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Tony Leachon
PMA warns of worsening shortage of doctors. http://www.abs-cbnnews.com/nation/01/30/14/pma-warns-worsening-shortage-doctors
Emmanuel 3D- Dispersal, Diffusion, Dedication
Daniel Most patients in the provinces can't
afford doctors. The government thought universal healthcare through the PHIC
will solve it. It just solved half the problem.
PHIC doesn't even pay for OPD consults. What, wait for
these patients to be sick enough to be admitted for insurance to start paying
for it? By then the healthcare cost could already skyrocket.
Ted The ratio should be 1 physician per 1000
persons. If we are 95million and we have 130,000 licensed isnt 1.3 doctors per
9,500 population? We definitely need more doctors! I believe PPP will be a
major solution as many of the doctors are in the private sectir.
Iris Hopefully UPCM Return Service will help and
that these new MDs will be encouraged to stay.
Minerva This issue definitely needs a
comprehensive analysis that considers demographics, changing practice patterns
and healthcare access. Most existing estimates of the shortage of physicians
are based on simple ratios. These estimates do not consider the impact of such
ratios on patients’ ability to get timely access to care and do not quantify
the impact of changing patient demographics on the demand side and alternative
methods of delivering care on the supply side. We are at the threshold of
collaborative practice which could be expanded to include the use of healthcare
teams of physicians, nurses, midwives. Telehealth is another option to address
timely access to care in remote areas. Improving allocations for physicians in
government, both national and local as well as improvement in facilities
through local government emphasis on health agenda is a must while we review
the Local Government Code.
As an educator engaged in organized medicine, I believe
we should also shift some of our focus in teaching medicine and include health
informatics, leadership and management of change, medical socio-anthropology
and immersion in public health issues in research, in elective rotations and as
part of case scenarios in medical subjects so that medical students will have a
grasp of the real world that they will face after medical school.
Ted If each private doctor accepted or was
assigned few poor families in consult and treatment under their care and
Philhealth paid for their servicrs, would that lessen the problem?
Daniel PHIC calls it capitation but its only
paid to the RHU doctors, which in most cases, the poor patients won't even find
in their clinics.
Adrian It might be time to consider Dr
Domingo's proposal for a national matching system. That will ensure a career
for doctors, while addressing distribution issues.
Minerva PHIC should in fact pay for the whole
continuum of care: preventive, promotive and rehabilitative. A tall order but
something that definitely needs to be considered. PHIC gets an infusion of
money from the SIN Tax, from people whose mindsets we probably cannot
change...so we have to think of ways (policy changes) to channel it to
compensate physicians who provide coordination of care, health maintenance and
disease prevention programs so as to reduce the burden especially of lifestyle
diseases. Let us have less sick people with health maintenance in mind. Let us
be CREATIVE and not REACTIVE!
Tony Thanks for your views. I think we need
5 strategies 1. Comprehensive Healthcare workforce plan - evaluation of
maldistribution , salaries , training , competencies , and mobilization of
local medical organizations 2. Process - maximization of Phil health benefits ,
use if sin tax funds , absorption of non doh public hospitals eg AFP med center
, VMMC , PGH etc; 3. Infrastructures - national template for the build up of
hospitals with a checklist of equipment matched with the level of training of
the local primary care physicians. 4. Improvement of health literacy of the
patients 5. Systemic environmental health approach with involvement of
different government agencies ( dilg , DepEd , CHED , DA , dost NNC etc and
private sector.) - once the strategic plan is in place - communication plan, we
need to put the right people for the right job , resources , balanced scorecard
and monitoring of the execution and implementation of the goals.
Daniel But let's be realistic about the PHIC
Premiums? 200 a month? What can the patients expect with that? They're getting
us all on the cheap. Do you see lawyers lining up to form their own LMOs (Legal
Maintenance Organizations)? Nah.
Iris I really think it's time for
telemedicine. Whatever happened to the telehealth bill?http://www.govhealthit.com/.../congress-introduces-bill...
Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
introduced a bill Dec. 1...See More
Rodel There are a lot of doctors, even
specialists who try working in resource-limited settings like in this province,
but the local climate does not value the contribution of the health care worker
much, which is why they leave. I think it starts with...
removing local politics from the equation. This would
encourage those committed to health to stay without the need to kiss ass. Plus
some politicians use the PhilHealth enrolment to their advantage so it is never
maximized. Telehealth is a good way...
...to bridge the gap but again even the little investment
is seen as a burden by non-health minded LGUs (which is most). Agree with
deployment of MDs, with possible retention as well as a true rural public
health elective in med school.
Minerva Yes, Telemedicine should be included
in our healthcare agenda to bridge the geographical divide. Each doctor has in
his hand, an android or iPhone or an iPad that can serve as a tele-clinic to
provide specialty consults to remote areas. But then again we need primary care
physicians, nurses and midwives to man our remote areas and bring their cases
to the attention of the specialists. Let us push the boundaries of healthcare.
Let us also bring Patient Education on Preventive Health
as part of our Medical Missions! When we are requested to go on Medical
Missions let us bring with us, aside from our stethoscopes...our bullhorns to
teach patients the value of disease prevention and proper nutrition.
Daniel Things that attract doctors to
practice in the provinces: peace and order, access to good educational
institutions, relatively stress-free lifestyle, nurturing practice environment,
self-fulfillment,attractive remuneration packages. Other reasons?
Adrian Medical missions are just a stop gap
measure.
Tony Ted
it's time to gather a group of people who are willing to help you and doh to
solve this huge problem. You don't have much time. There are individual
differences of course - let's go beyond the differences , chaos and clutter and
work for a better PH healthcare.
