10th National Convention on Statistics (NCS) EDSA Shangri-La Hotel October 1-2, 2007

Measuring Health and Wellness Tourism in the Philippines by Romulo A. Virola and Florande S. Polistico

For additional information, please contact: Authors name Designation Affiliation Address Tel. no. E-mail Co-Authors name Designation Affiliation Address Tel. no. E-mail : : : : : : : : : : : : Romulo A. Virola Secretary General National Statistical Coordination Board 403 Sen. Gil Puyat Avenue, Makati City (0632) 895-2395 ra.virola@nscb.gov.ph Florande S.Polistico Statistical Coordination Officer I National Statistical Coordination Board 403 Sen. Gil Puyat Avenue, Makati City (0632) 896 -7981 fs.polistico@nscb.gov.ph

1 Measuring Health and Wellness Tourism in the Philippines

by Romulo A. Virola & Florande S. Polistico 2

ABSTRACT The Philippine government has recognized the potential of the Health and Wellness Tourism industry in job creation and in spurring economic growth. To be able to monitor the contribution of this emerging economic sector to national development, obviously statistics are needed. However, currently the Philippine Statistical System (PSS) does not generate the necessary information that can provide a meaningful assessment of the health and wellness tourism industry. This paper presents the initial efforts of the PSS in the measurement o f this sector, with special focus on its relationship with the national income accounts, particularly with the Philippine Tourism Satellite Accounts (PTSA). It shows how the sector can be articulated as a subsector of private services under personal and medical services. The paper also shows how the health and wellness services can be highlighted in the PTSA as part of the tourism -characteristic industries. The paper further explores the existing statistical data generated by the different institutions in the PSS and proposes recommendations to make their data collection schemes respond to the requirements of measuring health and wellness tourism. Finally, it demonstrates the coordination and collaboration mechanisms that have been put in place in the PSS with the participation of the private sector to facilitate the generation of health and wellness tourism statistics. Keywords: health and wellness tourism, national income accounts, tourism satellite accounts, personal and medical services, tourism-characteristic industries.

I.

Introduction Many countries, including the Philippines have recognized the potential of health and

wellness tourism for economic growth. In its efforts to promote tourism, the Department of Tourism (DOT) has noted the countrys compara tive edge in health and wellness tourism due to abundance of natural resources, unique Filipino healing practices, fluency in the English language and competitive cost. The DOT (2007) has therefore targeted to position the country as the health and wellness destination in Asia. Indeed, the Republic of the Philippines (2007) has recognized that health and wellness is one of the major sectors for economic growth and has formulated a private sector-driven master plan for the
1

Paper presented during the 10th National Convention on Statistics at the EDSA Shangri-la Plaza Hotel, Mandaluyong City, Philippines on 1-2 October 2007. 2 Secretary General and Statistical Coordination Officer I, respectively, of the National Statistical Coordination Board. The views expressed in this paper are those of the authors and do not necessarily reflect the views of the NSCB. The authors acknowledge the assistance of Vivian R. Ilarina, Cynthia S. Regalado, Regina S. Reyes, Ar yl G. Zaguirre, Diana Christine O. m Lizarondo and Noel S. Nepomuceno in the preparation of this paper.

development of this service industry. 3 The Medium Term Philippine Development Plan (MTPDP) 2004 2010 also seeks to enhance and promote health tourism, together with other tourism products. In support of the MTPDP, the Philippine Statistical Development Program (PSDP) 2005 2010 has included the development of data systems to generate indicators on medical tourism among the statistical activities to be undertaken in the medium term. Based on the Philippine Tourism Satellite Account (PTSA), Virola et. al. (2001) estimated the total tourism expenditure in the Philippines at 140 billion pesos in 1994 and 274 billion pesos in 1998, translating to an average annual increase of 11 %. Value Added of Tourism Industries (VATI) was estimated at 200 billion pesos in 1994 and 334 billion pesos in 1998, representing 12% and 13 % respectively of the countrys Gross Domestic Product (GDP). However, Virola, et. al. (2002) recognizes that the preliminary results of the PTSA are limited in scope and coverage due to data constraints that hinder the analysis of the link between tourism consumption and the supply of tourism goods and services. The coverage of the PTSA must therefore be expanded to fully and more reliably measure the economic contribution of tourism; in addition, there is a need for a greater articulation of tourism aspects considered important in the Philippine setting, such as health and wellness tourism. Most importantly, there is a need to generate tourism statistics on a sustained manner in order to enhance the effectiveness of the PTSA as a tool in the formulation and monitoring of the tourism program of the country.

Proclamation 1280 also declares October as National Health and Wellness Tourism Month.

II.

Health and Wellness Tourism Statistics, the National Income Accounts and the

Philippine Tourism Satellite Accounts The Philippine System of National Accounts (PSNA) consists of a coherent and integrated framework that measures stocks of resources and flows of goods, services, income and other economic instruments that emanate from using these resources or as consequence of economic flows. The PSNA is compiled using internationally accepted guidelines, the latest of which is the System of National Accounts or SNA (1993). One of the flexibilities offered by the 1993 SNA is the expansion of the analytical capacity of national accounting for selected areas of concern without overburdening the central framework. This is done thru satellite accounts. The NSCB has compiled satellite accounts on the environment, education, tourism and health and has started work on science and technology/research and development.

The PTSA provides additional information for tourism concerns not present in the central national accounting framework. While using complementary or alternative concepts, classification systems and accounting frameworks, the PTSA is consistent and is fully linked with the PSNA. The PTSA aims to demonstrate the output of tourism industries vis--vis the consumption expenditures of visitors. However, while the Philippines thru the NSCB and the DOT are actively involved 4 in the UN-WTO efforts to promote and improve the compilation of tourism satellite accounts, as pointed out earlier, the PTSA has limitations that need to be addressed. At present, the PTSA consists of ten tables that correspond partially to the ten tables prescribed by the TSA:RMF (2000) as shown in Annex 1. It can be noted that the PTSA does not have information on outbound tourism. Moreover, the frequency and distance dimensions of the concept of usual environment need to be defined more explicitly

The principal author attended the 1998 World Conference on the Measurement of the Economic Impact of Tourism and the 2006 International Workshop on Tourism Statistics in Madrid, Spain while the second author attended the Expert Group Meeting on Tourism Statistics in New York in June 2007.

in operational terms; the borderline between characteristic and c onnected goods and services has to be drawn more clearly and the data support and/or the methodology for the estimation of expenditures of same-day visitors, domestic travels, household expenditures on behalf of tourists, etc. must be strengthened.

