“Do I get to play golf before you cut me open, doc?”

The image of the stereotypical American tourist in this country is about to undergo a major makeover.

At least, that’s what the Philippines is counting on once its medical tourism program gets up to speed in about three years. Photos of dear old dad in a loud Hawaiian shirt toting the inevitable camera; of mom snapping up Philippine handicraft with her Visa and the kids pounding on their GameBoys might soon go the way of the buggy whip.

Replacing them will be images of dad in a floral hospital gown awaiting open-heart surgery; of mom staring at Photoshop images of her sexier figure after a tummy tuck and the kids searching Google for the coolest spas is the Philippines.

And whether they’re in Manila, Cebu or Mindanao, Mr. & Mrs. John Q. Public will get A-list medical care from skilled Filipino physicians (many U.S. trained) working at globally accredited medical facilities.

But best of all, they’ll save a ton of money in the process (up to 80%). Now, that’s good news for the heart.

Baby Boomers can look forward to this pleasant state-of-affairs when both the public and private sector finish polishing the many facets of the soon-to-gleam jewel called medical tourism.

Perks for investors is one of those facets. Accreditation of doctors and medical and wellness facilities are others.

Then there’s insurance portability, an advantage that should lure millions of foreigners covered by medical insurance such as Blue Shield and Blue Cross.

Grand visions
The government has grand visions for a medical tourism program that focuses on attracting Americans and North American “balikbayans” to these “Islands of Wellness”.

The health and wellness tourism industry posted worldwide revenues estimated at $40 billion in 2005 and is expected to grow 33% annually. Medical tourism, spas and alternative treatments and cosmetic tourism are service sectors comprising health and wellness tourism.

The government projects medical tourism as a billion dollar service sector by early the next decade. Medical tourism is also expected to put a brake on the massive exodus of nurses to other countries, and help reverse the sad trend of Filipino doctors becoming nurses just so they can find work in the USA and the UK.

It is widely defined as a health holiday that includes cost effective private medical care and tour packages (sightseeing, golf and shopping, for example). It also includes leisure and relaxation activities such as spa therapies to re-invigorate patients.

It’s a growing worldwide trend targeted mainly at citizens of wealthy nations such as the U.S. where soaring health insurance costs are making many medical procedures prohibitively expensive.

One in five tourists is an American and over 10% more Americans visited the Philippines in 2005 compared to 2004. Balikbayan arrivals were up almost 15% in the same period. The Department of Tourism (DoT) expects those growth rates to double this year.

Korea, Japan, Taiwan and Hong Kong are the four other top sources of foreign tourists who, as a whole, poured $2 billion into the Philippine economy last year.

The government initially expected to earn some $300 million from the first year of its much-hyped “Philippine Medical Tourism Program (PMTP)” and $1-2 billion a year for the next five years.

But these numbers have been scaled back a bit as the Philippines realizes it first needs to focus more attention on strategic measures such as getting foreigners to invest in world-class medical tourism infrastructure.

Dr. Paul Reganit, PMTP Project Manager for the Department of Health (DOH) and a Masters in Public Health from Harvard Medical School, said the government is now busy organizing its medical tourism effort and cutting the red tape affecting both medical tourists and medical tourism investors.

On stream is a four-phase plan to identify and accredit partner PMTP medical institutions throughout the Philippines. The first two phases (1A and 1B) will identify partners in Metro Manila while the remaining two phases will select partners outside Metro Manila and inspect partner facilities nationwide, including spas and retirement villages.

“After the full implementation of Phase 1, we should see some 125,000 medical tourists a year,” said Dr. Reganit.

He estimates these tourists could spend $125 million during their short (less than a week’s) stay in the Philippines. And that’s based on each tourist spending only $1,000 during his stay. He expects these numbers to jump with the completion of all four phases.

Investor perks
Dr. Reganit said the government is putting in place investor perks to help build the medical tourism sector. A Memorandum of Agreement between DOH and the Philippine Export Processing Zone Authority (PEZA) creating “Medical Tourism Special Economic Zones” is due to be signed this year.

The MOA offers incentives such as income tax holidays, special resident visas and incentives under the Build-Operate-Transfer Law.

Executive Order 226 or the Omnibus Investments Code also grants incentives to activities in the Investment Priorities Plan (IPP). The Board of Investments (BOI) has included health and wellness services in the IPP for 2005 and 2006 and is expected to extend these perks into 2007.

Ownership or management of hospitals is an investment area worth considering, said industry sources. Over half the Philippines’ healthcare expenditure comes from the private sector, a fact that illustrates the key importance of private hospitals in healthcare delivery.

While the Constitution does not allow foreigners full ownership of land, foreigners can enter into joint ventures or invest in existing medical facilities.

The former was the route taken by Cardiovascular Hospitals of America, LLC (CHA) and owner of a four-hospital system in the USA.

