This story
was taken from Bulatlat, the Philippines's alternative weekly
newsmagazine (www.bulatlat.com, www.bulatlat.net, www.bulatlat.org).
Vol. V, No. 42, November
27-Dcember 3, 2005
SPECIAL REPORT
Public Health System:
On the Death Bed
“Health is wealth” is an old adage usually drummed by teachers on pre-schoolers
during lessons on proper grooming and hygiene. But under the health agenda of
the government, the adage now has a new meaning
-
transforming the public health system to make it less dependent on national
government and generate its funds for operations, and even produce income for
the perpetually cash-strapped Macapagal-Arroyo government. BY
AUBREY SC MAKILAN The Macapagal-Arroyo
government is at present pushing several programs that would make the health
sector more “independent”, among them the corporatization of public hospitals,
rationalization of medical services and medical tourism. According to the Department
of Health (DoH), corporatization is a strategy whereby hospitals will be made
financially and fiscally autonomous by making them generate funds for its
operation and maintenance. The corporatization of public hospitals is the
government’s response to the demand for higher budget allocation for health
care. But for health activists,
the government, by corporatizing, is just shifting the responsibility for
hospital care from the government to the individual. Thus, it is not so
different from privatization where the shift is from the government to the
individual through the new private owner, they said. “Corporatization of DoH
hospitals is no different from privatization in terms of impact,” said Remigio
D. Mercado, MD, a convenor of the Network Opposed to Privatization (No To
Privatization). “Corporate interest logically is divided between the desire to
serve and the desire to earn.” Privatization of hospitals
is not a new government policy though. During the Ramos administration, four
specialty hospitals in Quezon City were announced to be privatized. But due to
opposition to the plan, privatization was concealed under “corporatization.”
This term referred to hospitals that were transformed into government-owned
and-controlled corporations
(GOCC),
which have fiscal and managerial autonomy. Emma Manuel, president of
the Alliance of Health Workers
(AHW),
said in an interview with Bulatlat that “Considering the decreasing
budget allocation for health services by the government, public hospitals could
not in anyway be dependent on the government.” “Kung merong
dependent, military budget yun,” she quipped. “Yearly tumataas pero di
naman napagbubuti ang national security.” Data obtained by
Bulatlat showed 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 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). But even with the already
deteriorating condition of the country’s public health system, new projects of
the DoH are still aimed at attracting foreign and well-off Filipino patients. Medical tourism The
Philippine Medical Tourism Program (PMTP), as described in the DoH
website, “is a private-public initiative aimed at attracting international
patients to the Philippines for needed medical care as well as health and
wellness services coupled with sightseeing tours, vacation, and shopping
packages.” Although the term medical
tourism was used and adopted as a formal program only just recently, the
Philippine Heart Center
(PHC)
has already been doing it since its inception, said Reganit, MD, of the Office
for Special Concerns of the Department of Health (DoH). In an interview with
Bulatlat, Reganit said the program means “revenue for the physicians and for
our hospitals.” Reganit said the PMTP is
basically services that will be offered mainly to foreign patients. “Filipino
patients, who can afford, who would be more than willing to pay for what
hospitals has catered/alloted for them (foreign), would be more than welcome to
join, ” he said. Based on a paper
presentation by Office for Special Concerns Undersecretary Jade del Mundo, MD,
the program will be composed of the advisory panel, medical, tourism-business,
and accreditation and licensing clusters. However, there were names
in the list comprising these clusters and panel that have raised the eye brows
of health activists. These included the popular Vicky Belo, MD and Manny Calayan,
MD of the Belo Medical Group and Cosmetiderm, respectively. While in the
tourism-business cluster, the controversials were the names of SM’s Henry Sy,
Robinson’s Lance Gokongwei, Rustan’s Bienvenido Tantoco, KarenReina of the SPA
Association of the Philippines, and Humphrey O’Leary of the Hotel and Restaurant
Association. These people are part of
the whole program, Reganit said. In medical tourism, Reganit
said that spa and massage services have been offered in Thailand, Malaysia, and
South Africa where foreigners, like the Americans, preferred to have their
medical services as a cost-effective procedure that saves them dollars and at
the same time go to a nice exotic place. He added that aside from
shopping in the malls, a foreign patient, after recovering from a minor
operation for three or four days, could be arranged by tourist operators for a
trip to Boracay. Health activists, however,
argue that poor Filipino patients would not benefit from this. “For us, the government has
long abandoned its state responsibility to promote and protect the people’s
rights to health,” Manuel said. “Mas lalo lang inilalayo ng mga proyektong
ganito ang mga tao sa health services na kailangan nila. Kung tutuusin, dapat
‘yung ibinabayad na tax, napupunta na sa social services tulad ng health at
education.” And with the presence of
business tycoons, they fear that the services to charity patients would be
greatly affected. The standard DoH
restriction on pay bed capacity was 10 percent for retained DoH hospitals and
local government units developed hospitals. With this program, Reganit said the
hospitals which are going to participate in the medical tourism program would be
asked to give at least 10 % of their bed capacity to service or charity
patients. “This is clearly sort of a
bonus. Ten percent of the bed capacity for charity patients is good,” he said. Also in the same paper, the
PMTP will offer diagnostic, medical, and surgical services, health wellness,
traditional and alternative care services, and women’s and children’s
healthcare. But unlike the ordinary
practice to ordinary patients, it offers spa, massage, and “state-of-the-art”
diagnostic services like high resolution CT scan. The first phase, with five
government and five private hospitals participating, will have its soft launch
on December 14. State hospitals
participating are the PHC, the National Kidney and Transplant Institute
(NKTI),
the Lung Center of the Philippines
(LCP),
the Philippine Children's Medical Center
(PCMC)
and the East Avenue Medical Center
(EAMC).
