Checking Up on Philippine General Hospital’s Rates Increase

More than the hospital administration’s apparent lack of political will, the rates increase only abets the growing neglect of social services by the national government, to the detriment of disadvantaged Filipinos.

Philippine Collegian
Posted by Bulatlat
Vol. VII, No. 33, September 23-29, 2007

Rosa (not her real name) emerges from the Emergency Room (ER) of the Philippine General Hospital (PGH). She hurries past the long queue of charity patients, unmindful of the colorful streamers and posters celebrating PGH’s 100 years of existence.

Her husband Virgilio had an accident and she needs to buy his medicine. He has been in pain since they arrived from Parañaque, where the first hospital they had gone to, lacking the proper equipment, referred them to PGH.

At the PGH pharmacy, the medicine Rosa needs – sold at a discount to charity patients – is out of stock, forcing her to buy it at full price elsewhere. At the ER which charges a user fee, Virgilio’s X-ray shows the need for him to undergo surgery. This means more expenses for Rosa since the Operating Room (OR) now charges a fee of P1,500 ($33.10, based on an exchange rate of P45.31 per U.S. dollar). Virgilio, however, is the family’s sole breadwinner. His income as a tricycle driver barely covers the expenses incurred at PGH.

This situation has now become common at PGH, a dismal truth no colorful or glossy streamers and posters can cover.

Case presentation

Infrastructure projects, new equipment, extended services, and a miscellany of activities, like a fund-raising concert and a time capsule, serve as markers for the PGH in commemoration of “100 years of excellence.”

The PGH was established on August 17, 1907 through Act No. 1688 of the Philippine Commission. Construction began in Manila, and the hospital officially opened on September 10, 1910. It underwent numerous reorganizations and emerged in the 1950s as an administratively autonomous unit of the University of the Philippines Manila (UPM) College of Medicine. Accordingly, the PGH became a venue for the learning and practicing of the medical profession by the best and brightest minds, imbuing them with a commitment to serve the underprivileged.

One of them, Honorato Quisumbing, worked at PGH during World War II even after many of his colleagues left the area. He was shot in 1945 by soldiers as he attempted to secure medical supplies for the sick. Another was Johnny Escandor, chief of the research department at PGH, who offered free medical services to poor barrios and indigenous peoples. He was killed in 1983 after going underground to lead the resistance against the Marcos dictatorship.

In light of its history, the importance of the PGH as a provider of affordable, quality health care is well-established. This, however, seems lost in the government’s continued abandonment of the hospital as reflected in the allocation it receives.


The budget for PGH has been pegged at P1 billion ($22.07 million) since 1993. This, in real terms, can be considered a budget cut, considering that the actual cost of yearly operations has already increased to P3 billion ($66.21 million).

To address the deficit, PGH Director Carmelo Alfiler distributed on December 14, 2006 a memorandum on increased rates without proper consultation with the PGH community. The cost of blue cards from the medical records division was raised from P7 ($0.15) to P15 ($0.33); the use of the OR, previously free to patients, now costs P1,500 ($33.10).

Various sectors criticized the move, and Alfiler deferred the increase in rates pending further discussion. Last March 29, however, the UP Board of Regents (BOR) authorized the collection of OR fees from charity patients, to generate an additional P16 million ($353,122) annually. “Up to 70 percent of patients undergoing charity surgery,” announced the BOR, justifying its decision, “are covered by the Philippine Health Insurance, Inc (PhilHealth).”

Jossel Ebesate, head nurse at PGH and president of the Manila chapter of the All-UP Workers Union, challenged the accuracy of BOR’s defense. “A survey that we conducted showed the opposite. Seventy percent of charity patients do not have PhilHealth coverage. Only 30 percent do.”

Meanwhile, Marikris de Guzman, a councilor of the UPM student council from the party Alternative Students Alliance for Progress–Katipunan ng mga Progresibong Mag-aaral (Association of Progressive Students), said that there is a parallelism between the PGH’s increase in rates and UP’s tuition hike. “In both cases, the institutions suffered from inadequate budget given by the national government. Both resorted to fee increases to offset the deficit, in spite of opposition by their communities. Both are victims of administrations with mistaken priorities.”


These mistaken priorities are evident as PGH officials tout “self-sufficiency in resources” as a solution to fiscal problems. “‘Self-sufficiency’ is a term often used to conceal financial abandonment by the government,” Dr. Gene Nisperos, secretary-general of the non-government organization Health Alliance for Democracy (Head), said. “Another euphemism is ‘fiscal autonomy.’”

Instead of fighting for greater state subsidy, the PGH has channeled its efforts into increasing its rates. A smokescreen used is “modernization.” New equipment comes with new fees. For instance, after the “modernization” of the Sentro Oftalmologico Jose Rizal, almost everything from cardiac monitors to anesthesia machines had new user fees. “Ironically,” said Ebesate, “after upgrading the Sentro Oftalmologico’s facilities, less patients have been able to make use of them.”

A more glaring irony is that for lack of space, most patients are refused a room in the hospital unless they offer to pay. This shows that at the PGH, “service to the poor” has taken a back seat to revenues.


In 2006, as the PGH geared for its centennial celebration, President Gloria Macapagal-Arroyo pledged to release P100 million ($2.21 million) annually to PGH until her term ends in 2010.

“The government should institutionalize the allocation, instead of releasing it based on the President’s whims,” Nisperos said. “The PGH implemented a rates increase knowing that the government can afford a P100-million ($2.21-million) increase, in effect ceding to the government’s abdication of its responsibilities, instead of holding it accountable.”

More than the PGH administration’s apparent lack of political will, the rates increase only abets the growing neglect of social services by the government, to the detriment of disadvantaged Filipinos like Rosa and Virgilio, whose financial status should have made them the primary beneficiaries of accessible health care from PGH.

After 100 years of existence, the PGH has failed to ensure that enough of the underprivileged can avail of the topnotch medical services it can provide. For the PGH to continue its legacy of service to the poor, it must first cure the symptoms of its own deterioration. It must reaffirm its integrity as an establishment which seeks to serve the Filipino, for whom it exists. Philippine Collegian/posted by Bulatlat

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