Health and wellness tourism is of course a component of the PTSA and the PSNA. Establishments engaged in health and wellness tourism are part of the tourism characteristic industry; and the services provided by these establishments are covered by the PSNA under Private Services more specifically, under two subsectors: Personal Services and Medical Services.

However, primarily due to data constraints, there is nothing in the current PTSA or PSNA that can provide an explicit characterization of health and wellness tourism as a component of the Philippine economy. Health and wellness tourism is hidden somewhere under Personal Services or Medical Services of the PSNA. On the other hand, not one of the ten tables generated under the current PTSA shows information specifically on health and wellness tourism. The PTSA tables have data only for categories that are explicitly listed among the tourism-specific industries, whether characteristic or connected. The PTSA also does not have information on outbound tourism.

The measurement challenge for the PTSA is to be able to identify and separate tourism-characteristic industries from the rest of the industries comprising the economy. In order to be able to highlight the health and wellness tourism industry, the goal therefore is to separate it statistically from the rest of the tourism-characteristics industries. Information on the sector has to be collected and disseminated in a more timely manner. This will then provide a statistical tool for assessing the impact of the health and wellness industry in the

Philippine economy, such as on employment and revenue generation, foreign exchange earnings, clientele served by origin (residents and nonresidents), value added, investments and consumption, among others.

III. Efforts of the Philippine Statistical System (PSS) in Measuring Health and Wellness Tourism

The PSS is a decentralized system with the National Statistical Coordination Board (NSCB) as the agency tasked with the coordination function. One coordination mechanism that the NSCB uses is the creation of interagency/technical committees and task forces5. In recognition of the importance of trade 6 in the Philippine economy, the NSCB created the Interagency Committee on Trade Statistics (IAC-TrS) in March 2004. In order to address statistical issues on the emerging health and wellness tourism industry, the IAC-TrS created the interagency Task Force on the Measurement of Healthcare and Wellness/Medical Tourism Services (TF) in July 2006. The TF, chaired by the NSCB, is composed of representatives from the Department of Health (DOH), DOT, Department of Foreign Affairs, National Economic and Development Authority, National Statistics Office (NSO), Department of Trade and Industry, Bangko Sentral ng Pilipinas and the Philippine Institute of Development Studies.

On 22 October 2004, Executive Order No. 372 was issued creating a public-private sector task force (PPP TF) for the development of globally competitive Philippine service industries. The PPP TF created a Committee on Health and Wellness which identified four clusters of health and wellness development for promotion purposes: hospitals, specialty

5 6

As of September 7, 2007, the NSCB has 11 interagency committees, 6 technical committees and 5 task forces. In 2004-2006, Trade comprised almost 17 % of Philippine GDP in constant prices. The IAC-TrS is chaired by NEDA Deputy Director General Margarita R. Songco.

clinics, wellness and spa centers and retirement/elderly care homes.

Working on this clustering the NSCB TF has come up with a proposed definition of health and wellness tourism, drafted a questionnaire for a pilot survey of health and wellness tourism industry but excluding for the time being the cluster on retirement/elderly care homes and conducted a consultation workshop with stakeholders7.

The specific health and wellness services covered by each of the four clusters were determined through the 2002 Philippine Central Product Classification (PCPC), which is patterned after the United Nations Central Product Classification Version 1.1. On the other hand, the establishments providing these services were classified according to the 2004 Philippine Standard Industrial Classification (PSIC) patterned after the International Standard Industrial Classification Rev. 3.18.

The survey questionnaire (Annex 2) was designed to estimate the following, among others: a) total revenue by client (resident or nonresident) and by type of health and wellness service 9; b) cost by expenditure items; c) number of clients (resident or nonresident); d) employment and e) number of establishments. Definition As defined by NSCB (2007), health and wellness tourism refers to the activities of persons traveling to and staying in places outside their usual environment for not more than one consecutive year for health and wellness purposes not related to the exercise of an activity remunerated from within the place visited. The DOT (2007) associates it with travel

7 8 9

The workshop held on 18 April 2007 was jointly sponsored by the NSCB and the DOT The NSCB is now working on the 2007 PSIC.

Under the PCPC, these are hospital services, medical and dental services, other human health services, social services with accommodation, physical and well-being services and other beauty treatment services, nec.

to health spas or resort destinations where the primary purpose is to improve the travelers physical well being through a regimen of physical exercise and therapy, dietary control and medical services relevant to maintenance. Scope And Coverage From the 3 -digit level of the PSIC, we could identify three groups of activities under which Health and Wellness Tourism activities fall (Table 1). These are 1) PSIC Group 851 or the Hospital Activities & Medical and Dental Practices; 2) PSIC Group 853 or Social Work Activities; and 3) PSIC Group 930 or Other Service Activities.
10 Based on the Health and Wellness Tourism Classification (Annex 3) , the cluster of

Hospital Care and Treatment as well as Specialty Clinics belong to the PSIC group 851, Wellness and Spa Centers could be found under PSIC Group 930 while the cluster on Retirement and Rehabilitative Care belongs to PSIC group 853. Obviously, not all activities falling under these 3 -digit PSIC classifications are health and wellness tourism. Going down to the 5 -digit level will refine the scope and coverage but there still remain activities which cannot be classified as health and wellness tourism.

IV.

