Wednesday, August 02, 2006

Second class patients

Yesterday's Inquirer carried a story on medical tourism. I read it, and I got very upset.

Medical tourism is defined as travel with the intent of receiving health care in another country. There's nothing wrong with the practice itself. People who can afford it go to hospitals with the best specialists and the best facilities, even if it's in another country. Quality is the underlying factor, and it's the patient's right to see the doctor whom he thinks can provide the best care for his ailment.

But there's something seriously amiss once medical tourism becomes an institutional policy of the hospital -- or the country -- providing such services. Along with this institutional policy comes promotion as well as different classes of service. The underlying message now is no longer one of health care but of cost and profit.

At the extreme, such a plan might only be acceptable if the hospital has excess capacity and nevertheless commits to deliver equal care to its patients. It becomes odious when medical tourists are favored over citizens.

Particularly upsetting about the Inquirer story was the comparison between the services and the quality of care afforded to a Micronesian and to a Filipino. The Micronesian, because he has a higher health insurance, gets the "full treatment." The Filipino only gets the most basic services.

One doctor said a look at one private hospital would show the discrepancy between the treatment of local and foreign patients.

One floor has an unusually more efficient air-conditioning system and ambiance compared to the other floors. It’s exclusively for foreign patients who are accorded “five-star” treatment.

Unlike local patients whose meals are served in plastic or aluminum plates, theirs are elegantly served on real plates, replete with garnish.

Doctors and nurses are also instructed to be “extra attentive even to their littlest needs,” say, a Micronesian complaining of a minor cough in his hospital suite, the doctor said.

“Usually, doctors rush in only if the blood pressure is low, if there’s difficulty breathing, or chest pain,” he said. “That’s because they really have to prioritize considering the many patients that they have to attend to.”

In the case of foreigners, they rush to attend to “whatever the complaint is.”

If I'm upset, it's because I've seen the basic service that hospitals give to Filipino citizens. Last year, we rushed my father to the hospital because of sepsis. We were in the emergency room, and the nurses and doctors looked on blankly as my sister and I struggled to keep my father conscious. Then, the doctor, without personally checking my father, prescribed medicine to lower blood pressure when his blood pressure was already low. Fortunately, we caught it in time. That's basic service for you.

More painful is the present experience of one of my friends.

Once medical tourism becomes institutional policy, what's to prevent automatic discrimination against Filipinos? "Pinoy? Ah, wala yang pera, doon mo 'lagay yan sa basic service. Uy,foreigner! Sir, let me kiss your feet."

First, we lose our doctors and nurses to foreign hospitals. In the future, we won't even get proper health care in our own hospitals because the doctors and nurses that remain are busy with medical tourists.

Yet another way of cashing in on the almighty dollar, something that we're trading our souls for every day in an exchange rate that's forever diminishing.


  1. True. My Dad works in the Medical Dental ( or is it Dental Medical----field-- so anyway...) and he tells me how things are. It's sad. I always had this longing to change the country. It's frustrating.

  2. On the other hand, if medical tourism takes off here, then this may encourage more doctors and nurses to stay. It is even possible that we would be able to attract foreign doctors like those 500 Indian doctors i read about in Resty Odon's blog sometime back. Also, the fees paid by the foreign patients could help pay for the capital outlays for medical equipment and other overhead which could also be used by the locals. I agree that discrimination based on ability to pay is an issue that needs to be addressed, and this matter should be brought up to the medical profession as an ethical issue.

  3. Yet another way of making the Pinoy a second class citizen in his own country. Think of mangoes. The good ones are exported. The rejects are sold in local markets. So too with medical tourism, sooner or later. The good doctors and nurses will be employed at medical tourist hospitals. The mediocre ones will be at the RHUs. State-of-the-art hospital equipment will be installed at the tourist hospitals. Meanwhile, their discarded old equipment end up as donations to local hospitals and rural health clinics for use by the masa. What else is new?

  4. But, doctors and nurses are leaving anyway. It's better to have an alternative for those who are willing to stay. At least they will still be physically around, and maybe, with the right policies, the kind hearted ones can have the opportunity to devote some of their time to social services. In these matters, it's better to take advantage of market forces rather than work against it. Far from ideal, but that's how our more successful neighbors do it.

  5. Hi, Lani and CVJ. Thanks for the comments.

    CVJ: I think the problem goes beyond the nurses and the doctors who decide to stay and those who decide to go. Those who do fly out will do so regardless of the "medical tourism" industry in the country. They'll earn far more in the US and in Europe than they ever will here. Admittedly, those who do stay will probably have better opportunities: I won't begrudge them that.

    On the other hand, with medical tourism, you have a prescription for more social inequity. Can we really believe that once this takes off, overall health care in the country will improve? Or will it be limited once more to an elite social strata, one that's coming from foreign shores?

    I can't say for sure which way it will swing. But until all the factors have been studied, I'll hold off on the celebrations and its institutionalization.