Socialized Healthcare 11: Private Health Insurance and HC Vouchers

Last Friday, my left ear was in pain. Midnight that day, or early Saturday, I went to Makati Medical Center (MMC) for a check up. There was no more ENT (ear, nose, throat) specialist, a GP checked my ear. No wound as I suspected, but the ear drum is infected, reddish. She gave me 3 medicines to take:

1. anti-biotics, Co-amoxiclav 625mg tab (brand: Natravox): 2x a day for 7 days
2. pain reliever, Celecoxib 200mg cap (brand: Celebex): 2x a day for 5 days max, or only if the pain will persist.

3. decongestant, Phenylpropanolamine HCL + ... (brand: Nafarin A): 3x a day for 5 days.

Then I went to billing section, they gave me the phone where a staff from my private health insurance said my card subscription for the year is still "pending" and I need to clear with the office HR if the annual fee or other reqs have been sent to them. Meanwhile, I need to pay and ask for reimbursement later if the requirements have been complied with.

1. Hospital Emergency Room (ER) fee P800
2. Doctor's fee P500
Total P1,300, around US$32.

Medicine prices:
1. brand Natravox around P47, generic by Ritemed P34
2. Celebex P61, generic by Pharex P20
3. Nafarin P5.50.

Hospital fee + physician fee still a lot higher than medicine prices. I bought all the medicines, a mixture of the branded and generics, total of around P750. This is less than the ER fee alone. If there were diagnostic tests done (say Xray, blood test, urine test, etc. depending on the disease), the cost would have jumped higher.

My Filipino friend studying and working in Denmark, Bonn Juego, sent a comforting note. He added that I should be careful with strong anti-biotics, and one thing that he miss in the hospitals in PH, "you can always go direct to the ER. Here in Scandinavia, last summer I waited about two months to get an appointment with an ENT, but it's free (and medicines are subsidized as well). Advantages and disadvantages in two systems, indeed."

I replied that I slowly study anti-microbial resistance (AMR) due to anti-biotics abuse or non-compliance by many patients. Well, there's a whole day presentation later today by the DOH and WHO on the result of the AMR Rapid Assessment Tool.

  
A visit with a specialist (ENT, etc.)  should also be "free" courtesy of one's health maintenance organization (HMO) or private health insurance firm. PhilHealth is next to useless for outpatient services. One must be confined in a hospital for at least 24 hours before one can use the PhilHealth financing or reimbursement.

The pain reliever and decongestant worked within an hour, the pain has subsided. Which means they are not fake or counterfeit or substandard.

I talked to a physician friend one time, she saw how patients are affected by fake drugs. She's an anesthesiologist. One time the patient is already on the operating table, an anesthesiologist's turn to make the patient sleep or get numbed, they gave the medicine that the hospital purchased from a local drug manufacturer. It was a counterfeit or substandard, the medicine should make the patient sleep within minutes of taking it, or at least become numbed, but the patient was still wide awake, the surgeons could not slice his tummy. They have to get another round of medicines/anesthesia, otherwise the patient will be crying in pain under the knife.

The entry of many substandard drugs is often facilitated by the "cheap drugs at all cost" thinking and campaign. And too often, health discussions are too focused on medicine prices only. 

Other costs related to healthcare take a higher share than medicine prices. Too often, it's the (a) physician fee, (b) diagnostic tests fee, and (c) ER or hospital fee, that can bore a huge hole on a patient's pocket.

Free healthcare in many welfare states sounds cute.  It's free, right, but the government also has the freedom to make a patient wait, two months in Bonn's case, before he can see a doctor. The average waiting time for "free healthcare" in many rich and welfarist countries now are getting longer.  If something is provided for free or at highly subsidized rate, expect the demand to be larger than the supply, always. That is why government hospitals are always full while more expensive hospitals have little or no queueing. Or why fiestas are full of people seeking free lunch while expensive restaurants have little or no queueing.

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Thoughts on HC vouchers...

Let's have a voucher system in healthcare, government to privatize many of its hospitals.. The government through the DOH, will still get huge funding from us taxpayers. But the DOH will give back the money direct to the people, rich and poor, in the form of vouchers, instead of sustaining and subsidizing government-owned hospitals and health bureaucracies. 

The government will distribute two types of voucher to all households. Type A will be non-transferable, non-cashable and will be used only to purchase a health insurance to any of the many private providers (hospitals, HMOs, etc. competing with each other. This type can be valued at say, P2,000 per person per year. Thus, a five-member household will receive P10,000 per year. The family can choose a PhP16,000 family health insurance, use the voucher and pay the P6,000 extra, or solicit private donation to cover the gap. 