Bumrungrad Hospital, Thailand’s largest medical tourism facility, chose the latter alternative by taking control of the Asian Hospital and Medical Center in Alabang. Thailand is Asia’s leader in the medical and cosmetic tourism sectors. Singapore, Malaysia and India are among the frontrunners.

CHA advocates high quality patient health care by empowering physicians through governance, leadership and co-ownership of specialty hospitals.

It plans to build the American Specialty Hospital, a P1 billion medical facility, in Cebu City. The hospital will be accredited by Joint Commission International and will honor medical insurance from Blue Cross and other certified medical insurance companies.

Dr. Philip Chua, CHA vice president for Far East operations, said the hospital will cater to medical tourism. A Filipino, Dr. Chua is a Cardiac Surgeon Emeritus from Munster, Indiana.

He believes the prospects for Philippine medical tourism are quite bright since medical procedures are expensive in the USA. He noted that open-heart surgery can cost up to $70,000 in the US but only $8,000 in the Philippines.

CHA is also encouraging Filipino physicians to invest in the American Specialty Hospital. Dr. Chua said a growing number of physicians based in the Visayas are about to become investors.

Dr. Joel Beltran, Director for Business Development of the Asian Hospital and Medical Center, believes medical tourism should get up to speed after three years since partner hospitals need the time to improve their services and facilities.

“World class standards in hospital care entail huge investments in terms of physical plant, technology, human resource and clinical quality unlike spas and alternative therapies and cosmetic tourism,” Dr. Beltran pointed out.

He noted that Philippine hospitals have not seen that much investment for several decades except for Asian Hospital, The Medical City and St. Luke’s Medical Center, which are among the few hospitals accredited for medical tourism by the DOH.

In Asian Hospital’s case, the foreign investor is Bumrungrad Hospital. Bumrungrad handles close to a million patients a year (40% foreigners) and earned $150 million in 2005. Its experience is helping Asian Hospital prepare for the coming boom in Philippine medical tourism.

“While we have several international patients and clients at this point, the focus is on preparing our internal processes and support for the medical tourism project,” said Dr. Beltran.

UST Hospital (USTH) is accredited by DoT to service medical tourists. Located in Manila, USTH has transformed 70 of its rooms into international hotel-class rooms for medical tourists.

USTH has also partnered with the National Association of Independent Travel Agencies in the Philippines, the country’s largest association of independent travel agencies, to offer medical tour packages.

The services offered by USTH to medical tourists include plastic and reconstructive surgery, ophthalmology and laparoscopic surgery (a less painful surgical procedure since small incisions are used).

Eye operations, for example, cost $700 to $3,000 depending on the type. Medical and travel insurance, however, are not yet included in USTH medical packages.

“We have been doing medical tourism in USTH long before the term was coined . . . In terms of expertise and capability, USTH has a lot to offer international patients,” said France Manto, USTH Marketing Communications Consultant.

Healthy hospitals
Besides improving infrastructure and facilities, accrediting hospitals to international standards is vital to the growth of Philippine medical tourism, said Dr. Reganit.

He said accreditation of healthcare facilities will be managed in 2007 by the Philippine Council on Accreditation of Healthcare Organizations (PCAHO). The Philippine Health Insurance Corporation (PhilHealth) currently handles accreditation of hospitals and medical facilities.

The accreditation process now being developed will take into account standards set by the Joint Commission International and the PhilHealth Benchbook, a set of standards that measure the quality of healthcare provided by accredited healthcare providers. It will also consider standards in the international retirement industry and the DoT.

Filipino physicians will also be accredited and Dr. Reganit will take charge of this process.

Dr. Reganit said DOH is consulting with the Philippine Medical Association (PMA) about the problematic issue of American and foreign doctors practicing in the Philippines. He noted, however, that PMA does not encourage foreign doctors working here but will allow them in as consultants.

“If there is a reciprocating agreement, that will be OK,” said Dr. Reganit. “The Medical Act of 1956 is being revised (to allow foreigners to practice in the Philippines) and there is a pending bill in the Batasang Pambansa to this effect.”

PMA is expected to soon issue guidelines about foreigners practicing in the Philippines. Dr. Reganit pointed out that Thailand does not allow foreign doctors to practice locally. If a foreigner wants to do so, he must take the medical board exam—which is only written in Thai.

As regards medical malpractice, these cases will be coursed through PMA and its National Medical Grievance System. Consultation, mediation and arbitration will be the template used to resolve medical malpractice cases, said Dr. Reganit.

Fusing all the facets of medical tourism into an organized whole will be a “roadmap” the government expects to finish in September. This roadmap will be the game plan for Philippine medical tourism, said Dr. Reganit, and will set short-, medium- and long-term goals.

Philippine leadership is not the immediate goal; competitiveness in Asia is. Thailand, Singapore, Malaysia and India have too much of a head start to be quickly overtaken.

The Philippines’ great edge over its rivals is its “competent, compassionate and caring physicians.” It’s still the best prescription for a robust and competitive medical tourism sector.