Despite the absence of a law to integrate GOCC hospitals
Office Merging 5 Gov’t Hospitals in Place

Government authorities appear in a hurry to integrate five public hospitals to promote medical tourism. However, there is as yet no law calling for the integration, health authorities are themselves divided on its wisdom and health workers are in protest.

BY AUBREY SC MAKILAN
Bulatlat

There is yet no law integrating five public hospitals into a medical tourism-oriented hospital complex and some officials at the Department of Health (DoH) are lukewarm to the plan or are unaware that an office has been opened for the integration plan.

Bulatlat learned this last week following headlines lauding the planned hospital integration system and the competition the complex is expected to pose vis-à-vis similar dollar-earning hospitals in Thailand, India and other Asian countries. Bulatlat last week reported about protests by health professionals and workers’ against the plan who also warned it will lead to mass lay-offs in the health sector as well as a medical crisis in a few years’ time.

At the third floor of the National Kidney Transplant Institute (NKTI) in Quezon City is a new unit called the Integration Office. On a Bulatlat visit at the institute Nov. 10, two personnel of the office were busy decorating the room for the Christmas season.

Unlike other offices, this one does not have documents piled up on the tables yet. And the officer-in-charge was unavailable.

Most of all, its creation is being contested since the law which will institutionalize the new office’s operations has not been enacted in Congress, said militant health workers.

No law yet

Health activists are protesting the creation of the Integration Office emphasizing that there is no law which provides for the office’s creation in connection with the integration of five government hospitals. The state hospitals – all located in Quezon City - are the National Kidney and Transplant Institute (NKTI), Philippine Heart Center (PHC), Lung Center of the Philippines (LCP), Philippine Children’s Medical Center (PCMC) and East Avenue Medical Center (EAMC). Except EAMC, the hospitals are classified as government-owned and -controlled corporations (GOCCs).

House Bill (HB) 5741 and Senate Bill (SB) 1118 have been filed to integrate the five hospitals and pave the way for the creation of the Philippine Center for Specialized Health Care (PCSHC). Cebu Rep. Antonio Yapha Jr., the proponent of the House bill, chairs the Committee on Health which will examine the bill.

Aside from its questionable creation, health workers are also against the allocation of P1million ($19,355 at an exchange rate of $1=P51.665) from each hospital said to be for the operations of the Integration Office.

In an interview, Emma Manuel of the Alliance of Health Workers (AHW) said union leaders of the five hospitals confirmed this report in one of their meetings.

Elmer Collong, president of the PHC Employees Union (PHCEA)-AHW said that among the five, their hospital has the smallest budget allocation from the government. She said, however, that their 2006 budget - a reenactment of last year’s budget – does not include allocation for the Integration Office.

“Wala pang law na napasa para sa office na ‘yan” (There is no law that has been passed providing for the creation of that office), he said. “There’s something wrong with that.”

Collong also revealed that even without the law yet, the letterhead used by the Integration Office already bore the PCSHC title.

“Eh ‘yung bill nga tinututulan namin ngayon pa lang na ‘di pa tapos, tapos kumakana na sila” (The bill which we have been opposing has not yet been passed and yet they are already going about their business), he said.

AHW’s Manuel, on the other hand, said that the P1 million ($19,355) taken away from each hospital could have been used for badly-needed medical and other supplies rather than for the expenditures of the Integration Office’s secretariat.

Politics in health

Aside from institutionalization problems, health workers are also concerned with the politics behind this proposal.

The name of NKTI Executive Director Enrique Ona is being floated as a likely candidate for the position of president of the PCSHC.

“What I don’t like about these people is that they’re power hungry just like politicians,” Collong said referring to those pushing for the integration. “D’yan mo makikita ang plano talaga ng government.” (This reveals the real plans of the government.)

“It’s all hypocrisy,” he said, citing the government’s move creating another office while it claims that the budget is insufficient.

“One management does not solve the problem, parang nag-create ka pa nga ng another bureaucracy.” (They just created another layer in the bureaucracy)

Collong also said that the powers of the president of the proposed PCSHC would likely be used to direct the priorities of the center, including favoring pay patients in line with the thrust of medical tourism.

“Wala nang matigas na ulo na directors na di pwedeng sumunod. lalo na kung may medical tourism na, na gagawing priority ng center” (The government is getting rid of directors who are independent-minded and obstinate to the government’s plans, especially when the planned medical tourism becomes the priority of the proposed center), he lamented. “Once they’re appointed, they’re beholden to follow. Then they will be pressuring us to follow too.”

Directors of the hospitals, except Ona of NKTI, have expressed their reservations on the bills particularly provisions on fiscal autonomy, administration and specialized service. This is why the Integration Office was located inside the NKTI, said health workers.

Dr. Nestor Venida, who serves as chief coordinating officer, could not be reached at the Integration Office since he works at the LCP.

Meanwhile, Health Undersecretary Alexander Padilla said the department is also not in favor of the proposed creation of a monolithic center centralizing all the specialty hospitals. Officially, however, the DoH is promoting medical tourism, which the planned integration aims to promote.

When Bulatlat called the office of Director Criselda Abesamis, who is in-charge of monitoring the operations of hospitals, her staff, Phoebe Cabag, said that they are unaware of the Integration Office. 

Health is service, not business

In a separate interview, psychiatrist Dr. Rey Lesaca said that the integration of the five hospitals was originally introduced in the Health Sector Reform Agenda (HSRA) in 1998 at the start of the Estrada government. The HSRA, he said, is based on the free market policy and the supposed virtues of competitive efficiency to health care. Two of its major strategies are to "provide fiscal autonomy to government hospitals" and to "expand the coverage of the National Health Insurance."

Unfortunately, said Lesaca who is also against the proposal, the government cannot address the health needs of the country.

Health activists believe that the integration is in line with the Macapagal-Arroyo administration’s thrust of promoting medical tourism. Although medical tourism supposedly aims for “effective and efficient delivery of comprehensive and globally competitive, quality specialized health care,” health workers said that it will be detrimental to the poor. 

“I do not see any good happening here,” said Collong who has been working in the PHC for 14 years now.  “If before poor Filipinos are bumped off by pay patients who are also Filipinos, with medical tourism Filipinos will be bumped off by foreigners.”

He also refuted the argument of pro-integration officials that with medical tourism, health workers will realize the benefits that they have long fought for.

“Talagang mas lalaki ang sweldo namin kung idadagdag sa amin ‘yung sweldo ng mga matatanggal. But the point is may mawawalan ng trabaho.” (Of course our salaries will increase if the salaries of those who would be laid off will be added to ours’. But many will lose their jobs.)

If implement and to avoid duplication of functions, the integration plan will unify services and other hospital operations. Health workers note however that streamlining has been going on as called for by Executive Order No. 366 that provides for the “rationalization of government agencies.”

Collong admitted that government hospitals need to generate additional income because of the insufficient budget they receive from government. Still, he said, “The primary task of government hospitals is to provide health services to the Filipino people, not to generate income.” Bulatlat

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