Medical Tourism: A Critique

Medical Tourism: A Critique
A Brief Outline Prepared by Health Alliance for Democracy (HEAD)
02 February 2006, Revised 11 March 2007

I. Overview of the Health Situation

Basic Indicators:
• 7 out of 10 Filipinos die without getting any medical attention.
• Only 30% of the population has full access to essential drugs.
• The price of medicine in the country rank among the highest in the world, mainly due to monopolies in the industry (mostly foreign and TNCs).
• The top 10 causes of mortality and morbidity are mostly communicable and preventable diseases. This list has not changed significantly over the last three decades.
• 10 mothers die daily due to pregnancy- and childbirth-related causes.

Health Care Delivery and State Services
• The average hospital bill is three times the average monthly income.
• The range of waiting time for admission for 89% of patients in 13 public hospitals is 3 days to one month.
• There is a rapid decline in the number of hospitals, both in the private and public sectors.
• Most hospitals, especially the secondary and tertiary level, are urban-based
• Almost all public hospitals lack the basic medical equipment, laboratory facilities, and medical supplies.
• The 2006 budget of the Department of Health (DOH) for 11 government hospitals in Metro Manila is PhP 2.483B but the 2006 budget for the 2 hospitals under the Armed Forces of the Phils. (AFP) (AFPMC and VMMC) is PhP 1.348B.

Health Education and Human Resources
• Health workers and health professionals are largely overworked and underpaid.
• There is a skewed distribution of health personnel in favor of the urban centers.
• There is a critical problem of doctors and nurses leaving in the thousands to work abroad. Around 80% of public sector physicians are taking up nursing.
• The Philippine gov’t allocated only 0.33% of GNP in 2004, 0.21% in 2005, and 0.35% of the projected GNP in 2006 for health (WHO prescribes 5% of GNP).
• The public health care system will imminently collapse if these trends continue.

II. The Privatization of Health Care
• The key thrust of the national government from the 1980s has been to decrease public sector spending in line with structural adjustment programs (SAPs)
• With globalization, the national government instituted the privatization and liberalization of health care and services
• Privatization as a national policy is embodied in the policy papers of DOH: the Health Sector Reform Agenda (HSRA) and recently, Fourmula One
• Priorities of privatization include:
o Integration of public specialty hospitals
o Collection of and increases in “user fees” for services that used to be for free
o Fiscal autonomy  public hospitals are required to have income-generating projects and cost-cutting measures (but essentially abridge the benefits of health workers)
o “Cutting down on the bureaucracy”  laying-off health workers
o Social health insurance as an adjunct (PhilHealth)
o Medical tourism and medical zones

III. Medical Tourism

A. Medical Tourism as a Government Program
By Design
• Has an advisory panel composed of 2 ambassadors, 3 cabinet secretaries (DOH, DTI, DOT) + an individual (private sector?)

• Has 3 clusters: Medical, Tourism-Business, and Accreditation and Licensing Clusters
• The Accreditation and Licensing Cluster is headed by USec. Jade del Mundo and includes:
o 3 DOH directors
o 1 BOI governor
o 1 DOT director
• The Medical Cluster is headed by DOH USec. Jade del Mundo and includes:
o 4 other DOH personnel
o directors of 3 GOCC hospitals (NKTI, PCMC, PHC)
o director of East Avenue Medical Center
o 6 from big private hospitals
o 2 from specialty organizations
o 2 from cosmetic medical groups
o 3 from various health-related groups
• Linked with the creation of the Philippines Centers for Specialized Healthcare (PCSH)
o Merging the existing GOCC hospitals (NKTI, PHC, LCP, PCMC)
o Forming new “specialty” centers:
 Merging PCMC with NCH
 “Merging” Jose Fabella Memorial Hosp with LCP to form the Women’s Medical Center
 Transforming the East Avenue Medical Center into a “Trauma Specialty Center”