Minerva Yes, I agree! Surely Medical Missions
are just stop gap measures but changing mindsets through patient education has
long term impact. We just use Medical Missions to gather patients to come and
congregate then we teach them while they are waiting for their turn.
Ted I agree. our method and routes maybe
different but I suppose we all want better healthcare for our countrymen. Sure,
Im with you as when you also supported us during the Sin taxes. Now the money
is getting "locked" in PHIC. this must not happen. Those benefits
must be given to the patients and the doctors who serve them!
Daniel Let's form a Political Action Group
to lobby the decision-makers on the importance of health care reform
integrating all program that will advance all healthcare agenda.
USec Ted, why is it that its always a lawyer who runs
PHIC? Would lawyers like it if a doctor run an organization devoted for legal
concerns.
Rodel Agree with a multisectoral
health-focused group with representatives from the top level to the grassroots
workers. It really is time to start focusing on health-delivery agendas in this
country.
Rodel Even Telemedicine can be used for
primary health care, for like us, despite being a city, we have bgys about 5.5h
away from a health center. Telemedicine could help in that regard as well even
with primary health care delivery of the MHOs.
Minerva Listen, Learn and Legislate...that
should be the way to go for our policymakers! This is meaningful
conversation...this is what I mean by UNITY OF PURPOSE...policymakers listening
to the grassroots.
Tony Usec ,
Allow me to dream with you - what's the doh visual showcase for the coming SONA
, something that the people will be happy about w 2 years and 5 months to go. ?
We all worked for the sin tax law and we dreamt that it would be earmarked for
health. But can the leadership of doh expedite the changes ASAP ? We were able
to pass the sin tax law in a record one year time after languishing in congress
for 16 years ! Nothing is impossible with teamwork , courage and love of
country. Thanks for listening.
Naomi Has DOH convened a meeting with
schools, LGUs, and Philhealth? The problem needs a permanent working group with
concrete goals, eg all barangays will have one GP, one IM , one pedia and one
OB at least by dec 2016 (just an example) , funded by LGU, covered by PHIC,
linked with a referral system and mentoring of consultant partner to the
university hospital and DOH hospital for specialty consult etc. Then the
project can be tracked quarterly till attainment of goal, continuously
enhanced, maybe we can even get corporations to adopt and sponsor the needs.
Val Tony Leachon,
yes doc, we made a study. but not purely on HR. The problem is we do not have
actual data on private physicians. Data from PMA is erratic, while DOH only
collects public health workers. Again, we can address skewed distribution of
physicians by stirring the demand (by insurance) and the supply side of
physicians will kick in. I am so pro-free market. haha
Tony how about the WHO ? What s your view on
this ? Do you have local and global studies on this topic ? Thanks.
Naomi This needs a practical pragmatic
action oriented leadership by DOH and LGUs. Hope not too much analysis
paralysis...doesnt take a lot to identify zero headcount. Focus on the zero
headcount (zero gp zero pedia zero ob etc) municipalities as first priority and
go from there
Maria May I know the basis for the statement
of PMA that there is worsening shortage of doctors?
Doctors are in short supply.
Maria This is old news..... What needs to be
done is for DOH, LGUs and medical societies to sit down and make a plan to
address the problem. PMA should not be blurting out problems where they do not
offer solutions.
Minerva Yes we have to sit down
together...let us engage DOH, LGUs and the Medical Societies in crafting new
and creative solutions to this old issue. All of us physicians in the PMA
should put our act together. We have to show the community-at-large that we are
large enough to lobby on issues that affect the medical community. All of us
engaged in this conversation have contributed much in terms of solutions since
this morning...let us make all our dreams come true!
Tony Here are some facts
PRC : The press release lacks accuracy as far as statistics are concerned. As of March 15, 2013, there were 70,418 physicians in the list of active professionals. These have been renewing their PRC ID's. How many more have not been renewing their ID's? We do not know.
Circa 2010-2011, there were only 22,000 physicians accredited by Philhealth, with almost equal distribution between GP's and specialists, and with a tier 2 which had GP's with training performing specialty procedures.
PRC : The press release lacks accuracy as far as statistics are concerned. As of March 15, 2013, there were 70,418 physicians in the list of active professionals. These have been renewing their PRC ID's. How many more have not been renewing their ID's? We do not know.
Circa 2010-2011, there were only 22,000 physicians accredited by Philhealth, with almost equal distribution between GP's and specialists, and with a tier 2 which had GP's with training performing specialty procedures.
The government or even PMA lacks data on the human
resources.
The PMA said during the previous years that they had 70,000 members, 2/3 of whom are GP's and 1/3 are specialists. They should know the geographic distribution of both GP's and specialists. However, during discussion with DOH officials , no one actually knows which provinces lack specialists. The DOH has a list of towns without doctors (meaning municipal health officers belonging to the government service). So many Health Secretaries have passed without any one coming up with a serious effort to address the problem. What we have are the Doctors to the Barrios program which is very difficult to sustain. UP is the only med school with a return service program which is not adequate to meet national needs. The regionalization of medical schools may have solved problems in some regions but overall, has not really answered the needs of the country.
The PMA said during the previous years that they had 70,000 members, 2/3 of whom are GP's and 1/3 are specialists. They should know the geographic distribution of both GP's and specialists. However, during discussion with DOH officials , no one actually knows which provinces lack specialists. The DOH has a list of towns without doctors (meaning municipal health officers belonging to the government service). So many Health Secretaries have passed without any one coming up with a serious effort to address the problem. What we have are the Doctors to the Barrios program which is very difficult to sustain. UP is the only med school with a return service program which is not adequate to meet national needs. The regionalization of medical schools may have solved problems in some regions but overall, has not really answered the needs of the country.
