Surgery at Manila Doctor’s Hospital, Manila, Philippines. Hysterectomy. Manila has far more medical care options than anywhere else in the Philippines, by far. Some say the best hospital in Manila is the Philippine General Hospital (PGH). While it’s a public charity hospital, many of the most talented physicians in the Philippines practice there, as it’s the teaching hospital of the adjacent University of the Philippines Medical School. While PGH does accept private paying patients, the facilities and accommodations will generally be too basic and overcrowded for those who can afford hospitalization at one of the private hospitals. A notable exception is the new University Physicians Medical Center. UPMC allows UP and PGH physicians to provide outpatient services to private patients in a very modern facility. See http://www.upmc.net.ph/ An costs P6,000 or less than $150.
Manila has several upscale hospitals catering to those with the money to pay for them. St. Luke’s Medical Center, Makati Medical Center are two. Asian Hospital and The Medical City are the deluxe hospitals where paying patients can get the most deluxe facilities. Many Manila physicians practice at these elite hospitals, but also at more modest hospitals for less affluent or more thrifty patients. Some dedicated doctors teach at UP, treat at PGH and accept affluent patients at one of these elite hospitals. We especially admire those who keep their ties to UP and PGH even when they could have an easier life restricting their practice to the elite hospitals.
Carol was first diagnosed with small uterine cyst and endometrial problems in 2007. By 2010 Carol’s uterine cysts had really grown and it was clear that she would have to have surgery. We decided to consult a gynecological oncologist because they can be more experienced with surgery than a general practice ob-gyn. We saw a PGH-trained Iloilo surgeon, Dr. Lora Tupas. She recommended surgery and said that it would cost between P90,000 and P100,000 performed at Iloilo’s St. Paul’s Hospital. While Dr. Tupas was well-qualified, we went to Manila for a second opinion. We saw Dr. Christine Palma at her The Medical City clinic. She basically agreed with Dr. Tupas. We decided that we’d prefer to have the surgery at a Manila hospital. Dr. Palma said that a uncomplicated hysterectomy would cost about P150,000 at St. Luke’s Hospital.
We learned that Makati Medical Center offered an all-inclusive hysterectomy package for P92,000. This seemed a good option — surgery at a top Manila hospital for the same price as surgery in Iloilo. Since the surgeon’s fee is capped under the surgical packages, many surgeons will not participate. We were referred to Dr. Jay Famador a gynecological oncologist at Makati Med. During our first visit he suggested that we have a new ultrasound at MMC. We did so and the results really alarmed us, indicating the possibility of a large malignant ovarian tumor. These results were very different from those of prior ultrasound reports. We wanted to have the surgery at Makati Med very soon. Almost simultaneously we received a recommendation of gynecological oncologist Jean Anne Toral and learned that the “semi-private room” which is included in the Makati Med hysterectomy package was really a room in which five patients shared a bathroom. If we wanted better accommodation at Makati Med we would have to switch from being a “package” patient to being a “private” patient. Dr. Famador said we should expect to pay about P200,000 as a private patient at Makati Med. We were also disturbed by the account of an acquaintance at Makati Med. See http://tornandfrayed.typepad.com/tornandfrayed/2008/10/stabbing-in-taguig.html
We met with Dr. Toral at her clinic in a medical office building across from PGH. We both were impressed with her. She said we could have the surgery at the National Kidney and Transplant Institute or at Manila Doctor’s Hospital. We decided on Manila Doctor’s Hospital (MDH) or MaDocs, http://maniladoctors.com.ph. MDH is supported by the MetroBank Foundation. The objective is to provide excellent care at a price point below that of the elite hospitals. MDH is located quite near PGH and UP College of Medicine. Many UP/PGH physicians provide care to private patients at MDH. Dr. Toral told us that we would spend between P115,000 for a routine total hysterectomy and P130,000 if a malignancy was found. We scheduled the surgery for the following week.