By Promotion
o Is being promoted as “one of government’s responses a the exodus of health professionals” (USec del Mundo in PDI, January 10, 2006)
o Is supposed to bring down the cost of health care through “economies of scale and synergy”, including
o Savings in drug procurement through discounted bulk purchase?
o Negotiated lower professional fees?
o Other alleged benefits include:
o Lower laboratory fees because of bigger patient volume?
o Bigger profit = purchase of expensive medical equipment
o For example, USec del Mundo: “PCSH will devote 70% to charity cases and 30% to pay patients”
B. Medical Tourism: Our Critique
Medical Tourism is an outright sale of health services.
• Health services is marketed and promoted as a merchandise or commodity
• Principal market/clientele: foreigners
• Priority use of public facilities, equipment, and expertise on paying (private) patients
• Private patients use government funded facilities primarily meant for charity (service patients. For example: East Avenue Medical Center, Jose Fabella Memorial Medical Center (after it is changed into the “Women’s Medical Center”)
• Main objective is to provide more dollar-denominated revenues for the national gov’t

Medical Tourism will make health care more inaccessible to Filipinos.

• Poor patients will be further marginalized
• Benefits are “loquacious lies to sugarcoat harsh effects” (i.e. patient backlog in PHC, expenses in NKTI, PGH experience in “pay wards”)
• Funds and resources will be siphoned off to hospitals involved in medical tourism. For example, the capital outlay for the current “improvement and infrastructure changes in line with PCSH” is taken from ODA funds.
• Main direction is to cater to needs of primary clientele. Therefore, the trend will be for more specialized, high tech medical facilities
• Expensive, urban- and hospital-based, specialty-dependent, curative health care vs. strong preventive Primary Health Care

Medical Tourism is illusory at best as a solution to the exodus of health workers and professionals
• Big, private hospitals will monopolize new clientele
• Will new doctors and specialists benefit? No! (e.g. insurance requirements)
• Closure/integration of public hospitals will mean loss of employment for health workers
• Will spur, rather than stem, the loss of health personnel in the public sector to the private sector, if not abroad = “internal brain drain”
• Medical tourism does not address core issues and concerns of the health workers and health professionals – wages, tenure, institutional support, peace and order issues, gov’t corruption

Privatization is at the core of Medical Tourism
• Profit, rather than service, becomes the overarching consideration
• Health as a business rather than a state obligation
o Gov’t has abdicated its Constitutional obligation  one of the proposed changes in the Constitution is the removal of the clause pertaining to health as a State responsibility
o “organ trafficking”  promotes the sale or vending of organs (e.g. kidneys) that further exploits poverty in the country (the poor as cheap sources of organs)
o Further marginalizes the poor as paying clientele are prioritized even in public hospitals
• Diverts precious limited resources to services that do not address the needs of the majority of Filipinos  misallocation and wrong prioritization (e.g. building “massage and spa centers” in public hospitals)
• Medical tourism now, medical zones later

IV. Our Position
A nation’s health care system is a reflection of its socio-economic and political system.
• Not surprising to have an elitist, anti-poor, and irresponsive health care system as a product of a corrupt, anti-democratic, and neocolonial political system
• “Globalizing” health care under the framework of GATS and WTO is anti-poor and anti-people
• The framework of medical tourism in particular and the national health policy in general, is addressed to cater to the needs of “client states”, which are mainly developed countries
• The Arroyo government is essentially creating a privatized health care system, which should be exposed and opposed
• Social determinants of health (e.g. poverty, employment, housing and others) are not being addressed and instead, are worsening under the current gov’t

Definitive solutions, both long- and short-term, must be decisively made and genuinely implemented.'
• There is a need to address CORE ISSUES regarding the exodus of health personnel:
o Political uncertainties
o Economic difficulties
o Lack of professional advancement
o Poor remuneration
o Lack of government prioritization
• There is a need to implement immediate reforms or definitive measures
o Provide higher health budget
o Increase wages and improve benefits of health workers and professionals, esp those in the public sector
o Implement existing laws: Nursing Act of 2002, Magna Carta of Health Workers
o Rescind repressive measures: AO 103, EO 366
o Rescind WTO commitments