I passed the medical board exam in 1986. DoH sec Bengzon
started the devolution during that time. I was a Cory fan.
Blaming devolution as the cause, in addition to the shift of physicians to nursing, may not be accurate because right now we have doubled the number of takers of the NMAT from 5-6,000 to 12-13,000, mainly due to the shift of nursing graduates to medicine.
Blaming devolution as the cause, in addition to the shift of physicians to nursing, may not be accurate because right now we have doubled the number of takers of the NMAT from 5-6,000 to 12-13,000, mainly due to the shift of nursing graduates to medicine.
DOH-HHRDB, under Dr. Kenneth Ronquillo - good friend and
patient of mine , is the unit in charge of studying the health manpower
situation in the country, including projections on how many are needed. They
used a WHO model before, then changed to an ILO model. They should be consulted
regarding this problem. They have set up a very wide network and have conducted
conferences at the DOH and at hotels with the participation of a lot of
government agencies. I have attended one or two sessions of them in the
past.
UNDP used to publish the comparative number of physicians
based on 100,000 population, and there were also other studies based on 10,000
or 1,000 population. These data covered all countries.
The PRC and the Board of Medicine have the following data:
1. Number of medical schools: 38
2. Number of graduates: 4,500
3. Number of takers of licensure exams: 4,000-4,500
4. Percentage passing: 62-66%
5. Number of successful examinees per year: 2,500
The PRC and the Board of Medicine have the following data:
1. Number of medical schools: 38
2. Number of graduates: 4,500
3. Number of takers of licensure exams: 4,000-4,500
4. Percentage passing: 62-66%
5. Number of successful examinees per year: 2,500
Based on recent PRC data -
Of the 38 medical schools, 21 are satisfactorily performing based on passing percentage of graduates. Seventeen are poorly performing. Some schools were recommended to be phased out but not a single medical school has been closed (except for Muslim Christian CM in Antipolo).
Of the 38 medical schools, 21 are satisfactorily performing based on passing percentage of graduates. Seventeen are poorly performing. Some schools were recommended to be phased out but not a single medical school has been closed (except for Muslim Christian CM in Antipolo).
Should the CHED allow more medical schools to be opened? The PRC BOM does not agree that this should be done. The CHED should first deal with the quality of the medical schools and the quality of graduates. Poorly performing schools should be helped but if there really is no effort from their part to improve, then they should be phased out. Only then can the CHED allow more medical schools to open. Monitoring the schools is a big problem. Closing down the substandard ones is a bigger problem.
The problem of quality assurance should be taken very
seriously. Since external accreditation was made voluntary, only the excellent
schools have volunteered to apply for external accreditation. There is also a
policy of the accrediting body, PAASCU, that schools have to attain a passing
percentage equal to or higher than the national passing average before they can
apply for external accreditation. Right now, the gap between the actual passing
percentage and the national passing percentage has been widening, making it
impossible for the poorly performing to attain external accreditation.
Tony During the term of Pcp president Eugene
Ramos he created more chapters - to me , the problem of maldistribution is the
more pressing problem. We may be able to produce the needed number, but if
these physicians shy away from many areas of the country for reasons of their
own, then even if the control of local government hospitals is reverted back to
DOH, the problem will persist.
In 1987 I was at Mdh as a resident physician and up to
the time that we were residents already, the DOH was in control of all health
facilities of the government, but even during those times, we had been dealing
with the same problems.
Doc Get the money flowing to our health
workers. Make the compensation enticing and see most of the brain drain will be
solve. It all boils down to how much are we paying our doctors and nurses.
Mark Filipino citizen medical graduates
should work for the Philippine govt for a certain period of time, e.g., 5-10
yrs, before allowing them to migrate to another country. Or the Philippine
government can sponsor scholarships for med school and after graduation, the
graduate should work for the govt for a certain period of time to payback the
cost of education.
Maria There should be a more planned
effective mechanism to distribute doctors/specialists to various parts of the
country. Right now, there is this policy that specialty hospitals must
prioritize acceptance of doctors coming from hospitals where no specialist
exists. However, this is being abused by those who wants to be accepted into
training without going to the usual process even if the supposed hospital
sponsor has existing specialists in their place and even from within their
institution.
France No amount of policy change will
motivate any doctor specialist or not, to practice in the municipal level if
the salary they get dont even cover for the fuel they will consume in
Doing there job. Doctors are mortals too, if u have 5 mouths to feed, will 30-35k basic salary for an MO3 enough. Or for an MS1 or 2. Tssk...
Doing there job. Doctors are mortals too, if u have 5 mouths to feed, will 30-35k basic salary for an MO3 enough. Or for an MS1 or 2. Tssk...
Tony Agree with Doc France. The govt
should take the lead in providing solutions to this chronic problem. But we
will trigger an advocacy to find solutions.
Question : what are the priorities of the Philippine
government for 2014 =>
P84.36B (DOH) of P2.265T (2014 National Budget) = 3.79%
[http://www.dbm.gov.ph/wp.../uploads/GAA/GAA2014/DOH/DOH.pdf]
General Public Services are expenditures for general administration (such as fiscal management, foreign affairs, lawmaking, etc.) and public order and safety.
[ http://data.gov.ph/infographics/budget ]
16.0% goes to General Public Services
[http://www.gov.ph/.../2014-National-Budget-Briefer-VerB...]
P84.36B (DOH) of P2.265T (2014 National Budget) = 3.79%
[http://www.dbm.gov.ph/wp.../uploads/GAA/GAA2014/DOH/DOH.pdf]
General Public Services are expenditures for general administration (such as fiscal management, foreign affairs, lawmaking, etc.) and public order and safety.
