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Tuesday this week, an article from the Inquirer, Filipino horror story, was circulated and shared
in facebook and other social media. It
was written by Dr. Korina Ada D. Tanyu, 27, a
pediatrics resident at the Philippine General Hospital (PGH).
It was indeed
a heart breaking story about a five years old boy named Jamjam from a poor
family in Cavite, who has been coughing for two
months already, later losing weight and has recurring fever. The mother brought him to the
health center, the boy was given carbocisteine, the cough continued and he kept
losing weight.
The nearest hospital to them is privately owned and the consultation fee
is at least P500, aside from the costs of the lab tests. The nearest government
hospital according to the author is in Manila, the PGH. After two months of
this bad condition of the boy, the mother brought Jamjam to PGH. At first she
was turned down because the hospital’s emergency quota of 60 new patients a day
on top of old and returning patients has been reached. One doctor attended to
Jamjam that day seeing his bad condition.
They found out that Jamjam has tuberculosis complicated with severe
pneumonia; the infection has spread through his blood. When he was
brought to the PGH, his condition was already very serious. After several
attempts by the doctors and nurses at the ER resuscitating Jamjam that day, they
failed. Jamjam died. A heart breaking story.
I commented at the walls of my friends who posted that story, that the main
problem was the lack of health insurance by that poor family. The government
barangay health centers are supposed to be the de facto health insurance for
the poor because they can go there for free treatment, but the health center
only gave the boy Carbocisteine, an anti-cough syrup without checking what
caused the cough in the first place.
The barangay health centers should provide primary treatment. If they
cannot handle the situation, say they suspect that there is a bigger cause to a
symptom, they should refer the patient to government secondary or even tertiary
facilities, like the municipal health center or a district or provincial
hospital. It seems that the barangay health center did not do this job, and the
government provincial hospital seems far from the family’s house.
When the parents endured for two months not to bring the child to a
physician due to poverty, the disease has already mutated to something serious.
Pneumonia is actually easy to treat, if detected early. Some anti-biotics plus regular
hydration and good rest would usually allow a patient to recover from the
disease. But if pneumonia has become severe, even hospital treatment can be too
late.
There were discussions to increase really high the budget of the PGH and
other DOH hospitals. This might help, and assuming that the government has no
big public debt to grapple with. But the more cost-effective way to solve a
similar case like this is to improve preventive healthcare through a reliable and
competitive health insurance system for all households especially the poor. Health insurance especially for outpatient services should be
deregulated.
PhilHealth card is often useless for
outpatient services. One can use it only if he/she is already hospitalized,
when the disease is already serious and the patient is about to die. For
diseases like pneumonia or TB, patients can be treated at home provided that
correct diagnosis and treatment is given. When the condition has become
complicated, that is the time to bring the patient to a hospital for
confinement.
Community (barangay or municipal level) or private health insurance in a
deregulated environment where there are plenty of competing players, is the
solution. Government can pay for the annual premium of the poor and the latter
can look for a private or NGO health insurance provider, instead of maintaining
inefficient or costly health centers. In the case of Jamjam, can the family
complain of the barangay health center for just giving them Carbocisteine
instead of referring them to a district or provincial hospital early enough?
Government healthcare monopolization and nationalization is wrong. In the food sector, there is no government restaurant or
carinderia corporation, no government supermarket or talipapa, all such shops
are private, and people are eating. Compare that in healthcare where
there are about 40,000+ barangay health centers, hundreds of provincial, district
and city government hospitals, dozens of DOH hospitals, dozens of hospitals
from other agencies (AFP hospital, PNP hospital, Veterans hospital, UP-PGH,
etc.), there are thousands of government pharmacies (Botika ng Barangay, Botika
ng Bayan) there is drug price contro policyl, mandatory discount for senior
citizens, there is government health insurance monopoly, etc. And healthcare problems are expanding, not
declining.
Repeated statement and plea of "not
enough public spending on healthcare" is wrong. Maybe they can talk of
"not enough PGH budget" as the story above has illustrated and that
is true. But overall, nationwide, public healthcare is among the heavily
budgeted, and most probably, heavily wasted sector.
There are lots of government spending on
healthcare already via (1) DOH, P53 B this year alone, (2) PhilHealth with
P100+ B in reserve funds alone, (3) LGUs, from provincial health centers and
hospitals down to barangay health centers, (4) other agencies' spending like
UP-PGH, AFP hospital, PNP hospital, etc. (5) Health spending by different
agencies for their personnel and their respective dependents, and
(6) PCSO and PAGCOR support, indirectly through LGUs’ and DOH hospitals (usually
free ambulance, mobile clinics) or directly to patients in the form of
hospitalization cover.
When I was working at the House of Representatives in the 1990s, our healthcare protection was OA. Consider this: (1) we have PhilHealth membership with huge employer (HOR) contribution, (2) we have private HMO, Intellicare at that time, I don’t know now, and HOR is paying for the annual premium of all employees, and (3) we have a medical and dental office right at the HOR with full time doctors, dentists and nurses, with free basic medicines, etc. All this spending for healthcare by the HOR for its officials and employees is not counted as “public health spending” but “legislative spending”.
So when the WHO, ADB, WB, UN, etc. would say that the
Philippines’ health spending / GDP ratio is only 3% or so, they are wrong, the
numerator they use – DOH spending, PhilHealth disbursement, estimated private
sector spending, etc. – is understated. They miss health spending by all other
government agencies, local to national, that are not included in the numerator.
---------See also:
Healthcare Competition 8: Centralization vs. Deregulation of Healthcare, December 31, 2011
Healthcare Competition 9: Deregulate Further the Supply of Healthcare, August 25, 2012
Healthcare Monopoly 6: Cuba Socialism, January 14, 2013
Healthcare Competition 10: Alternatives to Government Health Monopoly, February 06, 2013
