Medical tourism is the buzz word in the health industry nowadays.

And as I was pondering on what to talk about for my professorial lecture on the Philippine Society of Geriatric Medicine (PSGM) annual joint convention I happened to visit the web site of Philippine Medical Tourism. To my disappointment I did not see "geriatrics" or "geriatrics services" in the list. So I decided, it’s probably time to push the "geriatrics cheese".

To those uninitiated, Geriatrics is a branch of medicine that deals with clinical, preventive, rehabilitative and social aspects of health and illness in the elderly. In the local setting, 60s and above will fall under the category, whereas in the industrialized world, 65s and above is the cut-off age.

In practice, geriatricians deal with patients who are mostly 75 years old and above with multiple chronic diseases. The so called geriatrics giants such as, dementia, depression, falls and fractures, osteoporosis, malnutrition, and incontinence. Most of these diseases are results of frailty and needs assistance from others to carry out everyday activities. Though geriatricians also sees patients in the hospital acute wards, emergency rooms and/or out-patient clinics, it is in the Long Term Care setting that they assume their dominant role.

Long Term Care is a spectrum of health services that encompasses the continuum of care outside acute care or hospital setting. It includes, but not limited to services such as, nursing homes, home health services, day care centers and other residential care.

To have a rough estimate of how much LTC would cost, in 1999, a year in a nursing home averages more than $ 40,000 and can exceed $ 100, 000 annually in some parts of the country. Imagine with inflation what the rates are now. We don’t have any local data, however, I would say that it is lot cheaper.

Home-based care is also expensive. Bringing a home health aide into your home every other day for a four-hour-visit can easily cost $ 1,800 per month. When the home care approaches eight-hour-visits everyday, the costs rise to $ 7,200 per month. At this point, the care is shifted to nursing or institutionalized settings for economic reasons.

Needless to say, Long Term Care is expensive in developed countries and a potential target for Medical Tourism.

Obviously there is a distinction between a medical tourist and a sick older patient. A sick elderly who is bed-bound or wheelchair-bound with some degree of dementia or cognitive problem can hardly be considered a tourist not even a retiree. They are actually patients who need Long Term Care facility and services.

But how then can they be considered as target for Medical Tourism?

Allow me to cite Japan as an example and I quote Mr. Eisuke Sakakibara otherwise known as Mr. Yen, a renowned international economist. He commented on the aging problem of Japan just before he retired in 1999 as the senior finance minister. He said, " Japan’s aging problem should be regarded as a regional problem (Asia), countries like the Philippines with excellent health professional and caring people can take care of Japanese elders who are sick with chronic diseases."

He further said " If only Japan will allow its government health insurance to be used outside Japan then this can happen, tourism industry in these countries will benefit most, since these patients will have families and friends to visit them on a regular basis therefore solving the problem of seasonal influx of tourists."

Simply put he singled out our advantage and strength. First, "our caring people, educated, trained, English speaking health professionals". Second he pointed out the opportunity, "bring in the sick elderly for LTC then their families and friends will follow". The potential target for medical tourism and perhaps the retirement industry included, I definitely agree with Mr. Yen. This, I propose, is the interface of Geriatrics and Medical Tourism and perhaps the Philippine retirement industry.

The Philippine Retirement Authority (PRA) presented the "young" retirees 45 to 59 years old as their priority target because of its sheer number and perhaps their spending capacity, by 2010, there are estimated 869.1 million of them, simple arithmetic they said, considering that only 10 percent (86.9 M) of them are actually thinking of retiring outside their own country and assuming that less than one percent of that 10 percent will actually be convinced to retire here, PRA predicts the arrivals of 859,250 retirees. Nice figure indeed, but how do we intend to convince them to come to the country when we have competitions from other developing countries not to mention other developed countries who have started years ahead of us in realizing their potentials as retirement havens. Even for medical tourism, competition is suffocating, the other medical institutions in India and Thailand has gained over us by virtue of being years ahead. We are playing catch up game.

Why not target first the parents of the young retirees, I suggest another arithmetic for this, supposing that 50 percent of those 45 to 59 years old (869.1 M) still have living parents who maybe 70 years old and above, you will still have 869.1 M targets because you have two parents.

We should not only focus on "housing" to jumpstart the retirement industry as what PRA chairman Gen. Edgar Aglipay has been promoting, perhaps the reason why most of those in the forefront are real estate experts. We should look at the option of focused Long Term Care for sick elderly to jumpstart the industry. We should convince those running major hospitals and medical center to venture and invest in Long Term Care services because of its exponential effect of bringing in generations of relatives and friends of the older patient from different countries. These relatives could be your captured audience to showcase what other services you have to offer.

Should we decide to go in this direction, however, we should look at certain important ethical and economic issues. We ask ourselves, are we that good in taking care of our own lolas and lolos that we want to take care of other countries’ sick elderly citizens? We should start with our own first, is the most logical answer.

Among the suggested feasible strategy was the Elderhood Policy. For non Filipino Senior Citizen who wishes to receive Long Term Care services, perhaps nursing care, rehabilitation, or dementia care in the country, the above or their families/government should be willing to sponsor or help an older citizen of the host country (Philippines) in terms of their Long Term Care needs and expenses. This way, we help one of their older person and they help one of our own. Win–Win solution!

For eight years till now, PSGM have been conducting outreach programs for our colleagues outside Metro Manila to preach the gospel of Geriatric Medicine, that means to say to teach the intricacies, challenges and updating them with the recent developments in dealing with health concerns of an elder patient.

However, this I think is not enough. Now that we have graduated and trained geriatrics specialist from south to north all over the country, we will propose to have a partnership program with DOH . The program will include that a geriatrician be posted in selected regional hospital where they practice or hope to practice for a period of two-year pilot program. They will personally develop basic elderly health services as well as training of health workers under the guidance of respective leaders in that Institution. The program can then be adopted and continued by the government hospital with the option of continuing the partnership with PSGM.

Long term care is expensive, even in the US, private insurance companies, patients themselves, the Medicare and Medicaid (Government) chips in to pay the providers, this is how they are able to survive. We need to look into this model, the Government (Philhealth, DOH/PCSO, DSWD), Private HMOs, Foundations, Civic Organizations should find a way to align their resources and come up with a system where the providers of LTC services can be compensated or reimbursed. We need to prepare for ourselves for the future while we are dealing with those older Filipinos who need it now.

The PSGM can help DOH/DSWD by providing minimum quality standards of care for the service providers to adhere so they (providers) can claim compensation and reimbursement.

(Dr. Miguel A. Ramos Jr. is currently the Director of the Geriatric Center of St. Luke’s Medical Center and currently the president of PSGM. For comments and reactions, email him at padig4119@yahoo.com.)