Evaluation of Existing Data Collection vs. Data Requirements of Health and

Wellness Tourism

The biggest issue confronting the PSS in the measurement of the emerging health and wellness tourism industry is the appropriateness and responsiveness of the existing data monitoring systems. In order to meaningfully quantify the impact of Health and Wellness tourism in the economy, it is desirable to gather the following data, among others: 1) outputs and
10

Annex 3 comes from the Preliminary Draft of the Medical Tourism Project Terminal Report

intermediate inputs of industries engaged in Health and Wellness tourism; 2) revenues derived from resident and non-resident users of health and wellness services, including foreign exchange earnings; 3) employment and compensation; 4) per capita visitors consumption expenditure on health and wellness; and 5) gross fixed capital formation of Health and Wellness industries.

The consultative forum sought to assess the feasibility of the survey/monitoring form to capture the needed statistics and indicators for the sector. The forum successfully solicited the commitment of the participants both from government and the private sector to support the data collection efforts that will be undertaken in the future. During the consultative forum, the following issues/concerns/suggestions came up: a) coverage should be extended to traditional (informal, unorganized) providers of health and wellness services; b) whether establishment-respondents have the capability to provide the details asked, such as distinguishing between resident and nonresident clients; c) difficulty in providing cost estimates; d) lack of familiarity with classification systems and e) separation of medical from nonmedical employees.

Towards quantifying health and wellness tourism, the possible data sources include the following: 1) Arrival/Departure (A/D) Cards- The A/D cards which are processed by the DOT provide information on purpose of travel which includes health/medical reason as a category of the purpose of travel. 2) Visitors Sample Survey (VSS) - The VSS is a monthly survey that generates information on visitor characteristics and preferences useful in tourism planning and in deriving estimates of foreign exchange earnings from visitors. One category under purpose of travel in the VSS is health reason s. It also asks questions on actual expenditures incurred

but not directly from availment of health and wellness tourism services. 3) Establishment-based surveys of the NSO- The NSO regularly conducts the Quarterly (QSPBI) and Annual (ASPBI) Surveys of Philippine Business Industries, and the Census of Philippine Business and Industry (CPBI). The CPBI 11 is a comprehensive collection and compilation of statistical information on the structure and level of economic activity of business establishments in the country. Information collected includes revenues, employment, hours worked, compensation, cost, capital formation, etc. The ASPBI12 collects the same information but only from a sample of establishments. The QSPBI collects quarterly data on gross revenue/sales, employment and compensation for each of the major industry groups, using purposive sampling. A more detailed description and profiles of these establishment-based surveys/census were compiled by NSCB (2000). The data collected from these data sources are summarized based on the 1994 PSIC. One limitation of these data sources is that at present, they cannot segregate revenues from visitors and nonvisitors. 4) Administrative and regulatory forms of the Department of Health (DOH) - The DOH maintains a Field Health Service Information System, which collects public health statistics emanating from barangay health stations. The DOH also maintains the Hospital Operations and Management Information System which is a computer-based system for effective hospital management that contains admitting and billing records among others. However, these systems do not currently generate information for health and wellness tourism. While the data sources cited cannot provide in general, the information needed, they certainly can be reviewed for more appropriate disaggregation or possible inclusion of data items/questions that can generate the necessary information for the measurement of health
11

Normally, the CPBI is conducted every 5 years. The latest CPBI was conducted in August 2000 with the year 1999 as the reference period. The preliminary release came out in April 2004 and the final tables were released by the NSO in June 2005. 12 The ASPBI is a nationwide survey of the NSO that covers all administrative regions of the country usi ng a one-stage stratified random sampling. For the 2002 ASPBI (reference period 2001) the preliminary release came out in January 2005, the final release in December 2005; for the 2003 ASPBI (reference period 2003), the preliminary release came out in June 2005, the final results in February 2007; for the 2005 ASPBI (reference period 2005), the preliminary results came out in April 2007 with the final tables targeted to be released in the last quarter of 2007.

and wellness tourism. For example, if the CPBI and ASPBI data could be processed at the 5digit PSIC level, the social work activities and other service activities can be purified to exclude many of the economic activities now included under health and wellness tourism statistics such as child care services, caring for the mentally and physically handicapped, charitable services, barber shops, beauty parlors and funeral and related activities (Table 1). Moreover, the information from the available data sources does not allow for the separation or revenues, cost, employment and other variables associated with visitors from those pertaining to non -visitors.

V.

Indicative Analysis So far, the pilot survey has not generated the response 13 needed to provide

information on health and wellness tourism with some degree of adequacy. As work on generating statistics for health and wellness tourism is at its initial stages, in addition to the limitations on the data sources already mentioned, there are also coverage limitations, both in terms of scope and classification. Subject to these limitation s, below are some of the statistics on health and wellness tourism based on three PSIC groups namely, hospital activities and medical and dental practices (851), social work activities (853) and other service activities (930) derived from the CPBI and the ASPBI. EMPLOYMENT INCREASED SUBSTANTIALLY IN 2005 ! While the combined employment of the three groups of activities under health and wellness tourism barely moved between 1999 and 2003, it surged by 13.2 percent from 2003 to 2005, one year after the issuance of E.O 372 that created the public-private sector partnership to formulate a development strategy for the industry. However, its share to total employment remained below one per cent. Hospital Activities and Medical and Dental

13

Two months after the deadline and despite commitments made during the consultative workshop, less than 20 % of the establishments have responded.

Practices constituted the b iggest employer among the three groups with more than 50 percent share and social work activities the smallest at just over one per cent (Table 2). REVENUES ROSE BY 36.1 % FROM 2003 TO 2005!

