Rizal Philippines
December 20, 2015
We celebrate Christmas in 4 days. Merry Christmas
Will the govt invest in preventive health care?
An accident proved to be very costly
But many will not be happy due to the sad state of health care costs, access, and availability in the Philippines.
Several years back, as I was teaching health professionals in their elective for MBA, I met an accident and had to be operated in a well known hospital in MM. I was attended to by no less than the chief of the hospital (what an honor) but my hospital bills ran up sky high. For two days and the operation (the surgeon and the anesthesiologist were free!) and the initial ER admission, the hospital bill ran into 6 numbers. It was good I had a credit card; (no health care yet as part time professional as a teacher in the school) The rates were definitely way way up ever since the hospital built a new building and revamped its image. It was sort of absurd and paradoxical because the CEO of the hospital who oversaw this jump in their tariff, was also mouthing lower drug costs (through the Generic Law) and nation building in the school where he leads and I follow.
Hospital acquirers are after ROI
Now as JCI accreditation were achieved, as one hospital after another were acquired by conglomorate, and as monopoly is achieved, the hospitals are bent on raising their rates, much to the discomfort of most sick people. The health professionals want also to recoup their huge investments in their education and training, thus some think of exorbitant rates for their procedures, or unhappy with low 5 digits earning More and more the cost of health care is becoming un affordable, and something must be done about this.
This has bothered me to no end. While I strive to make our price and costs in our business reasonable (as I learned in Japanese system of managing - lower costs means more sales and more competitiveness) most of health care facilities were increasing their costs (to attract MDs and buy state of the art facilities to serve medical tourism) the price of health care went up. (Except those which were reimbursed by Philhealth like delivery: natural and CS
Many scholars and experts on health care noted the health care system in the PHL to be largely unregulated with about 70% working in the private sector. No one controls the rates, pf and other costs related to health care although this has large impact on the society and economy. It looks absurd? Yes? The multinational pharrmas with the their agressive and innovative marketing campaigns pay for the trips of MDs abroad, and their conferences and banquet. Cant they be stopped to bring down the cost of medicine. Are some of our govt regulators at the payroll of the pharmas?
Pharmas in India cant do much to blunt govt efforts to bring down the cost of the medicine.
Why Indias Cheap Generic Drugs are important
India cant continue supplying cheap drugs to the world due to TRIPS of WTO
India cant continue supplying cheap drugs to the world due to TRIPS of WTO
And some facilities are escaping DOH regulation by naming their ER something else (urgent care centers?) And in one health facility being filled up for medical tourism the rates for rentals are high and unbelievable, and with those costs the rest of the rates in the country are affected.
I said something must be done about this. To address this, since I can not put up low cost hospitals
1. I created a blog which has a rather large number of page views. Cheapcures This is about preventive medicine, other points of view about Western Medicine. and various diseases like heart disease, cancer , GERD, how they can be prevented and treated cheap. There are features on food, nutrition, herbal medicine, and exercise
2. I talked to various health professionals who are students on MBA on how we can address the escalating health care costs:
1. I had 3 EENT and one class, and convinced them to write a paper on P5 cataract operation. It was just a business plan, and since the 3 were the brightest perhaps in the country, they cant agree to implement this. I wanted them to benchmark Dr. Vs Aravind hospital in India which does $5 eye cataract operation with lens for most of the poor people of India. Millions have been benefitted by this venture. All that it required were principles of economies of scale, lower costs inputs, (as employing high school girls as nurses) and some assistance from NGOs and foundation. And the passion to do it.
2. I had a GP surgeon in Tarlac try out a P1t fee for dialysis. In India, Dr Devi Shetty of Narayana hospital offer and charge only $10 for a dialysis. It costs P3,000 at the minimum. While Philhealth covers 90 days of such a procedure, it cant cover an individual for the rest of his life (since dialysis is for lifetime for someone who has kidney failure) It is simply unsustainable. Why can Dr. Devi Shetty do it. I wonder if the good doctor from Tarlac was able to do it for the good of his community, or whether the paper he did was for his MBA requirements only
3. I talked to the former Sec of Health, who was a classmate in college, and with whom I worked closely with in a school paper in college. I tried to talk him into the idea. I understand, after he finished from Med School and became a doctor, he became a doctor to the boondocks (some say he helped treat the cadres wounded in encounter with govt forces) Well he talked to me and that was the end of it.
4. I met frequently with a group of MDs who wanted to build a hospital in our town, but later scaled down their dream to an ambulatory center and lately back to diagnostic center. What I found out is that investors, and professionals will always go for the opportunity/money. I have talked to many of them, and advised them freely (gratis et amore) but will not reciprocate if I will seek their medical service. Unfair hindi ba?
Of late, I have a student who will run a hospital for a gentleman in the Queen City, a 300 bed hosptial whose mission in life resonates with this author. I said we will talk about this.
