At Large : Thinking about 'medical tourism'

At Large : Thinking about 'medical tourism'
, Jan 06, 2006
Updated 00:08amam (Mla time)
Rina Jimenez-David
Inquirer
http://news.inq7.net/express/html_output/20060106-62091.xml.html

ON one hand, the boom in "medical tourism" could stem the tide of the medical diaspora that has seen Filipino doctors not just leaving the country for more lucrative practices abroad, but even abandoning their medical training to "re-train" as nurses, for whom there is greater demand abroad.

On the other hand, since the great majority of medical tourists come to the country for cosmetic surgery or high-end procedures like heart bypass surgery and organ transplantation, the few doctors who do choose to stay on would most likely opt for these lucrative specialties, even as the great majority of the Philippine population lack even the most basic health care.

On one hand, medical tourism could restore the reputation for excellence of Filipino doctors and other health personnel. With doctors and allied health personnel striving to meet the higher standards of care in keeping with the stringent requirements of foreign medical tourists, the entire nation could only benefit from the services of a better-trained and regulated health corps.

On the other hand, the country's present health situation -- with health services polarized between a high-quality but expensive private sector and an affordable (if not free) public health system that however is not really accessible nor of any quality -- could only grow worse with medical tourism driving a bigger wedge between the "haves" and "have-nots."

On one hand, medical tourists could also encourage owners of hospitals and other tertiary health institutions to remain competitive by maintaining their facilities, upgrading their equipment and keeping up with the latest developments in research and technology.

On the other hand, the pressure to meet the market demands of medical tourism can only result in even greater emphasis on building bigger and more expensive hospitals, with perhaps government money even going to the construction of "medical centers," which could put the edifice complex of the infamous Imeldific to shame. This would only draw attention and money away from primary health care -- which the majority of Filipinos really need -- and which require no infrastructure other than small health centers, passable roads, clean water, skilled birth attendants and proper nutrition.

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WHAT should be obvious from this "on one hand...on the other hand" listing is that the prospects and challenges of riding the medical tourism wave, which has already crested in neighboring countries like Thailand and Singapore, cannot be viewed from a simple "black-and-white" perspective.

Medical tourism is neither completely evil nor completely harmless. What's needed at this point, as the Department of Tourism and Department of Health gear up to meet a rising demand for local health services from abroad, are clear policy guidelines that would minimize the negative impact of medical tourism while keeping the focus on the real health needs of the people.

One of the possible ways of mitigating medical tourism's less savory effects on the local health situation would be the imposition of a special tax on profits made from medical tourism. The tax money should then go to the training of "poor but deserving" health personnel who will in turn have to commit to serving disadvantaged communities for a minimum period, as well as to the provision of primary health care in the poorest areas.

* * *

A STORY right next to that on the "medical tourism boom" shows the way to go for poor communities.

The story features the recent graduates of a three-week training program for community health workers, also known as "barefoot doctors." As the accompanying photo shows, many of the graduates indeed trod the ground on their bare feet, as they are members of indigenous communities, for whom medical care, as one of the participants noted, is "very little if not nil."

Though they cannot conduct operations or even diagnose serious illnesses, the "barefoot doctors" receive enough training to perform basic first aid, diagnose simple ailments and basic diseases, spot the signs of health trouble that may necessitate referral to a trained doctor, and advocate for good "health-seeking behavior" among their neighbors.

Surveys conducted over the last few decades have shown that this is the kind of basic health care that the majority of Filipinos need -- but which is available to too few, such that too many of our countryfolk, especially children, die from simple, treatable diseases and ailments.

* * *

PERHAPS what we need at this point is to promote another kind of "medical tourism," with doctors and nurses based abroad or even in urban centers, paying regular visits to underserved communities around the country, making sure the poorest Filipinos get to see a doctor at least once in their lifetime.

Even better, these "visiting" doctors could be convinced to stay for even longer-through a system of incentives or recognition-either to serve communities directly or train young practitioners or "barefoot doctors" who could then provide long-term quality care.

A word of caution, though, about "medical missions" which involve lightning visits, some of which last only a few hours or a day, by teams of doctors, nurses and other health caregivers who provide free consultations and services to folks in a particular area.

Though these missions do take care of patients with acute conditions, they also serve to undercut the practice of permanent health care providers, such as midwives and small clinics. Too often, the missions end up creating a "mendicant mentality" among the poor, who choose to wait for the sporadic and rare medical missions rather than to prioritize regular visits to the clinics or adopt preventive health care strategies.

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