This story
was taken from Bulatlat, the Philippines's alternative weekly
newsmagazine (www.bulatlat.com, www.bulatlat.net, www.bulatlat.org).
Vol. V, No. 39, November 6-12, 2005
Official statistics show that seven out of every 10 Filipinos die without ever
seeing a doctor and that the nearly 75 percent of the population living below
poverty line are mainly in rural areas where there is no access to basic
services such as health and medical care. Yet the government has allotted a mere
30 centavos per Filipino per day for health care. And now, its thrust is the
“corporatization” of the health system translating into higher fees and
eventually the privatization of public health care services.
By Karl G. Ombion & Ranie Azue The reality in private
hospitals where an in-patient must first give a down payment of P2,000 upon
admission is now also true in public hospitals today. A public hospital patient
now has to pay a deposit of P500 to P1,000 first. This is why, according to
health activists, the health situation of Filipinos has become deplorable.
Official statistics show that seven out of every 10 Filipinos die without even
seeing a doctor. Nearly 75 percent of Filipinos live below the poverty line,
most of them from the rural areas. These are the people who have no access to
the most basic services including health care and medical treatment. Health activists conclude
that the inaccessibility of health services and the worsening health situation
are due to the government’s thrust of pursuing the policy of privatization,
where ownership and control of public services and utilities, like power, water,
schools, and hospitals, are being turned over to private corporations whose main
objective is to profit. This trend is called the “corporatization” of public
services. In 1998, the government
formed a “Task Force on Corporatization” led by the Department of Health (DOH).
It evaluated public hospitals regarding their viability for fiscal autonomy and
restructuring, in line with the thrust towards “corporatization” of 38 state-run
hospitals nationwide. The evaluation showed most
public hospitals are inefficient, unprofitable and unsustainable. Hence, the
government implemented the Health Sector Reform Agenda (HSRA) aiming for:
hospital revitalization or modernization, financing system expansion, conversion
into public corporation, improvement of hospital networking and patient referral
system, and organizational changes. Higher tariff for
medical services In line with the national
government’s thrust, the Negros Occidental provincial government raised the
tariff for medical services in government hospitals. Data obtained by
Bulatlat revealed that the provincial government passed Provincial Tax
Ordinance No. 92-002, amending Provincial Tax Ordinance 97-001, raising the fees
being charged by government hospitals at an unprecedented rate of 250% compared
to the year 2000. In Article C of the said
Provincial Tax Ordinance, the following standard rates are set:
Rates for the use of
laboratory facilitates vary from a minimum of P45 to a high of P400. Oftentimes
laboratory needs of patients are referred to private laboratories since most of
the procedures needed are not available. Worse is the reported blatant
collaboration between hospital personnel particularly laboratory technicians and
physicians and private laboratories. The charge for ultrasound
service ranges from P350 to P900.Use of x-ray machines is pegged at P150;
incubator fee at P240 a day or P10 per hour; respirator machine excluding oxygen
at P250; cardio monitor at P500; and respirator tubing, P950 per piece.
Negros Occidental Governor
Joseph Maranon said the imposition of standard rates is intended to generate
revenues for better services. The funds generated are used for the replenishment
of hospital supplies and upgrading of facilities, the governor said. A long time resident
nursing aide however belied the Governor’s statement saying that the provincial
hospital looks modern outside but is dilapidated inside. Requesting not to be
identified, she took Bulatlat around the buildings and showed how some of
the rooms and ceilings have remained unfinished while some have been severely
damaged or poorly maintained. Worse, she added, patients are charged for the use
of medical equipment donated by politicians and benevolent groups for the use of
the public. Privatization cum
“corporatization” Corporatization, as defined
the Center for Investigative Research and Media Services (CIRMS), is the process
of take over by private corporate interest of a public utility entity, which
eventually leads to full privatization. In its study of selected
cases of privatized government utilities, CIRMS said corporatization has two
types. One is the direct sale of a government or public utility to a private
company. The most common reasons given for this are government inefficiency,
slow modernization, and indebtedness of the utility. CIRMS cited the case of
national government companies as examples. The second is the indirect
takeover by a private corporate interest of a public utility firm for the same
reasons as above. CIRMS cited the case of local water units, financial
institutions, and the Corazon Locsin Montelibano Memorial Regional Hospital (CLMMRH),
which have heavy private investments. The CLMMRH, a case study The Corazon Locsin
Montelibano Memorial Regional Hospital (CLMMRH) started as a district hospital.
It became a regional hospital in the late ‘80s. But according to sources, its
status was elevated without the standards of a regional hospital being fully
satisfied. These include having separate buildings for each medical function,
standard medical equipments, a 300-bed capacity, a certain number of doctors,
nurses & health staff, including resident doctors, among others. In mid ‘90s, the CLMMRH was
listed as one of the pilot hospitals out of 38 priority state-run hospitals
nationwide by the Department of Health (DOH) for its privatization cum
corporatization thrust. Since 1998, it has carried out sweeping changes in
hospital management and systems in accordance with the government’s health
reform agenda. But after several years of
experimentation, CLMMRH has only turned for the worse. The envisioned hospital
modernization and delivery of affordable and quality services did not
materialize. Inside sources who requested anonymity said the new buildings were
erected from 1997 to 2000 but their construction was reportedly full of
irregularity. The medical isolation building for one remains unfinished despite
the P10 million spent on its construction. Three other buildings remain
under-utilized and one, which is supposed to be a modern laboratory building,
remains empty of modern equipment. Today, patients, including
children and infants, are cramped in small, old and dilapidated wards. Many lie
in the corridors, vulnerable to passing people who may be carriers of
communicable diseases. Higher cost of services Out-patients are now
required to pay a minimum of P30 per consultation. A nursing aide tells the
patient to first pay before being taken to the doctor. This was not the case
before, a nursing staff said. Meanwhile, the hospital
pharmacy often does not have basic medicines like paracetamol and aspirin, and
supplies like syringes and dextrose. Indigents and PhilHealth cardholders
interviewed by Bulatlat said even hospital patients are often told to go
outside and buy their prescribed medicines and supplies. A midwife interviewed by
Bulatlat confirmed this, saying some nurses and doctors at the emergency
room would often give purchase orders to their new patients with specific
instructions to buy them at private drugstores outside of the hospital. The midwife scored the lack
of the most basic medicines and supplies which could be crucial in the immediate
treatment of some deadly illnesses. Health system in crisis The Philippine health
sector is in a state of calamity. For decades, the health system reflects the
ill state of the people and the wrong priorities of the national government &
leadership. Data obtained by
Bulatlat revealed that from 1986 to 2004, government spending for health has
dropped significantly. In 1997, health appropriation was 2.9% of the national
budget. It was reduced to a mere 1.5% in 2004. This year, national budget for
health has dropped further to 1.3%. The bigger chunk of the
national budget goes to paying off foreign debts (up to 40 percent of the budget
in the past, and more than 60% this year) and funding military spending (15-20
percent). The much-hyped efficiency,
better and affordable health services under the HSRA never came. The opposite
happened. Profit has dictated the
supply and distribution of vital medicines and vaccines, and the accessibility
of medical facilities. Increasingly, it will determine the thrust of the
country’s health care system and services. Bulatlat © 2005 Bulatlat
■
Alipato Publications Permission is granted to reprint or redistribute this article, provided its author/s and Bulatlat are properly credited and notified.
Special Report
The
‘Corporatization’ of the Public Health System
Bulatlat