Second of two parts
I surfed the Internet in search of information on recent or ongoing “government hospital construction projects.” I found none. Instead, I saw a PowerPoint presentation from the Department of Health (DOH) titled “Public-Private Partnership Program in Health,” which outlined the government’s health agenda.
The presentation listed numerous modernization projects, from the expansion of existing facilities to acquisition of modern medical equipment, which would be done in partnership with the private sector.
The last slide, which made me somewhat apprehensive, stated that “Hospitals will reduce their dependence on the national subsidy for their operational needs [personal services and MOOE] and will move toward an efficient and effective fiscal discipline that will support the hospitals’ operational needs.”
Reducing government funding for the operations of public hospitals means transferring the financial burden to another. The last part of the statement, “move toward an efficient and effective fiscal discipline that will support the hospitals’ operational needs,” obviously points to the patients, or the public, as the new source of funding.
Strictly speaking, that will make the government or public hospitals no different from private hospitals. The statement did not use the word “privatization” but the first public-private partnership project of the DOH, the modernization of the Philippine Orthopedic Center, gives the private partner a 25-year concession to operate the new facility. (Last month the contractor withdrew from the project.)
Let me reiterate that the entry of the private sector in the hospital business is a positive development for the health of the people. Also, the government alone cannot meet the requirements for new hospitals, which the Private Hospitals Association of the Philippines (PHAP) last year estimated at 100 for the next three years. According to PHAP, the country currently has 1,800 hospitals, both private and government-owned, with a total of 77,000 beds.
The Philippines, based on a report from Zuellig Pharma, has an average of 10 hospital beds for every 10,000 people, one of the lowest in the world, and much less than the average 20 beds for every 10,000 people in the United States and Britain.
As a businessman, I agree with the universal view that the government is a bad businessman, and it should leave business to the private sector. The private sector looks at a hospital as a business establishment, which is expected to generate revenues and yield profits from treating and taking care of sick people who can afford to pay.
However, because of its constitutional mandate, the government cannot treat a hospital as strictly business. Section 15, under “State Policies” of the 1987 Constitution provides that: “The State shall protect and promote the right to health of the people…”
A study by the World Health Organization (WHO) showed that about 60 percent of national health expenditures go to the private sector, which also employs more than 70 percent of all health professionals in the Philippines.
The private health-care providers, which are largely market-oriented, provide services to an estimated 30 percent of the population, who can mostly afford to pay the hospital and professional fees.
Thus, the majority, or 70 percent of the 100 million Filipinos, still look at government hospitals for consultation, diagnosis and treatment when they get sick.
This is why I suggested in last week’s column that the government, taking advantage of the growing economy and its healthy finances, to continue building hospitals in different parts of the country, so even those in remote areas will have access to affordable health care.
Aside from expanding the network of public hospitals, the government must also strengthen the national health insurance program, more commonly known as Philippine Health Insurance Corp. (PhilHealth). The program is already benefiting a lot of Filipinos, and it is fair to say that, because of PhilHealth, more Filipinos are now encouraged to go the hospitals when they become ill.
The PhilHealth said that in 2014 it paid out a total of P78.18 billion in benefits. For the first six months of 2015, PhilHealth benefits amounted to P44.44 billion. And PhilHealth estimates that it now covers 99 percent (as members, dependents or beneficiaries) of the country’s estimated population of 101.45 million. Except for the new service that allows PhilHealth members to get free medical checkups, the insurance program generally does not cover expenses for medicine and laboratory procedures unless the patient is confined.
PhilHealth must be flexible enough to reflect innovations in health care in its benefits package. For example, while PhilHealth subsidizes surgery or radiation therapy for some types of cancer, it does not extend financial help for the purchase of anticancer medicines for outpatients.
Oncologists in the Philippines are now prescribing newly developed chemo-therapy drugs in the form of tablets, which can be taken at home, instead of the intravenous (and more physically exhausting) chemotherapy medicines. The new drugs, however, are expensive, with the 200-milligram tablets costing as much as P2,500 each.
In the light of recent controversies regarding schemes used by some hospitals or doctors to increase their PhilHealth claims, the agency must strengthen its monitoring and evaluation procedures.
PhilHealth subsidies are supposed to reduce the financial burden on patients but unscrupulous hospitals, instead of deducting the PhilHealth subsidy, may just add it on top of the regular bill. The patients (and PhilHealth) end up paying more.
The expansion of PhilHealth’s membership and benefits has made it a reliable source of revenues for private hospitals. According to the WHO, private health- care providers derive a significant portion of their incomes from PhilHealth payments because majority of PhilHealth members are private-sector employees and usually go to private hospitals for health care.
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