Type B voucher will be transferable but non-encashable. Richer people can donate this to their house helper/s or family driver/s or other poor people, and the latter can get a more comprehensive, wider coverage health insurance without forking out extra cash.

LGUs can also issue their own vouchers to their local residents as add-on to the national government voucher. Or they can continue operating their city or provincial hospitals and pay for their costly maintenance. Or LGUs can contract with a big health insurance firm for a fixed amount and this firm will cover all residents of that city or province at specified minimum services.

The poor can further tap or approach private charities and health NGOs through the latter’s medical missions, or by asking for additional insurance cover so that poor households with special or high demand for their sickly family member/s can get an insurance with larger healthcare coverage. 

This private health insurance will be on top of PhilHealth membership. The former will cover mainly outpatient benefits (consult a physician, undergo diagnostic tests if necessary, buy the medicines if any, then go home and rest) while PhilHealth will cover hospitalization expenses. A higher premium for private health insurance should also cover additional hospitalization benefits.

This way, healthcare as personal/parental responsibility will be reflected, and government responsibility can top it off. The poor especially can be spared from the horror of high out of pocket even for ordinary ailments  affecting any family member. 

My friend, an academic in UP Diliman and her physician hubby, they have 3 kids, told me that they have been asking around for the best health insurance for a family package. She said that _____ HMO seems to have the best package. 

If none of them in the family got hospitalized for the past 5 years, they get some form of dividends, or lower premium for the next 5 years. Meaning, the company is thankful that their clients are taking care of their body, so they give back to their clients. The staff of the company too, she said, are very courteous.

How many times have we heard that several or many personnel in government hospitals are unfriendly, "masungit" and less courteous? Since personnel in government hospitals (or in any other offices for that matter) are "pre-paid", meaning they will get their salaries whether they treat 1 or 10 or 50 patients a day and their patients are non-paying anyway, there is indeed a tendency to be less courteous to the poor patients, but they can be extra courteous to the politicians or the high hospital officials who appointed them to their position.

It is important that government money should go direct to the people, and the people will choose among the various hospitals or health insurance companies or health NGOs, that can give them courteous, friendly services. Government and the legislators will over-spend on public healthcare, whether we like it or not. We might as well steer such high spending towards more market oriented, more efficient schemes.

Another Filipino friend based in Tokyo, Jules, sent a link from BBC, http://www.bbc.co.uk/news/health-14430309. He added that "one outlier in the chart defies the historical trend. That increasing affluence DOES NOT necessarily lead to obesity. Incidentally, it is also the country with longest life span both for men and women...But why target obesity? Because, obesity along with smoking, lack of exercise and over eating accounts for most lifestyle related diseases...IF Health Economics is about efficient allocation of resources, we should instead focus spending on health on two things: our children and measures to prevent lifestyle related diseases."

I thanked Jules for his comment. That is really the main purpose of encouraging people to have private health insurance, on top of their PHilHealth membership as the latter is forced upon us by government. Whether we like it or not, we are PhilHealth members and hence, must pay a monthly contribution to it. 

People own their body. They can over-smoke, over-drink, over-eat, over-sit and have lots of lifestyle related diseases, fine. Their private health insurance will help them get over the huge cost of their healthcare someday, so it is not good to further hike the monthly contribution to PHilHealth because "healthcare is a right and government responsibility." No, healthcare is personal and parental responsibility, first and foremost. 
Corruption in government -- national and local -- hospitals definitely happen, like in many other government offices. If hospitals are private, the professionals there have to be nice and courteous to patients as even poor patients have the money, the voucher they get from the govt which used to be funded for government hospitals. If patients are unhappy with the service of one hospital or health insurance provider, they can stop patronizing it and move to another HC provider the next year. No need to demonstrate in the streets, to lobby politicians and in media exposing this and that hospital administrators are insensitive to the public, especially poor patients.

That many health bureaucrats in government hospitals will oppose this move is understandable. The huge perks and discretionary power they have -- whom to hire and promote, from whom to buy medicines and medical supplies at what discounts, etc. -- will be removed from them. But there is huge demand for universal HC, and the voucher system might be the most efficient to attain that goal.

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See also:
Socialized Healthcare 6: Student Debates, Charity Beds and UHC, August 22, 2012

Socialized Healthcare 7: Degnan and Wagner on ICIUM and UHC, September 04, 2012

Socialized Healthcare 8: Anita Wagner on UHC and Medicines, September 05, 2012

Socialized Healthcare 9: Grassroots Consultation, Insurance for Catastrophic Diseases, October 15, 2012

Socialized Healthcare 10: Peru Doctors' Strike, Health Financing, October 29, 2012