[ http://data.gov.ph/infographics/budget ]
16.0% goes to General Public Services
[http://www.gov.ph/.../2014-National-Budget-Briefer-VerB...]
Minerva Our problems revolve around system
and we ought to have people sitting down together (perhaps a group like what we
have now) to look at the root causes...We ask ourselves the following
questions: How do we mould the minds and hearts of our medical graduates? How
do we instill in them the Love of the Supreme Being, Love of Country, Love of
Fellowmen and Love of Profession? How do we teach them to advocate for Health
and Wellness versus just Cure of the Sick, for Professionalism versus Politics
in the Profession?
Rosel Somewhere in the assessment, the
fragmentation of the health care system as caused by the Devolution Law ,
authored by Senator A. Pimentel, has to be discussed.
Tony Sin tax funds will augment the doh
budget - and the reallocated PDAF !
Rosel Taking the cue from Ted, I agree that
vigilance and advocacy is needed in this area of Sin Tax Implementation because
there is a possibility that most of the money might be locked up in Philhealth.
If Philhealth is run by lawyers and bankers, the priority will be to
increasingly augment the asset base, If it were run by the likes of Dodo Banzon,
a different battle plan would be in place in the service of universal health
care. It is a matter of policy direction and orientation of the Fund actually.
Maria Sin tax funds is meant to augment DOH
funds for programs. I don't believe that it should be poured in to pay for
personnel. We should advocate for more budget for health in the LGUs and this
should cover for health personnel. LGU chief executives must realized that
health should be a priority
Edge Hi Tony, sorry for joining this
discussion late in the hour. My take on this is that we need to examine the
situation from an evidence-based and strategic standpoint. Dr Marilyn Lorenzo's
research on HRH in the Philippines in 2008 points to a growing need not just
for doctors but for other types of health workers as well:
However, at the time of the said research, these were the
available positions:
Now considering the cost of training health workers, and
hence projecting the investments needed to produce the required number of
health workers, a broad national strategy has to be crafted in order to match
the need for HRH vs the available HRH supply vs the positions available in both
public and private sectors, rural and urban settings vs the investments needed
by both government and private sectors to address the HRH gap.
For me, evidence should drive the strategy, not emotions
or mere subjective opinions so that we would be able to arrive at the sanest,
most feasible policy interventions that will benefit the country, and not just
appease specific group or individual vested interests..
Let us all remember, too, that the issue is complex and
multi-factorial, hence the approach needs to take on a systems perspective so
that all bases are covered and the complexities are addressed in a
comprehensive manner, and not biased for or against any particular group..
Minerva Yes indeed, Evidence to drive
Strategies and Advocacy to drive Change!
Ted Edge. I agree with you. This problem has
been there since the 1960's. This is not a sole Philippine issue. To think sin
taxes can solve it nor should we blame a decentralized health system. We need
to have also a global view as the Philippines is sourced by other countries for
HRH. Globalization factors play a major role. Then there is an issue of
geographic and economic maldistribution.
Maria We need to analyze the impact of
devolution on health services. People keep on thinking that health is just a domain
of the DIG. While the direction and general programs emanate from DOH, the
implementation rests on the LGUs. Agree that evidence is key but we need to
look at areas where research is needed.
We need to analyze the impact of devolution on health
services. People keep on thinking that health is just a domain of the DIG.
While the direction and general programs emanate from DOH, the implementation
rests on the LGUs. Agree that evidence is key but we need to look at areas
where research is needed.
Gilbert Not news anymore. It has been like
that for ages. Hindi pwedeng madaliin ang solution kasi Baka lumabnaw. Mas
mahirap Kung ang manggagamot ay hilaw. Think out of the box. Fix the system. It
may obviate the need for numbers.
Edge Hi Sir Ted, yes, the HRH problem
is not just a national problem, it is a huge global challenge. Hence, if we are
to think outside of the box, as Gilbert suggests, the policies that should be
adopted must be a combination of both "train for export" and
"train for local needs" approach so that the numbers being produced
will be able to cater to both markets. The western-oriented medical education
we are getting from Philippine schools makes our graduates capable of competing
in the global HRH market, which is both a boon and a bane for the country.
Nevertheless, from a global perspective, it is not at all bad for the global
community if you look at HRH as global "common good".
Looking more closely at the national situation, the
greater challenge is the maldistribution of doctors and other health workers in
favour of urban areas, hence much more effective "HRH deployment
policies" are needed, coupled with attractive incentives to make our
graduates want to go and work in rural settings, as well as retention policies
that would want them to stay. This goes without saying that the training of
medical students should include skills development in managing municipal or
community-based health systems, from advocacy to resource mobilisation,
community financing, health planning, etc..
If we are looking at "structural change
policies", then clearly, financing of training as well as remuneration of
health workers, focusing on provider payment mechanisms should be radically
revamped. Investments in training should cater to both the global and local
markets, while compensation package for doctors or other HWs should be made
much much more competitive to ensure a decent quality of life for the HW and
his/her family. International development organizations and multinational
companies have an adjustment rate depending on the degree of risk present in
the area of deployment. Same approach could be used in the country where there
is a factor to be added to the compensation package depending on how remote or
underserved the rural area is. Of course, based on our experience with the
DTTBs, an attractive training programme like the MBA-Health from Ateneo,
supported by Pfizer and other private corporations, should be made available to
those who would decide to work in these areas.
Holding them back to work in the country for a couple of
years before they're allowed to compete in the global market is fine, but
without providing the requisite training, structural changes and support
systems will stifle our graduates' professionaldevelopment rather than
incentivize them to stay and work for health development in the countryside.
And I am saying this based on personal and professional experience as a
community-based health practitioner from way back...