To our great relief, Dr. Toral found no significant ovarian tumor when she operated, rather there was a very large uterine cyst (myoma), and smaller myomas. The surgery turned out to be a fairly routine total hysterectomy with bilateral salpingo-oophorectomy (“TAHBSO”) – e.g. removal of uterus and ovaries. Because of the pre-surgical ultrasound suggestion of a large, possibly malignant ovarian tumor, Dr. Toral arranged for a pathologist to perform a “frozen section” histopathology during the surgery. Dr. Toral also asked for a pre surgical CA125+HE4 ovarian cancer biomarker test. The cost of the test was P3,400. After surgery we found out that the Carol’s CA125+HE4 results were essentially negative for ovarian cancer. It’s unclear why the pre surgical ultrasound report was so far off the mark, but we’re grateful that it was.
We appreciate Dr. Toral’s skill as a surgeon and her directness, modesty and compassion as a physician. Although the surgery lasted almost four hours, Carol did not require a blood transfusion because she lost only an estimated 700cc of blood. The suturing was nicely done, unlike that of her sister who had similar surgery by another surgeon at St. Luke’s in Manila. There have been no complications. We can recommend her without reservation. Her office phone number is 2-567-3908.
The total cost of Carol’s hospitalization was as follows:
P60,255.17 to the hospital. This includes six days in a private room, laboratory, medications, operating room and all other expenses.
P3,500 to the pathologist
P61,200 to Dr. Toral
P25,000 to Dr. Christinanette Songco, the anestheologist
Total : P149,955.17. Of this, the Philippine Heath Insurance Corporation (PhilHealth) paid P11,200 to Dr. Toral, perhaps P5,000 to Dr. Songo and P10,255.17 to Manila Doctors Hospital, so PhilHeath paid a total of P26,455. reducing our out-of-pocket expense to P123,500. Since our annual PhilHealth premium is P1,200, PhilHealth is a bargain.
Of course there were other expenses. We paid our Iloilo cardiologist to do the pre-surgical cardiac clearance. There was airfare and the cost of staying in an apartment in Manila for a week after Carol was discharged so that she could have a follow-up appointment with Dr. Toral and recover enough for the flight home. Still, we feel the cost was very reasonable. The lavish Bumrungrad Hospital in Bangkok estimated over $10,000 for diagnosis and treatment. Our cost in Manila was less than a third of that. As is the custom in the Philippines, Bob stayed in Carol’s room as her “minder”. The hospital supplied a padded bench for the minder to sleep on. The cost of the private room was P2,500. This is the standard room at MDH.
Many hospital costs are linked to the daily room rate. If you have a fancy suite, many of your hospital costs will be more. If you are in a ward, they will be lower, so, while we could have afforded a suite at P4,000+, it would have raised the cost of the hospitalization much more than just the additional price of the fancier room. Anyway, our eighth floor private room was fine, air conditioned, cable TV, refrigerator and private bathroom. Our room had a great view of the city. We received a newspaper every morning and there was hot water and a microwave available at the nurse’s station.
Our experience with Manila Doctor’s Hospital was a good one. The hospital is very well run. No doctor’s orders were overlooked. We never had to remind the staff of anything. We were interviewed to see if we were happy with the housekeeping. The food was surprisingly good. The bill was very detailed and the charges all seemed reasonable. The upscale hospitals such as The Medical City offer better appointed facilities, but we’re doubtful that the care will be any better.
Our one beef regarding Carol’s care was inadequate post-operative pain medication. This is not the fault of the hospital. It has to do with Philippine paranoia about using opioid medications, even for surgical patients. Post-op Carol was given a NSAID “Arcoxia”. It’s similar to Celebrex or ibuprofen. Arcoxia is not approved for use in the U.S. because the manufacturer has not been able to convince the FDA that it’s effective or safe. Carol suffered due to lack of effective pain control. A few days of opioid pain killers would have been far more effective and safer than the Arcoxia.
A friend who had surgery in Iloilo had exactly the same problem. Post-op he was given Celebrex. It was ineffective at controlling his severe pain. It was not until he got home to Miami that he received proper treatment. Our complaints fell on deaf ears. If one is concerned about post-surgical pain medications, we suggest that you get a hospital pain management specialist as part of the treatment team. Again, this is not a problem with Dr. Toral or Manila Doctor’s Hospital but is a well-documented problem with medical care in the Philippines generally. If the Philippines expects medical tourists to be satisfied with their care, this issue should be addressed. See /philippine-pain-management/