As with employment, revenues of health and wellness tourism industries rose faster after EO 372. Prior to 2004, revenues grew at slower rates than either Gross Value Added (GVA) of Total Private Services or Gross Domestic Product (GDP). Revenues however, remain at about 1.3% of GDP, close to the contribution of the smallest economic sector, Mining and Quarrying. On the other hand, the share of revenues of health and wellness tourism to the GVA of total private services, while increasing slightly between 2003 and 2005, is still below 10 percent. Almost 80 percent of the growth in revenues between 2003 and 2005 came from Hospital Activities and Medical and Dental practices (Table 3). COST OF HEALTH AND WELLNESS SERVICES SOARED IN 2005! The cost, or the expenses incurred during the year whether paid or payable as defined in the CPBI and the ASPBI, likewise indicated comparatively greater increases after EO 372, rising by 18.3 % from 1999 to 2001, by 19.4 % from 2001 to 2003 and by 40.6 % from 2003 to 2005 (Table 4). As with revenue and employment, the bulk of the costs came from Hospital Activities and Medical and Dental Practices. Compared to revenue, the cost increased faster, causing the Revenue to Cost ratio to continuously decline from 1.86 in 1999 to 1.72 in 2001 then to 1.65 and 1.60 in 2003 and 2005, respectively. The decline was caused mainly by the continuing decline in the Revenue to Cost ratio of the biggest component of health and wellness tourism, namely, Hospital Activities and Medical and Dental Practices, from 1.85 in 1999, 1.71 in 2001, 1.61 in 2003 and 1.56 in 2005. This deserves careful scrutiny (Table 5). If these statistics are indicative of the performance of the health and wellness tourism

industry, it would be interesting to know if the 2005 trend was replicated in 2006 14 and if the trend is being sustained in 2007. It must be stressed however, that the information shown is very preliminary and cannot be conclusively used as a measure of the performance and contribution of the Health and Wellness Industry in the country. Nonetheless, these statistics show that it is possible to provide estimates of the importance of the health and wellness tourism industry to the entire economy. In this regard, the Philippine Statistical System (PSS) must take on the challenge to enhance the health and wellness tourism statistics in the country.

VI.

Strengthening Coordination and Collaboration Mechanisms in the PSS At present, the NSCB and the DOT are the two agencies with the most active role

towards the measurement of health and wellness tourism in the country. Because of t e h collaborative work of NSCB and DOT, the Philippines has been actively participating in moving the TSA agenda at the international level. However, the other stakeholders have important roles to play. Institutional arrangements have to be agreed upon to address data gaps. Fortunately, aside from the IAC-TrS and the TF, the NSCB has also created an Interagency Committee on Tourism Statistics (IAC-TS) that in fact, paved the way for the development of the PTSA. These bodies serve as venues for discussion of technical and operational issues covering the sector. Based on the Philippine experience, inter-agency committees are effective tools for coordination and provide the fora for a meaningful exchange of views and expertise and the resolution of statistical issues. The member agencies of the IAC-TrS, the IAC-TS and the TF have been supporting and cooperating in the joint activities. However, it is necessary to further strengthen the roles and the monitoring the commitment of these bodies.

14

It would be possible to assess this because the NSO is conducting a 2006 CPBI.

VII.

Concluding Remarks Obviously, despite the availability of some data collection mechanisms, the PSS is

not yet able to generate the data needed to adequately measure health and wellness tourism. And while collaboration and cooperation among the stakeholders exist, stronger commitment is needed from concerned sectors in order to efficiently and effectively implement plans and agreements that have been formulated. Concerned data compiling government agencies like the DOT, the NSCB and the NSO should try harder to collect and disseminate the necessary health and wellness tourism statistics. The NSO should be ready to produce statistics with lower levels of disaggregation or at least produce Public Use Files of its establishments surveys/censuses to allow researchers access to information on health and wellness tourism. At the same time, tourism planners from both the private sector and government should develop the capacity to use statistics in their decision-making and policy formulation. Likewise, households, establishments and data source agencies from government must show greater willingness and to provide support to data collection efforts. This includes the willingness to provide data that have not been provided in the past, such as on foreign exchange earnings and clientele served. Finally, statistics require resources; it is therefore imperative that both the government and the private sector develop the political will to invest in statistics.

References Commission of the European Communities, International Monetary Fund, Organization for Economic Cooperation and Development, United Nations and World Bank (1993). System of National Accounts (SNA) 1993 Commission of the European Communities, Organization for Economic Cooperation and Development, World Tourism Organization and United Nations (2000). Tourism Satellite Accounts: Recommended Methodological Framework. New York DOT, Department of Tourism (2007). Philippine Health and Wellness Tourism Program. Consultative Forum on the Pilot Survey on Health and Wellness To urism Statistics NEDA, National Economic Development Authority (2000). Medium Term Philippine Development Program (MTPDP) 2004 - 2010 NSCB, National Statistical Coordination Board (2006). Philippine Statistical Development Program (PSDP) 2005- 2010 NSCB, National Statistical Coordination Board (2000). Profile of Censuses and Surveys Conducted by the Philippine Statistical System. NSCB, National Statistical Coordination Board (2007). Study on the Measurement and Generation of Statistics on International Trade in Services (Focus on Healthcare and Wellness/Medical Tourism Services) for Use in Trade Negotiations and as Data Support in the Formulation of National Positions. First Draft. Republic of the Philippines (2007). Proclamation No. 1280, 24 April 2007. NSO, National Statistics Office. Technical Notes for CPBI and ASPBI http://www.census.gov.ph/data/technotes/index.html Virola, R., M. Remulla, L. Amoro and M. Say (2001). Measuring the Contribution of Tourism to the th Philippine Economy: The Philippine Tourism Satellite Account. Convention Papers, 8 National Convention on Statistics, Westin Philippine Plaza, Manila 1 -2 October 2001. Virola, R., M. Remulla, L. Amoro and M. Say (2002). Dealing with Data Shortfalls. An article in the publication Best Practice in Tourism Satellite Account Development in APEC Member Economies by the Asia-Pacific Economic Cooperation (APEC) Tourism Working Group, June 2002.