Tony No one has ever thought of addressing
health inequities in one piece. Always fragmented. People. Process.
Infrastructure. System approach.
Two years to ago in this admin - nothing has changed. . Still hopeful.
Re Edge proposal
to liberalize the mobility of Fil doctors globally, it is a wise proposal. Why?
1. "Brain drain" is temporary; they leave as young doctors, many of them will come back as highly specialized physicians, or as doctor entrepreneurs, putting up their own hospitals and specialized clinics. Plus the money, network, tech transfer they bring in. That's "brain gain".
2. The more restrictions and prohibitions that government will impose, the more government corruption and black market transactions will happen. Classic cases are prostitution, drugs, jueteng and other gambling, all are supposed to be non-existent due to blanket prohibition, yet they are all around.
3. Being a physician or nurse, etc. is not a crime that practice anywhere should be heavily regulated by government. Government should focus its resources and energy in catching outright criminals, like the manufacturers and traders of fake and counterfeit medicines, fake and deceptive "cure all diseases" food supplements and drugs, etc.
4. Physicians who graduated from private universities (ie, non-taxpayers funded), the more that government should not dictate where they will practice. For UP College of Medicine and other state universities' medicine graduates government may impose conditionalities in exchange for taxpayers' subsidy of their education.
Nonoy Oplas "Yasuyuki Ota (respondent)
is a Japanese national, married to a Filipina... failure of respondent to prove
that there is reciprocity between the laws of Japan and the Philippines in
admitting foreigners into the practice of medicine. Respondent has satisfactorily
complied with the said requirement and the CA has not committed any reversible
error in rendering its Decision dated November 16, 2004 and Resolution dated
October 19, 2003.
WHEREFORE, the petition is hereby DENIED for lack of merit."
Yes, the SC has ruled on it -- foreign doctors, even if they took their medical education here, even if they practiced intership here, even if they pass the PRC medical board exam, can NOT practice medicine here, unless there is explicit reciprocity bet. their governments and the PH government.
So to your question, "why aren't they coming here?"
Because they are not allowed to come and practice here.
------------Two years to ago in this admin - nothing has changed. . Still hopeful.
Ted to plan for both is just too expensive and
risky. If we don't have excess HRH, why export it? Simple supply and demand, if
we don't have enough doctors, then shouldn't we just ban them from leaving the
country? The DOH gives a clearance for any physician who wants to train abroad.
It certifies that their training is necessary and yet they never come back!
Just some radical thoughts. Shouldn't we just ask those doctors licensed by PRC
to come home and serve the country or loose their license? They can't practice
abroad without a current license from their origin, well except those who have
immigrated. Wouldn't these double the Physician numbers locally? Radical
solutions an authoritarian state would do!
Nonoy Oplas A year ago, Jan 23, 2013, Dr. Jaime
Galvez Tan gave a lecture at the AIM on "Who will Heal Us Now?" re
unavailable or under-utilized health human resources. Gave figures like to
balance the need for more doctors, some P3.07 B will be needed by the
government; P13.6 B to get more nurses; P7.06 B to get more midwives; total,
P23.77 B. Then he explained why government should focus on getting more nurses.
Some of his slides here, http://funwithgovernment.blogspot.com/.../socialized...
1. "Brain drain" is temporary; they leave as young doctors, many of them will come back as highly specialized physicians, or as doctor entrepreneurs, putting up their own hospitals and specialized clinics. Plus the money, network, tech transfer they bring in. That's "brain gain".
2. The more restrictions and prohibitions that government will impose, the more government corruption and black market transactions will happen. Classic cases are prostitution, drugs, jueteng and other gambling, all are supposed to be non-existent due to blanket prohibition, yet they are all around.
3. Being a physician or nurse, etc. is not a crime that practice anywhere should be heavily regulated by government. Government should focus its resources and energy in catching outright criminals, like the manufacturers and traders of fake and counterfeit medicines, fake and deceptive "cure all diseases" food supplements and drugs, etc.
4. Physicians who graduated from private universities (ie, non-taxpayers funded), the more that government should not dictate where they will practice. For UP College of Medicine and other state universities' medicine graduates government may impose conditionalities in exchange for taxpayers' subsidy of their education.
Rosel One dimension of the issue is to
understand health economics. Market forces will play a role. The supply of
manpower to under served areas will rise if financial resources support it . We
can look to the Petilla Model in Leyte. Incentivization schemes married to
Philhealth enrollment and reimbursement strategies have provided a solution to
the once serious physician manpower problem.
Ted I disagree that the Brain Drain is
"temporary" it's a lame excuse. 50% of success in anything is being
present. The problem is lack of doctors. If 90% of your doctors leave for
abroad or just stay in urban private healthcare! you can only serve as a factor
for the richer countries. The real economic solution is to provide doctors
compensation similar to what would make them leave. Yung doctors of first world
countries don't go abroad for training, they lead the world with innovation
from their own countries. Factory for the richer countries!
Adrian I also agree that the brain drain is
still continuing until now. With very poor incentives to stay, medical
graduates will keep on leaving.
Nonoy Oplas So USec Ted, there is zero
"brain gain" at all? None, zero of those Fil doctors who migrated and
practiced abroad, ever come back to either practice here again or put up their
own hospitals or clinics, and hire more young doctors, nurses, admin staff? I
doubt that it is a realistic assumption.
Many doctors in rich countries cannot practice in developing countries because the latter impose protectionism and double standards. Their doctors, other professionals, can practice in N. America, Europe, Australia, etc. but they do not tolerate doctors from those rich countries to practice in their countries. Local doctors (and lawyers, engineers, accountants, nurses, pharmacists, etc.) are protected, they compete only among themselves here.