The private hospitals are the St. Luke's Medical Center, the Asian Hospital,
Medical City, the Makati Medical Center, and the Capitol Medical Center. The government also plans
to put up medical centers in tourist destinations like Boracay where simpler
medical procedures can be performed. Rationalization While it is feared that
medical tourism will hamper even more the poor’s access to health services,
another program that is causing alarm is the rationalization of medical
services. It is under this program that the New Women’s Medical Center has been
created, combining the services of the Jose Fabella Memorial Hospital in Sta.
Cruz, Manila and the EAMC Obstetrics and Gynecology Department. The women’s center will be
set up at the Lung Center, leading to fears that the LCP would be abolished.
Health Secretary Francisco Duque however, in a letter dated Oct. 17 to LCP
administrators, doctors and employees, denied that the LCP would be abolished.
“Only a similar act of Legislation, a Law, could do this as the LCP was founded
by virtue of a presidential decree,” he said. Although the physical
structure of the LCP would be retained, based on the project’s implementation
plan dated July 21, the Women’s Center will occupy the second to fourth floors
of the LCP building, leaving only the ground floor or about 20 percent for
respiratory patients. At present, a full house
LCP can accommodate around 190 patients. Not included are the out patients whose
number doubled from 50 to 100 per day. Lorna dela Cruz, president
of the LCP Employees Association and head nurse of the St. Therese Isolation
Unit, said that the proposed merging of the OB-Gyne and respiratory patients in
one building would be very risky. “TB is air borne and the
newborns could acquire this disease easily, even the Center’s other patients,”
she said. Aside from health hazards,
dela Cruz charged that the merging is profit-driven project. In the implementation plan,
the Gleneagles Medical development Corp., the company commissioned to study the
Center’s creation, said the LCP already has a “gross deficit” of P60 million.
Given this, it projected that “the current LCP will be short of funds to meet
their operating costs inclusive of DoH subsidy for 2005.” It also said that ‘the
equipment budget of 2005-2006 which is equivalent to P109,687,000 is
unattainable from corporate earnings based on current income generations.” It also noted the
uncollected fees amounting to P21 million. Dela Cruz however belied
the report. She said that when the study was made, they had just moved to their
new building after a fire that disrupted hospital operation. As a result, the
study showed LCP was not earning. But most importantly, she
said, “it (making
profit)
is not really the objective of the LCP.” She said around 60 percent of their
patients are indigents. But with only a floor now
for its services, the “LCP Wing” would eventually have only 60 charity and 28
private beds. Twenty to 25 percent of its patients are tuberculosis
(TB)
patients. With Fabella Hospital’s
transfer, the current charity status of almost all the 900 patients per day
would have to compete for only 344 charity beds with the full implementation of
the Center. Meanwhile, TB patients can
be transferred to the EAMC while outpatient TB cases may receive medical
attention at designated Directly Observed Treatment Short
(DOTS)
Centers, the implementation plan said. Meanwhile, the NKTI is
supposed to undertake both the laboratory and radiology services of the LCP.