Table 1. Summary of Activities under PSIC Codes 851, 853 and 850 a /
PSIC Code 851 85111 85112 85113 85119 85121 85122 85123 85124 85129 85190 853 85311 85313 85314 85315 85319 85321 85322 85323 85324 85329 930 93010 93021 93022 93029 93030 93092 93093 93099 INDUSTRY DESCRIPTION HOSPITAL ACTIVITIES & MEDICAL & DENTAL PRACTICES PUBLIC HOSPITALS, SANITARIA AND OTHER SIMILAR ACTIVITIES PUBLIC MEDICAL ACTIVITIES PUBLIC DENTAL AND LABORATORY SERVICES PUBLIC MEDICAL, DENTAL AND OTHER HEALTH SERVICES, N.E.C. PRIVATE HOSPITALS, SANITARIA AND OTHER SIMILAR ACTIVITIES PRIVATE MEDICAL ACTIVITIES PRIVATE DENTAL AND LABORATORY SERVICES PRIVATE CHILD CARE CLINICS PRIVATE MEDICAL, DENTAL AND OTHER HEALTH SERVICES, N.E.C. OTHER HOSPITAL ACTIVITIES & MEDICAL & DENTAL PRACTICES, N.E.C SOCIAL WORK ACTIVITIES CHILD CARE SERVICES CARING FOR THE AGED AND THE ORPHANS CARING FOR THE MENTALLY AND PHYSICALLY HANDICAPPED REHABILITATION OF PEOPLE ADDICTED TO DRUGS OR ALCOHOL OTHER SOCIAL WORK WITH ACCOMODATION, N.E.C. CHILD-CARE ACTIVITIES (INCLUDING FOR THE HANDICAPPED) WELFARE AND GUIDANCE COUNSELLING ACTIVITIES VOCATIONAL REHABILITATION AND HABILITATION ACTIVITIES CHARITABLE ACTIVITIES OTHER SOCIAL WORK WITHOUT ACCOMODATION, N.E.C. OTHER SERVICE ACTIVITIES WASHING & (DRY-) CLEANING OF CLOTHING & TEXTILE BARBER SHOPS ACTIVITIES BEAUTY PARLOR ACTIVITIES BEAUTY TREATMENT AND PERSONNAL GROOMING ACTIVITIES, N.E.C. FUNERAL & RELATED ACTIVITIES SAUNA AND STEAM BATH ACTIVITIES SLENDERING AND BODY BUILDING ACTIVITIES MISCELLANEOUS SERVICE ACTIVITIES Not in the list Not in the list Not in the list Yes Not in the list Yes Yes Yes Not in the list Yes Not in the list Yes Not in the list Not in the list Not in the list Not in the list Not in the list Not in the list Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Health and Wellness Activity?

a/ Health and Wellness Toruism Activities are all covered by this three groups of activities. Correspondence between Health and Wellness Tourism Clusters, Philippine Central Product Classification (PCPC) and Philippine Standard Industrial Classification (PSIC) for Health and Wellness Tourism Services can be found in the Annex 2 of the project report on the "Study on the Measurement and Generation of Statistics on International Trade in Services with Focus on Health and Wellness Tourism Services

Table 2. Employment Data of Selected Health and Wellness Tourism Activities Activities in Health and Wellness Tourism Hospital Activities & Medical and Dental Practices Social Work Activities Other Service Activities Total
Employment of Health & Social Work and Other Community, Social & Personal Service b/ Activities Total Employment (Philippines) b/
a/

1999 129,852 2,278 79,881 212,011 *

29,003,000

Total Employment 2001 2003 130,711 1,861 77,743 210,315

1,229,000 30,090,000

2005 145,468 2,912 90,575 238,955

1,143,000 32,875,000

Growth Rates (%) 1999 - 01 2001 - 03 2003 - 05 0.7 -18.3 -2.7 -0.8 0.3 -24.9 1.0 0.3
-0.7 3.7 4.9

131,087 1,397 78,525 211,009

1,221,000 31,553,000

11.0 108.4 15.3 13.2

-6.4 4.2

% Share to
Employment of Health & Social Work and Other Community, Social & Personal Service Activities Total Employment (Philippines)

*
0.73%

17.11% 0.70%

17.28% 0.67%

20.91% 0.73%

Source: a/ Census of Philippine Business and Industry (CPBI), 1999 and Annual Survey of Philippine Business and Industry 2001, 2003 & 2005 b/ Labor Force Survey (October round), NSO 2001, 2003 & 2005 * Classification of Major Industry Groups using the 1994 Philippine Standard Classification (PSIC) started only in 2001. Employment data in 1999 is still lumped in broader levels.

Table 2a. Explanatory Table on the Industry Classification used in Employment Data Activities in Health and Wellness Tourism Hospital Activities & Medical and Dental Practices Social Work Activities Other Service Activities
Health & Social Work and Other Community, Social & Personal Service Activities Hospital Activities and Medical And Dental Practices Veterinary Activities Social Work Activities Sewage and refuse disposal, sanitation and similar activities Activites if business, employers and professional organizations Activites of Trade Unions Activities of Other membership Organizations Motion picture, radio, television and other entertainment activities News Agency Activities Library, achives, museums and other cultural activities Sporting and Other recreational activities Other Service Activities * Out of 12 Industries (3-digit PSIC classification) in Health and Social Work and other community, social and personal service activities, only three are identified as Health and Wellness Activities 851 852 853 900 911 912 919 921 922 923 924 930

PSIC CODE (3-digit) 851 853 930 Health and Wellness*

Health and Social Work

Other Community, Social, and Personal Service Activities

Table 3. Revenue Data of Selected Health and Wellness Tourism Activities Activities Hospital Activities & Medical and Dental Practices Social Work Activities Other Service Activities Total (in thousand pesos)
Gross Value Added of Total Private Services b/ (in million pesos: at current prices) Gross Domestic Product (GDP), In million pesos: at current prices
b/

1999 29,970,709 545,473 9,727,580 40,243,762

335,404 2,976,905

Revenues (Php '000) 2001 2003 33,462,035 520,509 9,848,886 43,831,430

433,674 3,631,474

a/

2005 53,831,498 1,105,768 13,574,428 68,511,694

741,984 5,437,906

Growth Rates (%) 1999 - 01 2001 - 03 2003 - 05 11.6 -4.6 1.2 8.9
29.3 22.0

39,359,225 424,803 10,553,324 50,337,352

556,490 4,316,402

17.6 -18.4 7.2 14.8

28.3 18.9

36.8 160.3 28.6 36.1

33.3 26.0

% Share to
Gross Value Added of Total Private Services

12.00% 1.35%

10.11% 1.21%

9.05% 1.17%

9.23% 1.26%

Gross Domestic Product (GDP)