Many doctors in rich countries cannot practice in developing countries because the latter impose protectionism and double standards. Their doctors, other professionals, can practice in N. America, Europe, Australia, etc. but they do not tolerate doctors from those rich countries to practice in their countries. Local doctors (and lawyers, engineers, accountants, nurses, pharmacists, etc.) are protected, they compete only among themselves here.
Adrian The trickle back is too little to
support a viable health care system.
Ted Yes the education of a doctor is just
too long and expensive. All that investment is gained by the country that hired
them. We have become a HRH factory for the world while our own people lack
medical care.
Ramon Solutions should be systemic, from the
selection of students from the rural areas, to a transformative health
professional education, and to proper support from national govt, DBM and LGus.
It certainly can not be achieved under the present "rationalization"
plan of govt which is a euphemism for downsizing in the face of an increasing
population!
Ted The rationalization plan is for offices.
The hospitals and health facilities have an increased staffing pattern. We have
hired the 25% of the total required fot health personnel and downsized offices
or Bureaus. More to services delivery.
Nonoy Oplas The one who made medicine
education too long, too costly, is... government, through curricular
regulations. The one who removes 1/3 of the monthly pay of fixed-income doctors
(and other professionals and ord employees) via witholding tax alone is...
government. The government is intervening, regulating and taxing more than what
the regulated could tolerate. Adding another regulation like banning Fil
doctors to practice abroad will only create more corruption, bribery and black
market in government.
Doc Paterno, I do not see any significant indicators that the government is "downsizing" in healthcare. The opposite is happening, actually. Public health spending is rising via many govt agencies: (a) DOH and PhilHealth, (b) UP-PGH, AFP hospital, PNP hospital, other agencies, (c) own clinics with full time medical staff, free medicines, etc. in many big agencies (HOR, Senate, SC, BSP, state universities, etc.; (d) PCSO, PAGCOR spending and subsidies; (e) provincial, district, city hospitals; (f) regular LGUs health centers, from provincial down to barangays.
Doc Paterno, I do not see any significant indicators that the government is "downsizing" in healthcare. The opposite is happening, actually. Public health spending is rising via many govt agencies: (a) DOH and PhilHealth, (b) UP-PGH, AFP hospital, PNP hospital, other agencies, (c) own clinics with full time medical staff, free medicines, etc. in many big agencies (HOR, Senate, SC, BSP, state universities, etc.; (d) PCSO, PAGCOR spending and subsidies; (e) provincial, district, city hospitals; (f) regular LGUs health centers, from provincial down to barangays.
Adrian Sir Nonoy: In the post-9/11 world,
it's more difficult to smuggle in doctors than drugs. Comparing the effect of
banning migration to banning these harmful substances is not a viable argument.
And protectionism preventing the practice of foreign doctors here? Requiring foreign physicians to get a visa, and to pass our board examination isn't such a significant barrier to practice. I don't think that's what's really preventing foreign doctors from practicing in developing countries. I think they DON'T WANT to practice here. Why? Financial incentives
And protectionism preventing the practice of foreign doctors here? Requiring foreign physicians to get a visa, and to pass our board examination isn't such a significant barrier to practice. I don't think that's what's really preventing foreign doctors from practicing in developing countries. I think they DON'T WANT to practice here. Why? Financial incentives
Nonoy Oplas Hi Doc Adrian. I am referring to
large-scale corruption and bribery at DOH, Bu of Immigration, if there is a
policy to ban Fil doctors to work abroad. That's what's happening now,
large-scale corruption and bribery in government why prostitution,
addictive/dangerous drugs, jueteng and other gambling, are still around even if
the official policy is that they are prohibited, banned, disallowed. Even minor
restrictions like rice protectionism creates large-scale corruption, like the
on-going rice smuggling controversy. You create more prohibitions, more
restrictions, you create more corruption, more robbery in government.
Protectionism is explicit in the Constitution. Not only foreign investments are restricted or banned, foreign professionals -- doctors, lawyers, engineers, accountants, etc. -- are also banned or restricted. There is big money to be realized here, otherwise big/multinational hotels, restos/food chains/coffee shops, banks and insurance firms, BPOs, etc. will not come here.
Protectionism is explicit in the Constitution. Not only foreign investments are restricted or banned, foreign professionals -- doctors, lawyers, engineers, accountants, etc. -- are also banned or restricted. There is big money to be realized here, otherwise big/multinational hotels, restos/food chains/coffee shops, banks and insurance firms, BPOs, etc. will not come here.
Adrian Give us an example of those
protectionist restrictions placed by the Philippine Government on foreign
doctors, beyond the Medical Board Exam and a working visa.
And remember we are speaking of health professionals
here, not prostitutes and drugs. How can a doctor practice abroad when he
doesn't have legitimate credentials of entry?
Nonoy Oplas 1987 PH Constitution,
Article XII, National Economy and Patrimony
"Section 14. …. The practice of all professions in the Philippines shall be limited to Filipino citizens, save in cases prescribed by law."
There is no law yet as far as I know, allowing foreign doctors, nurses, pharmacists, dentists, etc. to practice here.
From Arangkada, it says,
"laws regulating... pharmacists, and radio and x-ray technologists state the profession is restricted to Philippine nationals and contain no reciprocity provision."
http://www.investphilippines.info/.../foreign-equity-and.../
Article XII, National Economy and Patrimony
"Section 14. …. The practice of all professions in the Philippines shall be limited to Filipino citizens, save in cases prescribed by law."
There is no law yet as far as I know, allowing foreign doctors, nurses, pharmacists, dentists, etc. to practice here.