Eighty percent of the LCP
building burned down in May 1998, killing 25 people. Dela Cruz recalled that LCP
doctors were allowed to occupy offices at NKTI for pay patients. Charity
patients were accommodated at the unburned part of the LCP building. Until now,
there are still some LCP doctors in NKTI, she said. After corporatization Under the Health Sector
Reform Agenda, the government’s blueprint for undertaking reforms in health,
government hospitals are to be converted into corporate hospitals by upgrading
the hospitals’ capabilities, ensuring fiscal viability and legally converting
the hospital into a corporate organization. To do these, Mercado said
hospitals were allowed to collect, retain and allocate revenues from socialized
user fees through the following mechanisms:
·
Revenue enhancement through
increased number of pay wards, private rooms and outpatient clinics, and
expanded hospital services for ambulatory surgical and domiciliary care;
·
Review and implement the
appropriate hospital fees and charges. DOH has issued Executive Order 197
(March 10, 2000) authorizing increase of fees by 20 percent;
·
Stricter collection of fees
through voucher system and other effective means;
·
Reduce the turn-around time for
the return of hospital income from the Bureau of Treasury to the Department of
Budget and Finance and back to the DOH;
·
Upgrade hospital pharmacies to
make them more competitive in order to earn more income;
·
Expand the health insurance
coverage. Once the hospitals are
financially stable and viable, Mercado said the government will convert the
hospitals into corporations. He said that the first to be corporatized would be
the overloaded hospitals with a reasonable number of private rooms and pay wards
with high potential for increased income-generation. Next will be overloaded
hospitals with high percentage of indigent patients. And finally, the overloaded
hospitals with 95 percent indigent patients and negative budget follows. Manuel cited the case of
Quirino Memorial Medical Center in Quezon City. After it was corporatized in
2003 and able to make profit, new buildings were constructed but more people
have been unable to pay for the increasing rates of medical services. Unfortunately, the same is
expected to take place to the 38 hospitals in the country the government will be
corporatized by year 2010. Bulatlat
Hospital Budgets of Selected Government Hospitals in
Metro Manila (In
pesos)
Hospital
1999
2000
2001
P300,836,000
P292,673,000
P269,043,000
179,449,000
157,893,000
150,555,000
303,122,000
164,504,000
160,110,000
157,661,000
137,066,000
106,908,000
100,269,000
254,964,000
254,422,000
228,964,000
136,634,000
121,008,000
112,254,000
465,487,000
461,881,000
429,053,000
326,490,000
303,885,000
279,614,000
309,443,000
289,976,000
252,605,000
92,514,000
87,063,000
112,622,000
97,358,000
86,309,000
84,653,000
Hospital
2002
2003
2004
2006
291,778,000
303,783,000
283,266,000
275,661,000
152,242,000
159,339,000
148,066,000
146,327,000
301,228,000
305,167,000
297,711,000
287,646,000
169,729,000
158,187,000
146,996,000
145,168,000
100,212,000
102,474,000
99,953,000
99,054,000
240,347,000
250,862,000
242,696,000
241,124,000
113,382,000
120,076,000
115,314,000
115,861,000
429,724,000
444,287,000
430,154,000
431,192,000
286,335,000
289,686,000
280,433,000
276,317,000
263,984,000
269,177,00
268,168,000
262,598,000
118,196,000
122,737,000
131,766,000
122,125,000
82,583,000
84,517,000
82,749,000
80,040,000
SPECIAL REPORT
Devolution and Corporatization of Health Services
Poor Pay, Working Conditions are Driving Health
Professionals Abroad
Related article: © 2005 Bulatlat
■
Alipato Publications Permission is granted to reprint or redistribute this article, provided its author/s and Bulatlat are properly credited and notified.
First of three parts
Bulatlat
Jose R. Reyes Memorial Medical Center
Rizal Medical Center
East Avenue Medical Center
Quirino Memorial Medical Center
Tondo Medical Center
Jose Fabella Memorial Hospital
National Children's Hospital
National Center for Mental Health
Philippine Orthopedic Center
San Lazaro Hospital
Research Institute for Tropical Medicine
"Amang" Rodriguez Medical Center
Jose R. Reyes Memorial Medical Center
Rizal Medical Center
East Avenue Medical Center
Quirino Memorial Medical Center
Tondo Medical Center
Jose Fabella Memorial Hospital
National Children's Hospital
National Center for Mental Health
Philippine Orthopedic Center
San Lazaro Hospital
Research Institute for Tropical Medicine
"Amang" Rodriguez Medical Center
The solution
or the problem?
Second of three parts
Last of three
parts