Source: a/ Census of Philippine Business and Industry (CPBI), 1999 and Annual Survey of Philippine Business and Industry 2001, 2003 & 2005 b/ National Income Accounts, National Statistical Coordination Board

Table 4. Cost Data of Selected Health and Wellness Tourism Activities Activities Hospital Activities & Medical and Dental Practices Social Work Activities Other Service Activities Total 1999 16,166,471 306,239 5,129,717 21,602,427 Cost ('000 Php) 2001 2003 19,571,716 321,827 5,654,078 25,547,621 24,374,952 263,310 5,856,104 30,494,366 2005 34,420,291 587,838 7,872,965 42,881,094 Growth Rates (%) 1999 - 01 2001 - 03 2003 - 05 21.1 5.1 10.2 18.3 24.5 -18.2 3.6 19.4 41.2 123.2 34.4 40.6

Source: Census of Philippine Business and Industry (CPBI), 1999 Annual Survey of Philippine Business and Industry 2001, 2003 & 2005

Table 5. Revenue to Cost Ratio by Activity Activities Hospital Activities & Medical and Dental Practices Social Work Activities Other Service Activities Total 1999 1.85 1.78 1.90 1.86 Revenue to Cost Ratio 2001 2003 1.71 1.62 1.74 1.72 1.61 1.61 1.80 1.65 2005 1.56 1.88 1.72 1.60 Growth Rates (%) 1999 - 01 2001 - 03 2003 - 05 -7.8 -9.2 -8.1 -7.9 -5.6 -0.2 3.5 -3.8 -3.1 16.6 -4.3 -3.2

a/

a/ Derived by dividing the Revenue data (Table 3) by the Cost data (Table 4)

Annex 1 Tables Generated in the Philippine Tourism Satellite Accounts (PTSA)

a/

Table Number 1

Table Title Tourism Demand in the Philippines, 1994 and 1998 Tourism Consumption Expenditures in the Philippines, 1994 and 1998 Tourism Collective Consumption Expenditures in the Philippines, 1994 and 1999 Gross Fixed Capital Formation of Tourism Industries in the Philippines, 1994 and 1998 Estimated Value Added of Tourism Industries (VATI) in the Philippines, 1994 and 1998 Production Accounts of Tourism Industries and Non-Tourism Industries in the Philippines, 1994 Supply and Use Table of Tourism Industries and NonTourism Industries in the Philippines, 1994 Estimated Tourism Ratio Based on the Tourism Final Demand, 1994 and 1998 Employment Generated by the Tourism Industries in the Philippines, 1994 and 1998 Various Tourism Statistics (Physical Indicators)

WTO TSA Table Description Number No Total tourism demand cross tabulated by equivalent tourism characteristic products and categories of demand Tables 1, 2 Total consumption expenditures cross and 4 tabulated by tourism characteristic products and type of visitors Table 9 Total collective consumption expenditures by type of tourism collective Non-Market Services GFCF of Tourism Industries cross tabulated by Type of Fixed Capital Formation VATI presented by Type of Tourism Characteristic Industries Table derived from the 1994 Input-Ouput (IO) Accounts

Table 8

No equivalent Table 5

Table 6

Table derived from the 1994 Input-Ouput (IO) Accounts

No equivalent

Tourism Ratio was computed by comparing Internal Tourism Consumption expenditures with the final demand for the tourism industries Employment Classified by type of Tourism Industries Includes Tourist Arrivals, Means of Transportation and Port of entry and Forms of Accommodation Available for Tourists

Table 7

10

Table 10

a/ Due to data constraints, not all tables prescribed by the World Tourism Organization (WTO) were compiled. Table on Outbound Tourism (Table 3 in WTO) was not compiled. The other tables, while compiled had their limitations. Table 2 (Tables 1, 2 and 4 in WTO) did not include same day visitors and other components of visitor consumption such as final consumption expenditures in kind, tourism social transfers in kind other than individual non-market cultural services and tourism business expense.Table 7 (Table 6 in WTO) was short of establishing the linkage between tourism supply and internal tourism consumption. Table 8 was established with the objective of estimating tourism ratios to eventually come up with Tourism Value Added (TVA). but this still needs refinements to correct doubtful tourism ratios.Table 9 (Table 7 in WTO) did not include information on the number of jobs and status of employment. Table 4 (Table 8 in WTO) classified capital goods on the basis of available disaggregation. Table 3 (Table 9 in WTO) did not provide disaggregation by level of government and in Table 10 (also Table 10 in WTO) not all suggested sub-tables were compiled.

Annex 2 Survey Form of the 2006 Pilot Survey on Health and Wellness Tourism
COVER PAGE

2006 Pilot Survey on Health and Wellness Tourism*

OBJECTIVE The Pilot Survey on Health and Wellness Tourism aims to gather information on health and wellness tourism providers. This information will be used as basis for informed policy decisions and advocacy for legislative support for the health and wellness tourism sector. REFERENCE PERIOD Report should refer to the period from January 1, 2005 to December 31, 2006. INQUIRIES For inquiries please contact Name: _________________________ or E-mail us at: ____________________________ Tel. No.: _________________ DUE DATE Duly accomplished form should be submitted ON or BEFORE MAY 31, 2007

* - Health and Wellness Tourism Health and wellness tourism comprises the activities of persons traveling to and staying in places outside their usual environment for not more than one consecutive year for health and wellness purposes not related to the exercise of an activity remunerated from within the place visited (UNWTO and DOT)

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PLEASE ENTER THE DATA REQUESTED ON THE APPROPRIATE SPACE OR BOX.

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PLEASE ENTER THE DATA REQUESTED ON THE APPROPRIATE SPACE OR BOX.

Part I - GENERAL INFORMATION ABOUT THE ESTABLISHMENT 1. Company Name (or Name of Establishment)

Part III - REVENUE Revenue refers to cash received and receivables for services rendered. Please include revenues of all branches.