From Arangkada, it says,
"laws regulating... pharmacists, and radio and x-ray technologists state the profession is restricted to Philippine nationals and contain no reciprocity provision."
http://www.investphilippines.info/.../foreign-equity-and.../
All countries allow, prohibit, or restrict foreign
economic activity within thei...See More
Adrian There is a law, dear sir. Sections 8 and 9
of RA 2382 show that foreign professionals are allowed to register and practice
as physicians once they pass the board exams here, as long as the countries
reciprocate with similar regulations.
http://www.lawphil.net/.../repacts/ra1959/ra_2382_1959.html
http://www.lawphil.net/.../repacts/ra1959/ra_2382_1959.html
Republic Acts -THE MEDICAL ACT OF 1959
Nonoy Oplas Come on, Medical Act of 1959,
enacted on June 20, 1959, has precedence or supremacy over the 1987
Constitution? Can you cite foreign doctors practicing here using RA 2382 as
their basis, and they are allowed by the PRC?
Adrian Um, the Supreme Court has also
settled this legal question.
http://sc.judiciary.gov.ph/juris.../2008/july2008/166097.htm
http://sc.judiciary.gov.ph/juris.../2008/july2008/166097.htm
sc.judiciary.gov.ph
Before the Court is a Petition for Review on Certiorari assailing the ...See
More
Melvin Doctors are leaving because of low
pay and oppressive taxes. Then there are so many pseudo doctors and pretenders
like some nurses I know, some hilots, comadronas, fake doctors. Many patients
are poor and would rather "borrow" the prescription of their neighbors,
friends and relatives. Then there is Philhealth which strictly adheres that all
Filipinos should have Philhealth. Good idea but there are loopholes. How fast
does Philhealth pay doctors fees? Ages or probably never.
Adrian The question, sir Nonoy, is: why
aren't they coming here? Is it possible that practicing here isn't as
attractive as it seems?
WHEREFORE, the petition is hereby DENIED for lack of merit."
Yes, the SC has ruled on it -- foreign doctors, even if they took their medical education here, even if they practiced intership here, even if they pass the PRC medical board exam, can NOT practice medicine here, unless there is explicit reciprocity bet. their governments and the PH government.
So to your question, "why aren't they coming here?"
Because they are not allowed to come and practice here.
Ramon Ted agree RAT plan is for offices
but take this example: probably one of the more important office in DOH and for
that matter in the health sector, is the health promotion bureau. RAT plan has
reduced , decimated its personnel. Rat plan is a manifestation of a small govt
mentality that DBM is applying to HHR in the community. LGUs are constrained
from increasing their HHR because of PS/MOOE ratio requirements
Eduardo Kung ang salary packages ng gobyerno
sa congressmen at senators ay at least 200k a month...bakit Hindi sa MDs?
Nonoy Oplas Doc Ed, Senators and Cong. have
slam-dunkin salary + pork barrel packages because they are also expert in
slam-dunkin tax-borrow-tax policies. Would MDs also want to follow their path? J
Eduardo that's the simplest way to entice MDs to
practice outside the cities....Baka nga konti pa rin pumatol dyan....Kung yung
mga taong nagbibigay ng inessential services nga binabayaran natin ng ganyan eh
bakit Hindi MDs?
Melvin The worsening lack of doctors
indicates that the number of doctors graduating from med school, passing the
board exam and eventually deciding to practice here in the Philippines cannot
keep pace with the growing population of baby bloomers who are by now in their
50's 60's and 70's plus the growing pediatric age group and women in the
reproductive age group. Doctors leave because of lack of incentives to stay and
the lucrative practice abroad is very attractive. Raising doctors salaries to
200k is a very attractive incentive. Well trained doctors are equivalent to the
CEOs of private and government corporations and much more because doctors care
for the well being of Filipinos and their families.
Adrian Nonoy: Sorry, I think you misread.
The petitioners are the Board of Medicine. The respondent is the Japanese
doctor. The petitioners were unsuccessful at preventing the practice of the Japanese
doctor here, that's why, as you quoted very nicely, the "petition is
denied for lack of merit"
Nonoy Oplas OK Adrian, Yes I misread the SC
decision, thanks for persisting on it. Then there should be other regulatory
bottlenecks that discourage or even outrightly prevent foreign doctors from
practicing here on a long term basis. I think short-term practice is allowed,
like bringing in a foreign specialist if the patient is incapable of travelling
abroad, the PRC gives temporary permit.
Adrian I'm just puzzled why you refuse to
engage on the point that there really is a lack of incentives for any doctor
(Filipino or foreign) to practice here.
Bakit kelangan dahil sa barriers ang lahat? I mean, I know you're with the NGO Minimal Government Thinkers because we share mutual friends who know you. But sometimes, we have to think beyond our own advocacy.
Bakit kelangan dahil sa barriers ang lahat? I mean, I know you're with the NGO Minimal Government Thinkers because we share mutual friends who know you. But sometimes, we have to think beyond our own advocacy.
Nonoy Oplas Look Adrian, there ARE foreigner
bankers, hotel managers, securities traders, headhunters, BPO leaders, etc.
here, meaning those foreigners smell the profit and money in practicing their profession
here so long as there are no clear and explicit barriers to them. Medical and
legal practices, engineering, architectural and accounting practices, are big
money making professions here, so the attractiveness -- financial and
professional -- is there. Why the foreign doctors (and lawyers, engineers,
pharmacists, etc.) are not here, the most likely factors are government
bureaucracies or outright prohihbitions. Not fear of the NPAs or Abu Sayyaff or
professional kidnappers.
You can extend the question to Why are Harvard, Wharton, other big international universities, not here? Or big international hospitals not here? It's not financially attractive to put up a business here? The answer is No. Many Filipinos can afford expensive international schools from elementary to high school, many Filipinos send their kids abroad for tertiary education. The root is with government regulations if not prohibitions, starting from the Constitution down to getting certification or authorization from various agencies and departments.
