Interview
With a long career and extensive experience in both the public and the private health sectors, Dr Rui Furtado, a specialist in General Surgery, has a unique vantage point on the local health industry’s current state and future development.
As the local government prioritizes ‘Big Health’, Dr. Furtado shared his insights, opinions and suggestions in an exclusive interview with the Times, which started with his take on Macau and Greater Bay Area integration in the health field.
Dr. Rui Furtado, Macau-based physician
MDT – We often speak about the GBA and the regional integration. How do you see this integration regarding the health sector, since you mentioned earlier the significant differences in creating and maintaining a business of this kind in different places?
Dr. Rui Furtado (RF) – I can imagine GBA integration from a political standpoint, but economically and financially it is more complex.
At the moment, if I go to Hong Kong to transfer a patient (which has happened many times in the past when I worked in the public sector), I would go on ferry with the patient. But upon arriving in Hong Kong, I am immediately informed that I don’t qualify as a doctor there, and so I cannot do anything from there.
They are airtight with this, and the same happens with Macau and with the mainland. There is no easy way of practicing our profession among even the neighboring cities.
Even within Macau this happens. A doctor from a public hospital cannot work at a private one. A surgeon from Conde de São Januário Hospital Center (CHCSJ) who has completed the CHCSJ specialty who wants to go to Kiang Wu Hospital must go as a general practitioner, not as a surgeon because they will not recognize you as such. There is a lot of work to be done. I would hazard to say that for the health sector, everything still needs to be built from the ground up.
MDT – One of the perceived advantages of the new medical complex (Macao Union Hospital) is its potential to provide services related to medical tourism. What is your opinion on this?
RF – Health or medical tourism does not just depend on the hospital; it depends on several factors. One of the most important factors is the region’s political decisions. There are two main types of medical tourism. The first is treatment-based, where people seek out treatment at facilities with higher technical capacity or better prices. Fundamentally, I would say that this type is not so much about the price, but more about the technical quality that different places, hospitals and regions can offer people.
The second type is preventive medicine, which includes services such as medical check-ups. While the new hospital could serve both purposes, it is not currently part of any specific preventative medicine scheme. However, being a very large facility, it has the capacity to provide both treatment-based services and preventative medicine.
The main focus of this new hospital appears to be providing Macau with advanced and modern medical services, operating as a well-equipped unit with a medical team that offers guarantees and backed by accreditation from international entities.
Macau Union Hospital, in the islands
As such, it almost certainly can offer treatments and other medical services beyond preventative medicine. To provide medical check-ups is possible, but ultimately means it will need to offer this service to the public. That is not currently on offer, and I don’t know when it will be.
MDT – Do you believe this unit can attract patients from other regions to be treated in Macau?
RF – I believe so, but the Macau SAR and Health Bureau must understand two fundamental things. Firstly, medical advances must be honest and well-regulated, and overseen by a governing entity. Secondly, there must be close cooperation between the private and public sectors.
On my first point, take services such as in vitro fertilization, stem cell treatments, sex changes, and cosmetic surgery as examples. These are common practices everywhere abroad, with places in Asia specializing in these services. Why has this been possible? Because governments looked for opportunities to support this.
Macau has been doing the opposite of that and I don’t know why exactly.
I give you one example: for in vitro fertilization, Macau requires that the unit for carrying out in vitro fertilization must have a newborn unit for newborn care. Why is this required when the two procedures are completely separate? In a sense, it is a form of protectionism as it restricts the procedure to just one or two big hospitals. In contrast, elsewhere in the world, IVF can be performed in a small clinic. The same goes for stem cells. The application of stem cells is a basic therapeutic principle. Of course, I know this opens the door to potential fraud and wrongdoing, but that is why we need to have a supervisory body that monitors these activities.
Further to this, the lack of cooperation between the private and public sectors has caused public healthcare systems to become overwhelmed. There is no system allowing patients with minor illnesses to be treated in private clinics with some form of financial support. Instead, they go to the emergency room, which instead of having 50 cases that need attention, now has 400 cases that must be triaged.
Cooperation between public and private healthcare services would ease the burden on public healthcare systems and improve overall healthcare quality. The public service should not fear competition from the private sector. They have a lot more resources to navigate by themselves, and they should only seek cooperation to improve and complement their services. Some private services are resourceful enough to do this, but a uniform approach would be ideal.
There is no need to prohibit activities for the private sector and make everything difficult for private doctors. It’s bad for the territory.
MDT – Does Macau have the ability to be a medical tourism destination?
RF – I believe that medical tourism needs to exist here. But first, the government needs to want health practitioners to provide medical tourism services. We have had examples before, for instance, the Maló Clinic at the Venetian. He had an idea, and it was brilliant. In this case, the services provided were mostly preventive medicine, but it also provided surgery and curative medicine.
In this clinic, they had everything organized for the person to come, get their tests done, and receive any treatments or procedures within a day.
Some patients would attend for an initial consultation and elect to have a treatment on site, while others merely wanted their results. But it proves that medical tourism within Macau is possible and that there is a market for such services.
To make Macau a destination for medical tourism, there is work to be done in the background with physicians and additional work to raise the credibility of Macau in this field. Of course, for the market, this is not a problem, as we are in an area of an almost endless demand.
We can see from Thailand as an example, which started to promote medical tourism and packages as early as the 1960s. As they progressed, they started to specialize.
I also mentioned earlier that those who travel for medical services are either driven by price or quality. As Macau does not have the conditions to compete on price, we must focus on quality to attract patients.
In Zhuhai, for example, if I wanted to open a clinic to do check-ups, everything from reagents, facilities, staffing costs would be a tenth of the price. Even the suppliers of materials sell them at different prices between Macau, Zhuhai, and Hong Kong. Everything is much more expensive here.
Nonetheless, curative medicine is a very profitable business when done properly and with appropriate quality standards. But being an industry that moves a lot of money also attracts a lot of players and competition, so there is a need to make our product consistently more appealing than our competitors.
MDT – How about other services that are more related to wellness tourism?
RF – This is a completely different thing and not medical tourism anymore. It’s more of a business, and interestingly is controlled and regulated by the Health Bureau in Macau. I can’t perform Botox injections here or fillers, but beauty centers or institutes next door can without much oversight. Anyone brave enough can start a business to inject fillers, Botox, and similar procedures, and will find it profitable.
In the example I gave you before, Maló Clinic also offered these services. They had different services operating under one roof under different sections, and there were a lot of people primarily from the mainland coming for those. Again, the services were organized for that, so the clients would also come.
But medical tourism is a much more serious thing, and we are missing some important management aspects.
By Renato Marques, MDT
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