2. Location (City/Province)

1. Revenue from Health and Wellness Tourism Services (CY 2005) In PhP a. Hospital Services b. Medical and Dental Services

Total

From Local Client

a

From Foreign Client

b

Part II - OUTPUT OF THE ESTABLISHMENT in 2006

Output refers to the goods and services produced in the Philippine economy. Primary/main output refers to the output that contributes the biggest or major portion of revenue of the establishment

c. Other Human Health Services d. Social Services with accomodation e. Physical and Well-Being Services f. Other beauty treatment services, n.e.c.

Does your establishment provide any of the services listed below? Please tick ( ) only one for Primary Output. Tick any applicable service/s for "Secondary Output"

PCPC Code

Output Description

PSIC Code

Primary/Main Output

Secondary Output

2. Revenue from Health and Wellness Tourism Services (CY 2005) In PhP a. Hospital Services b. Medical and Dental Services c. Other Human Health Services d. Social Services with accomodation e. Physical and Well-Being Services f. Other beauty treatment services, n.e.c.
a b

Total

From Local Client

a

From Foreign Client

b

9311

Hospital Services (Includes surgical,medical, gynecological, rehabilitation, psychiatric services and other hospital services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining health Medical and Dental Services (Includes general 1 2 3 medical , specialized medical and dental services consisting of the prevention of physical and/or mental diseases of general nature thru consultations, physical check-ups and can be provided in general practice

9312

Includes OFW who are permanent residents of the Philippines Includes Overseas Filipinos (OF) holding Philippine Passport who are permanently residing abroad and expats.

9319

Other Human Health Services (Includes deliveries and related services, nursing services, physiotherapeutic and paramedical services provided by authorized persons, other than medical doctors)4 Social Services with accomodation (Includes social assistance services involving round the clock services by 5 residential institutions) Physical and well-being services (Includes physical well-being services such as those delivered by solarioums, spas, reducing and slimming salons, fitness centers, massage (exclusing therapeutic massage) and the like (e.g Turkish baths, sauna and steam bath)

Part IV Cost
Cost refers to cash paid and payable for goods and services incurred. Please include costs of all branches.

1. Cost/ Expenses incurred to the following items (In PhP)

9331

2005

2006

a. Compensation of Employees * b. Supplies and Materials (Incl. Drugs & Medicines) c. Machineries and Equipment d. Sub-Total [(d) = (a) + (b) + (c )]
2. Other Cost (other cost items not included under Items a,b and c above) 3. Total Cost [(3) = (1.d) + (2)]
* - Includes salaries and wages, commissions, other remuneration plus the actual or estimate of professional fees.

9723

9729

Other beauty treatment services, n.e.c. ( Includes personal hygiene, body care, depilation, treatment with ultraviolet rays and infra-red rays and other hygiene services)

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PLEASE ENTER THE DATA REQUESTED ON THE APPROPRIATE SPACE OR BOX.

Part V - PATIENT INFORMATION Local Total Number of Patients in 2006 Foreign Total

NOTES:
1

General medicine refers to the branches of medicine dealing with the general care and treatment of the diseases of adults who have not yet reached old age. Includes public medical services (including perdiculture and laboratory services) under PSIC code 85112, and Private medical services (inc. laboratory services) under PSIC code 85122.
2

Part VI - EMPLOYMENT Average Total Employment (ATE) is the average total number of persons who worked in or for this establishment. It includes employees of all branches 2005 Average Total Employment 2006

Specialized medicine refers to branches of medicine devoted to particular practice areas; e.g. podiatry, proctology, ophthalmology, cardiology, ear-nose-throat, etc.n. Includes public specialized medical services that is part of PSIC code 85111, 85119; and private specialized medical services that is part of PSIC code 85121 and 85129 3 Dental medicine refers broadly to diagnosing and treating dental problem. Includes public dental and laboratory services with PSIC code 85113 and private dental and laboratory services with PSIC code 85123
4

Part VII - COMMENTS ON THE QUESTIONNAIRE Part I - General Information

Includes private child care clinics (PSIC code 85124), other services provided by midwives, nurses, physiotherapists and paramedical personnel (part of PSIC code 85119 and 85129), private ambulance services (part of PSIC code 85119), public ambulance services (part of PSIC code 85129), residential health facilities services other than hospital services (part of PSIC code 85112) and other human health services, n.e.c (part of PSIC code 85190) 5 This includes caring for the aged (PSIC code 85313) and rehabilitation of people addicted to drugs or alcohol (PSIC code 85315)
6

Part II - Output of the Establishment

(Additional comments to improve the description of services/output will be appreciated. Your comments will serve as valuable inputs in the updating of the Philippine Central Product Classification)

This includes sauna and steam bath services (PSIC code 93092), slendering and body-building services (PSIC code 93093) and other physical and well-being services, nec (PSIC code 93099) ACRONYMS

PSIC - Philippine Standard Industrial Classification PCPC - Philippine Central Product Classification
Part III - Revenue

Part IV - Cost

Part V - Patient Information

Part VI - Employment

Part VIII - CERTIFICATION I hereby certify that this report for the period ________________ to ________________ has been completed as accurately as the records of this establishment allow and with the best estimates in some instances. Name: _____________________________________ Title/Designation: ____________________________ E-mail Address: _____________________________ Signature: ________________________ Date: ____________________________ Contact Number/s: _________________

Annex 3. Health and WellnessTourism Classification

Clusters Based on EO 372*
a. Hospital care and treatment

PAGE 1
PSIC**

PCPC**
9311 - Hospital Services This includes: surgical services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining the health of a patient; medical services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining the health of a patient; gynecological and obstetrical services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining the health of a patient; rehabilitation services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining the health of a patient; psychiatric services delivered under the direction of medical doctors chiefly to in-patients, aimed at curing, restoring and/or maintaining the health of a patient; other hospital services delivered under the direction of medical doctors chiefly to in-patients,aimed at curing, restoring and/or maintaining the health of a patient. These services comprise medical, pharmaceutical and paramedical services, nursing services, laboratory and technical services including radiological and anaesthesiological services, etc.; military hospital services; prison hospital services. This subclass does not include: services delivered by hospital out-patient clinics, classified in 9312; dental services, classified in 93123; ambulance services, classified in 93192. 93111 - Public hospitals, sanitaria and other similar services 93112 - Private hospitals, sanitaria and other similar services

