ALABANG Philippines — The blue-uniformed security guard outside the Asian Hospital and Medical Center here has seen enough of them to recognize the steady flow of Guamanians who come for complicated cardiovascular and diabetes procedures. And he thinks he has figured out the root of their diet-related medical problems: “We hear their problem comes from eating all the time and having fiestas every Sunday.”

Crude health assessments aside there is more than anecdotal evidence of the increasing acceptance of the quality of care at medical institutions in the Philippines. Continental Airlines sees the growing traffic as an important segment of its hub-based service from Guam. “You wouldn’t believe the kind of activity we have going over for medical stuff ” said Walter B. Dias staff vice president of sales and promotions for Continental Micronesia. “We don’t keep records on the reasons people travel but we recognize that it’s a major component of our traffic to the Philippines.”

The records do speak loudly about the traffic trend:

• The Guam Medical Referral Office a government agency that assists Guamanian patients in Los Angeles Honolulu and the Philippines with transportation accomodations and grocery shopping gave lifts to 109 patients in the first six months since the office opened in Pasig City Philippines and eclipsed the number of patients served in the other locations only five months after establishment with 35 in November.

• NetCare Life & Health Insurance Co. a sister company to Moylan’s Insurance Underwriter’s Inc. which established an office in St. Luke’s in 2000 on July 1 will move the office from the 14th to the 18th floor to a larger space with three additional employees. NetCare reported a 22% increase in members going to the Philippines for care in 2004 compared to 2003.

• In the 18 months since the Asian Hospital created its International Medical Services department 1 780 patients have arrived from islands in Micronesia.

• The American Eye Center is seeing about 10 patients a week from Guam for Lasik surgery alone. “They are mostly referred by other patients on Guam ” said Mickey Jiz de Ortega an administrative assistant at the center. “We’re getting a lot compared to last year and it’s doubled in the first three months this year.”

In recognition of the trend the Marianas Business Journal and the Guam Medical Society on June 24 and 25 are putting on the Marianas Manila Medical Symposium with medical directors and doctors coming from Asian Hospital St. Luke’s Medical City and the American Eye Center. The doctors on Day 1 will tout their medical facilities to an exclusive audience of Journal subscribers and their guests. The medical society is working with the visiting doctors to arrange credentials so they can conduct classes for local doctors on Day 2 for continuing education credits.

Joseph Husslein president of PacifiCare Asia Pacific said PacifiCare doctors have been making referrals to St. Luke’s and six other facilities in the Philippines for more than a decade. “My gut feeling is that we are seeing more going to the Philippines ” Husslein said. “It seems like it’s growing — mostly self-directed versus being channeled there.” Though referrals are tilting to Manila Husslein said certain conditions and procedures continue to mean referrals to Hawaii or California — Medicare-covered treatment for instance or neurological problems.

If a medical procedure cannot be done on Guam or if it can be done at lesser cost in the Philippines NetCare pays the patient’s air fare. That equated to 10% of all referral cases last year most of them going to St. Luke’s due to its convenience and comprehensive offering. Jerry Crisostomo plan administrator for NetCare said second most popular is Makati Medical Center followed by University of Santo Tomas Medical Center Asian Hospital and Medical City. NetCare began referring patients to the Philippines in July 2000 and sent 260 that year from a total of 1 323 off-island referrals most going to the States for treatment. That has swung around over the past five years: in 2004 NetCare referred 3 716 patients for specialized treatment — 2 338 or 63% chose the Philippines.

“I think I see our consumers being more informed about the choices ” Crisostomo said. “One of the driving forces is lack of confidence in having it done here. A lot of Filipino members prefer to go home. Plus we had an increase of Chamorros of about 12% going to the Philippines since January. We’re seeing that the P.I. is becoming more acceptable for them to go for medical care. A lot of it has to do with the Asian Hospital being built and a lot of it is word of mouth.”

Crisostomo said that the reputation of medical care in the Philippines is boosted by the fact that St. Luke’s is the only medical facility in all of Asia that is approved by the Joint Commission on the Accreditation of Healthcare Organizations a measure of overall quality of patient care. Guam Memorial Hospital lost its JACO accreditation in 1983 because of problems with the physical structure and the hospital’s operations.

Asian Hospital which opened in May 2002 has aligned itself with SelectCare a sister company to Calvo’s Insurance Underwriters Inc. Asian Hospital said medical traffic from Guam brought in about $800 000 in 2004. “The numbers are going up ” said Dr. Joseph B. Barril head of the International Medical Services department which opened in August 2003. “We put together a mini-symposium for health-care providers and got to know who the health-care providers were in Guam. A month later we took 10 doctors to Guam in different specialties for a cocktail symposium to meet the local doctors ” Barril said. Without any formal arrangement SelectCare started sending patients to Asian Hospital and the number has steadily grown. He said SelectCare sends about 90% of Asian Hospital’s foreign patients.

Patients from Guam have come to Asian Hospital for annual physicals and treatment of cardiac disease cancer diabetes and renal problems. Barrill head of cardiovascular surgery said he has done 20 heart-bypass operations on Guamanians in the past 18 months. “It’s not a big number but it’s a start.”

Dr. Vincent T. Akimoto president of American Medical Center and president of the Guam Medical Society said Guam doctors over the past two years have begun sending many of their trauma and emergency cases to the Philippines for specialized procedures. “The reason is confidence. Patients are coming back and saying good things about their treatment. The patients are confident. It was hard at first to feel good about referring patients to the P.I. because the country’s infrastructure is so poor.”

Barril said he wants to work closely with Guam’s doctors so they can refer patients who require procedures that are not available on Guam. “Basically what I’d like to do is not to take patients away from doctors on Guam but provide care for those they can’t handle. For instance on Guam they are capable of diagnosing heart disease but they may need to send them off for further tests and surgery. They also need help with cancer radiation therapy cardiac and laparoscopic surgery. I think I have broken the notion that we are here to steal patients away. If you need help we are there.”

Barril who was trained at Washington Hospital Center in Washington D.C. and returned to the Philippines beginning in 1989 on missions to perform open-heart surgeries said most patients want American-trained doctors which the top medical centers in the Philippines offer.

Barril said some providers in the Philippines were afraid for a while to do business with Guam insurers due to the debts left by Guam Memorial Health Plan once Guam’s largest medical insurance company which filed for bankruptcy on July 24 2000. MBJ