Philippine health care system, from bad to worse

A country's health care system is a sensitive indicator of how government values the health of its people, underscoring the truism that the people's general health constitute the very foundation of socio-economic development and ultimately, the people's wellbeing and happiness.

Even as a medical student more than three and a half decades ago, it was already starkly clear to me that the Philippines health care system was sick.  It was a dual system: one for those who could afford to pay; another for those who could not.  One was private, the other public.

On the whole, private health care was of better quality in terms of facilities and personnel although one could find substandard care in private hospitals because of poor regulation and the overriding motivation to turn a profit rather than provide a badly-needed social service.  The public system sufficed for the majority of the population who had little choice when stricken by disease except to avail of what was available and affordable
regardless of quality.

These hospitals and clinics were clustered in urban centers. The tertiary centers or the most well-equipped with the widest choice of specialist doctors would be found in Metro Manila. In the rural areas, people continued to live and die without ever seeing a nurse much less a physician because health care was absent or inaccesible, physically and financially.

Of coure there were the crown jewels of the Marcos martial law era, the Heart, Lung and Kidney Centers and the Philippine Children's Medical Center that were part of the showcase edifices of First Lady Imelda Marcos but that's another story.

In time, with the growing social inequality, there was hardly room left for anything in between as even the not-so-rich but not-yet-miserably-poor started to avail themselves of public hospitals to avoid dissipating their life savings on health care.  That was when the so-called middle class could be seen in the Philippine General Hospital's charity wards or, at best, its more affordable but scant private rooms.

As the cost of curative care soared (after all everything, from the simplest syringe to the state-of-the-art diagnostic machines, is imported) and the public health budget became tighter due to chronic misprioritization, the trend towards charging fees for laboratory procedures and making patients buy their own supplies became the norm even among supposed "charity・patients. (Government hospital pharmacies are notorious for always running out of mediciens and supplies so that patients have to buy from private boticas located just outside the hospital premises.)

Meanwhile, most public hospitals in the urban centers continued their slide towards decline and decay, starved of government subsidy.  Brain drain among poorly paid health personnel was the rule rather than the exception, mitigated only by the vagaries of the market for nurses and doctors abroad. The negative effects included a constant turn-over of hospital personnel even in critical-care units requiring highly-trained staff.

Private hospitals continued to do brisk business catering to the country's elite but became more and more unaffordable to the shrinking middle class.  Medical health insurance for the regularly employed through the old Medicare covered only a small portion of hospitalization costs such that out-of-pocket expenses ballooned uncontrollably.

Clearly the system could not remain the same - inaccessible and unaffordable to the vast majority because it was urban-centered, curative care-oriented, and dualistic. Health reform was urgently needed but what kind?

Apparently government heeded World Bank recommendations that were geared towards reforming how health care was to be paid for, less from scarce public funds and more from the private pockets of patients and their families.  The assumption was that there were far too many freeloaders availing of the public health care system when it should be focussed on providing services only for the very poor (who now have to prove their state of indigency).

The trend towards commercialization of medical services and eventually the privatization of entire public hospitals stealthily crept up on the unsuspecting public.  The shining examples held up to policy makers of how a government hospital can be top-of-the-line without being a drain on the national health budget are the National Kidney and Transplant Institute and the Philippine Heart Center.

These public hospitals have spanking new facilities for pay patients while maintaining some beds for charity patients.  They have leased portions of hospital property to private businesses such as shops and restaurants.  They seem to have resolved the problem of financing their operations by increasingly catering to pay patients and relying less on government subsidy.

Under the Aquino administration the acceleration of privatization and commercialization of public hospitals reached a new high with the targetting of a slew of hospitals for conversion into public-private-partnership projects.

Prime example is the National Orthopedic Hospital that was slated to be auctioned off to the highest bidder for conversion into a modern, state-of-the-art facility. This would have meant throwing out the thousands of charity patients depending on the old ramshackle facilities and leaving them willy-nilly to their own device to get adequate medical assistance. Only the united opposition of patients, health reform advocates, hospital staff and administration as well as social acitivsts and sympathetic media practicioners prevented the corporate take-over.

In the meantime the government has been overhauling the national health care insurance system called Philhealth. The claim is that there is now close to universal coverage with more than ninety per cent of the population able to avail of health insurance.

Are these the wide-ranging and fundamental health reforms our people have been waiting for? Or are they merely exacerbating the deteriorating health situation of our people by denying them access to basic and life-saving health care? #

Next week's column takes a critical look on Philhealth.

Published in Business World
28 March 2016