85111 - Public Hospitals, Sanitaria and Other Similar Activities 85121 - Private Hospitals, Sanitaria and Other Similar Activities 85190 - Other hospital activities and medical and dental practices, n.e.c

b. Specialty Clinics

9312 - Medical and Dental Services 93121 - General medical services This subclass includes: services consisting of the prevention, diagnosis, and treatment by doctors of medicine of physical and/or mental diseases of a general nature, such as: - consultations; - physical check-ups, etc. These services are not limited to specified or particular conditions, diseases or anatomical regions. They can be provided in general practitioner's practices and also delivered by out-patient clinics, clinics attached to firms, schools, etc. 931211 - Public medical services 931212 - Private medical services 93122 - Specialized medical services This subclass includes: consultation services in pediatrics, gynecologyobstetrics, neurology and psychiatry, and various medical services; surgical consultation services; treatment services in out-patients clinics, such as dialysis, chemotherapy, insulin therapy, respiratory treatment, radiation treatment and the like; analysis Thisand interpretation ofinclude services of medical subclass does not medical images (X'ray, laboratories, classified in 93199.

85112 - Public medical activities 85122 - Private medical activities

Annex 3 PAGE 2

Clusters Based on EO 372*

PCPC**
931211 - Public specialized medical services 93122 - Private specialized medical services 93123 - Dental services This subclass includes: orthodontic services, e.g., treatment of protruding teeth, crossbite, overbite, etc., including dental surgery even when given in hospitals to in-patients; services in the field of oral surgery; other specialized dental services, e.g., in the field of periodontics, paedodontics, endodontics and reconstruction; diagnosis and treatment services of diseases affecting the patient or aberrations in the cavity of the mouth, and services aimed at the prevention of dental diseases. Note : These dental services can be delivered in health clinics, such as those attached to schools, firms, homes for the aged, etc., as well as in own consulting rooms. They cover services in the field of general dentistry, such as routine dental examinations, preventive dental care, treatment of caries, etc. 931231 - Public dental and laboratory services 931232 - Private dental and laboratory services 9319 - Other human health services 93191 - Deliveries and related services, nursing services, physiotherapeutic and para-medical services This subclass includes: services such as supervision during pregnancy and childbirth;supervision of the mother after birth;services in a field of nursing care (without admission), advice and prevention for patients at home, the provision of maternity care, children's hygiene, etc. services provided by physiotherapists and other paramedical persons (including homeopathological and similar services); physiotherapy and paramedical services are services in the field of physiotheraphy, ergotherapy, occupational therapy, speech therapy,homeopathy, acupuncture, nutrition, etc. These services are provided by authorized persons,other than medical doctors. 931911 - Private child care clinics 931919 - Other services provided by midwives, nurses,physiotherapists and paramedical personnel

PSIC**
85119 - Public medical, dental and other health activities, n.e.c. 85129 - Private medical, dental and other health services, n.e.c.

85113 - Public dental and laboratory activities 85123 - Private dental and laboratory activities

85124 - Private child care clinics 85119 - Public medical, dental and other health activities, n.e.c. 85129 - Private medical, dental and other health services, n.e.c.

93192 - Ambulance services This subclass includes services involving transport of patients by ambulance, with or without resuscitation equipment or medical personnel. 931921 - Public ambulance services 931922 - Private ambulance services

Part of 85119 - Public medical, dental and other health activities, n.e.c Part of 85129 - Private medical, dental and other health services, n.e.c

Annex 3 PAGE 3

Clusters Based on EO 372*

PCPC**

PSIC**

c. Wellness and Spa Centers

93193 - Residential health facilities services other than hospital services This subclass includes combined lodging and medical Part of 85112 - Public medical activities services provided without the supervision of a medical Part of 85119 - Public medical, dental and other doctor located in the premises. health activities, n.e.c Part of 85129 - Private medical, dental and other health services, n.e.c 93199 - Other human health services, n.e.c. 85190 - Other hospital activities and medical and This subclass includes: dental practices, n.e.c services provided by medical laboratories; services provided by blood, sperm and transplant organ banks;diagnostic imaging services without analysis or interpretation, e.g., X-ray, ultrasound, magnetic resonance imaging (MRI), etc.;dental testing services;medical analysis and testing services;other human health services, n.e.c. 9723 - Physical and Well-Being Services This subclass includes physical, well-being services such as delivered by sauna and steam baths, solarium, spas, reducing and slimming salons, fitness centers, massage (excluding therapeutic massage) and the like. This subclass does not include medical treatment services, classified in 931. 97231 - Sauna and steam bath services 97232 - Slendering and body building services 97239 - Other physical well-being services, n.e.c.

93092 - Sauna and Steam Bath Activities 93093 - Slendering and body- building activtities 93099 - Other physical well-being services, nec

9729 - Other beauty treatment services, nec 93029 - Beauty treatment and personal grooming This subclass includes personal hygiene, body care, activities, nec depilation, treatment with ultraviolet rays and infra-red rays and other hygiene services. This subclass does not include medical treatment services, classified in 931 d. Retirement and rehabilitative 9331 - Social Services with accomodation 93311 - Welfare services delivered through residential care institutions to elderly persons (and persons with disabilities) This subclass includes: social assistance services involvinground-the-clock care services by residentialinstitutions for elderly persons; social assistance services involvinground-the-clock care services by residentialinstitutions for persons with physical orintellectual disabilities including those havingdisabilities in seeing, hearing or speaking. This subclass does not include: combined lodging and medical services,classified in 93110 (Hospital services) if under thedirection of medical doctors, and 93193 if withoutsupervision by a medical doctor. 933111 - Caring for the aged and orphans 933194 - Rehabilitation of people addicted to drugs or alcohol

85313 - Caring for the aged and orphans 85315 - Rehabilitation of people addicted to drugs or alcohol

* Based on the Committee on Health and Wellness, under the PPP Task Force on Globally Competitive Industries, created by virtue of EO 372 * Highest revenue was the basis for coming up with the correspondence between clusters and the PCPC/PSIC.