travel and availability of information—economic globalization has made travel across nations more convenient and with less restrictions and the Internet provides information for patients from many countries to “shop” for healthcare in nations other than their own.

All of these factors are making global healthcare travel a practical, less costly, and effective means for overseas patients to seek various forms of medical care and wellness treatments in places outside of their home countries. So many countries have already transformed themselves into medical tourism destinations and are reaping the economic and social benefits—without sacrificing the health of their own people. So there is no reason for the Philippines to be hesitant about providing medical care to overseas patients through its own medical tourism program—in fact, overseas patients have already been coming to the Philippines since the 1970s for treatments, even before the words “medical tourism” became a buzzword.

PHOTO COURTESY OF ST. LUKE’S MEDICAL CENTER FOR PHILIPPINES: THE HEART OF ASIA TRAVEL GUIDE

Public health and medical tourism

The challenges facing the Philippines in terms of public healthcare are considerable. There are an estimated 5.2 million families considered to be among the “poorest of the poor” and these are the most urgent beneficiaries of the Aquino administration’s Universal Health Care or Kalusugang Pangkalahatan program. These more than five million families, identified by the National Household Targeting System for Poverty Reduction (NHTS-PR) of the Department of Welfare and Social Development or DSWD, will receive the greatest benefit from UHC.

The lead agency that is implementing UHC in the Philippines is PhilHealth. It marks its 17^th anniversary as government’s health insurance provider with an even stronger push towards creating the infrastructure that will make UHC a reality for all Filipinos. Universal Health Care for Filipinos will be implemented through membership with PhilHealth.

The suite of benefits available through PhilHealth has also been modified to make Universal Health Care more effective in serving Filipinos’ needs. Notable among these are the Improved Primary Care Benefits and the No Balance Billing.

PhilHealth’s Primary Care Benefits package focuses on diagnostic and preventive services that members may avail of free of charge. Eventually, this benefits package will also include the most commonly needed outpatient medication such as drugs for hypertension, diabetes, and antibiotics. (More information on how PhilHealth is implementing UHC for Filipinos is available on their website, www.philhealth.gov.ph).

Now what part does medical tourism play in all of these? It does play a part, albeit indirectly. The most direct benefit that medical tourism plays in UHC in the Philippines is by providing funds that may be used for public healthcare benefits. Medical tourism, obviously, brings additional revenue to Filipino hospitals, clinics and other healthcare providers. Following a model that is already in place in India and Malaysia, the government would be able to give incentives to Filipino hospitals and similar facilities who cater to medical travelers, in exchange for a percentage of profits from medical tourism being channeled towards public health funding.

In other words, a portion of the earnings from medical tourism ought to be made available for use in providing public health facilities and services to the local population. This idea that those who could better afford health care should subsidize the health care of the less fortunate is neither new nor far-fetched. In fact, government hospitals like the National Kidney Institute and the Philippine Heart Center are already doing such a thing without compromising or discriminating the service provided to the Filipino patients.

Then there are the indirect benefits of medical tourism to public health. Any Filipino healthcare provider who wishes to provide services to overseas patients would have to meet international healthcare standards, if it wishes to compete with other facilities in India, Singapore, Malaysia, etc. This means that the Filipino hospital or medical facility would have to get accredited by a globally-recognized certifying body recognized by the International Society for Quality in Health care (ISQuA) like the JCI, NABH International, Accreditation Canada, etc. Applying for accreditation entails that the hospital must improve its facilities, equipment, operations and services to be of international quality.

This will, in turn, raise the standards of Philippine healthcare across the board, so that most, if not all, medical facilities will improve the quality of care that they give to Filipinos as well as foreign patients. This is not a far-fetched notion. We have the experience of India to look to as an example: when more and more hospitals in India improved their facilities, operations and services to meet NABH standards (created by their government under Quality Council of India which later got accredited by ISQuA), the overall quality of healthcare in India moved up, benefitting Indians and overseas patients—and raising the standards and the quality of the Indian public healthcare system as well.

Other indirect benefits of medical tourism have to do with creating more job opportunities for Filipino healthcare professionals (as our medical facilities expand to meet greater demand from local and overseas patients, not to mention the expansion and improvements due to increased revenues from medical tourism); and more income for the tourism sector, arising from the dollar-spending generated by medical tourism.

Fortunately, the present administration sees the complementary roles of both UHC and medical tourism. Hopefully, this sends a signal to Philippine medical healthcare providers to invest more of their resources in both medical tourism and public health.