You can extend the question to Why are Harvard, Wharton, other big international universities, not here? Or big international hospitals not here? It's not financially attractive to put up a business here? The answer is No. Many Filipinos can afford expensive international schools from elementary to high school, many Filipinos send their kids abroad for tertiary education. The root is with government regulations if not prohibitions, starting from the Constitution down to getting certification or authorization from various agencies and departments.
Adrian Are you saying that these
protectionist policies are selective for "big money-making"
professions? Because even the examples you cited, like BPOs, hotels, food
franchises, are making it big here. They've made it past all these regulations
and they're earning a lot.
I will agree that corruption is a turn off for investment. I will also agree that the less red tape there is, the better things are.
But at THIS MOMENT, is there any more red tape than there is in, let's say, the US? or in Japan? or in the other ASEAN countries?
Don't you think that there are OTHER things that affect a decision to invest, or migrate, than government red tape? Because you make it seem like it's the single most important reason why people don't stay
I will agree that corruption is a turn off for investment. I will also agree that the less red tape there is, the better things are.
But at THIS MOMENT, is there any more red tape than there is in, let's say, the US? or in Japan? or in the other ASEAN countries?
Don't you think that there are OTHER things that affect a decision to invest, or migrate, than government red tape? Because you make it seem like it's the single most important reason why people don't stay
Nonoy Oplas I did not even mention
"corruption" or "red tape" above. I mentioned
"regulations if not prohibitions". Putting up a foreign university,
foreign media, etc. here is not allowed under the Constitution.
Adrian But we're talking about the health
care workforce. There's already a legal precedent for foreigners to practice
here. Clearly, the migration of doctors, nurses, physical therapists, is NOT
because of government clamping down on them.
In fact, it might be the reverse. The government may not be paying enough attention to the welfare of government health workers! There is little incentive to stay.
In fact, it might be the reverse. The government may not be paying enough attention to the welfare of government health workers! There is little incentive to stay.
And red tape refers to government regulations and
prohibition. Just in case you thought it meant something else.
http://en.wikipedia.org/wiki/Red_tape
http://en.wikipedia.org/wiki/Red_tape
en.wikipedia.org
Red tape is excessive regulation or rigid conformity to
formal rules that is con...See More
Nonoy Oplas I avoided using "red
tape" above because I don't think it's the main explanation why foreign HC
professionals are not coming here. You just keep using it as if it's coming
from me.
Again from Arangkada,
"laws regulating... pharmacists, and radio and x-ray technologists state the profession is restricted to Philippine nationals and contain no reciprocity provision."
It's the outright prohibition, bawal, hindi pwede.
Again from Arangkada,
"laws regulating... pharmacists, and radio and x-ray technologists state the profession is restricted to Philippine nationals and contain no reciprocity provision."
It's the outright prohibition, bawal, hindi pwede.
Adrian Sigh. There is an SC decision. Hope
we don't have to post that again
Nonoy Oplas You should have your own answer
to your question why foreign HC professionals are not coming here.
Adrian I stated it earlier, and repeatedly.
Lack of incentives.
Nonoy Oplas So be it. You may be right.
Re Docs Ed and Melvin's proposal to raise the monthly pay
of (government) doctors to P200k/month so they may be encouraged to practice
outside of M.Mla and not work abroad, and hence plug the lack of doctors, I
don't think it's a sound proposal. For one, hiring of govt physicians receiving
that level will be heavily poiticized. Congressmen and Senators who approve and
appropriate the annual DOH budget (raise or retain or cut it) will definitely
pressure the DOH to hire their kids or siblings ot close relatives and friends
despite lack of eligibility.
Two, the fiscal cost will be very high. You don't just give doctors high pay, you must also provide high caliber facilities and laboratories to maximize their talent. In a situation where even a P2/tablet can become P10 or more under some govt procurement, abuse of such new high spending is not a far out possibility.
The PH's public debt or government debt stock is rising by P400 to P450 billion a year. With or without econ crisis, the government simply over-spends yearly and hence, over-borrows yearly. Interest payment alone of about P334 billion a year is the single biggest leakage from the annual budget. The big challenge for government actually is how to live within its means, to limit spending to what its domestic revenues can finance and avoid borrowing whenever possible.
Two, the fiscal cost will be very high. You don't just give doctors high pay, you must also provide high caliber facilities and laboratories to maximize their talent. In a situation where even a P2/tablet can become P10 or more under some govt procurement, abuse of such new high spending is not a far out possibility.
The PH's public debt or government debt stock is rising by P400 to P450 billion a year. With or without econ crisis, the government simply over-spends yearly and hence, over-borrows yearly. Interest payment alone of about P334 billion a year is the single biggest leakage from the annual budget. The big challenge for government actually is how to live within its means, to limit spending to what its domestic revenues can finance and avoid borrowing whenever possible.
Tony We
need to plug all loopholes. Human resources and infrastructures should be
improved with sin tax funds. It's a big opportunity that past admin missed out.
I see silver lining here.
UHC 18: DOH Budget, Healthcare Deregulation and PharmaWealth, August 08, 2013
UHC 19: Health is a Right, Health is a Responsibility, September 19, 2013
UHC 20: Health Equality Will Never Happen, September 20, 2013
UHC 21: The PGH, Manila City Government and Civil Society, December 10, 2013
2 comments:
Thank you for sharing this informative article and conversation..
mbbs in philippines
I heard also that Qualimed Hospital in Quezon City is open for medical job opportunities as of this moment. Anyways, thank you for this article. God speed!
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