I have a cousin, who runs a clinic and who plans to have affordable birthing center in both MD and midwife assisted delivery
In my travel to Thailand, I had the opportunity to talk to a doctor who spoke freely on Thai Health Care. For only 1,200 baht a year, a Thai can be admitted into any hospital 3x during the year, paying only 30 baht. That is what you call real affordable health care. They were able to rationalize deployment of resources as medicines and manpower through computerization (applying principles of good management
Future of Universal Health Care in the Phil by Ramon PedroPaterno - SSS must reform its first peso policy
However, the funds ran out due to lifestyle diseases, so the govt had to invest in preventing lifestyle diseases
Is anyone out there interested to help our country men live healthier and longer
Full text on some of the conclusion on health care study by Asian Scholar on health care situation in the Philippines and these be taken note of as we address the issue of lower health care costs in the country
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Pdf from Asian Scholarship Org
It has also been noted that the public health reforms focused mostly on municipal facilities. As a result, there is a need to secure the link between centrally and locally provided public health programs. Changes in a community’s health status invariably lead to changes in health care practice, which may also require changes in health financing mechanism and their organizations. Sustainable financing schemes to allow patients to have access to health services and essential drugs, particularly for long-term care should be put in place, particularly for indigent population and near poor population quintiles. Health Poverty and Equity Mechanisms in Philippines Dr. N. Ravichandran ASIA Fellow Therefore, action to prevent these diseases should focus on controlling risk factors in an integrated service delivery as the most appropriate way to provide services in a cost-effect manner to address the health care needs across the care continuum. The country with minimal resources for health care, the cost of treating these catastrophic diseases felt to be enormous and could drain vital resources as well their controls entails a different public health approach. Intervention at family and community levels is essential for prevention because the causal risk factors are deeply entrenched in the social and cultural framework of the society. A supportive environment for behavior change that can provide material, human and political resource to promote, adopt and maintain towards healthy lifestyle should be created.
Changing values and rising expectations
The present study noted that poor integration of health sector reform activities and programs in the convergence sites – BFAD and BHDT, especially at local government unit level and provincial level. Activities to ensure presence of accredited drug retailers and medical equipment through the so-called BFAD and BHDT quality seals have been notable absent or non-functional at the convergence sites. This escalated the drug and medicines costs and constitutes 46.4 per cent of total household expenditure for medical care. This has resulted in highly inequitable situation where more than a half of the Filipinos lack access to essential drugs for catastrophic disease. Furthermore, 42.4 per cent of the respondents stated that they given up the care and follow-up care due to the high cost for treatment. This shows that people are unaware of the full scope of health system that creates inequalities. What is more alarming in the Philippines is the fact that local drug prices are in the range of two times to as much as thirty times higher than in India or other neighboring Asian countries. However, while people’s knowledge on the drug and medical related topics may be partial, the present study showed that respondent regard social gradient in health as profoundly unjust, on the one hand. This shows the level of regulatory exists, on the other hand, and forces the system to focus on strengthening the regulatory mechanisms. Furthermore, due to intensive lobbying and massive marketing campaigns; promotion, gift-giving schemes and advertising targeting mainly towards physicians and pharmacists on the part of multinationals; and concentrated monopoly in the drug procurement and distribution, the Generics Act (RA 6675, 1988), was enacted to promote, require and ensure the production of an adequate supply and distribution of essential drugs, failed to remove the cloud of doubt over the perceive inferior quality of local generics, thus consumers continued to patronize branded over generic products, despite the price differential. In addition to these efforts, the government created Botika ng Barangay /Botika ng Bayan networks for drug importation and making home remedies available in National Food Authority rolling stores so as to make quality drugs accessible to the country’s population, particularly poor, is still a dream. The health care market in the Philippines are competitive and in the unregulated, fee for service payment system, providers are able to maximize profits by increasing volume, use of high cost technology and intensive resource use, increasing the overall cost of care, necessitating designing of alternative system of financing health care that would have incentives to contain cost. ASIA Fellow observed that about 63 per cent of Botika ng Barangay and 31.5 per cent Botika ng Bayan (out of 660) are non-functional and also noted that ‘poor pharmacist’ who lacks enterprising skills constitute only four per cent of the market. This fueled in sustained increase in the essential drugs and medicines prices, which are no more affordable to poor or near poor population. This calls for strong regulatory mechanism in delineating the various roles that different stakeholders play, ranging from the supply side to the demand side, in terms of production, distribution, regulation and financing, ensure support across the whole spectrum. 26 Health Poverty and Equity Mechanisms in Philippines Dr. N. Ravichandran ASIA Fellow Devolved health Service Delivery: Unclear Mission Field experiences and discussion with both public and private key stakeholders revealed that national and local governments are at times unclear on the operational definition of ‘devolved health services’. The perceived exclusivity of devolved health services as a local government unit does not conform to certain service delivery functions of Department of Health. This vague characterization of ‘devolved health services’ at times becomes the source of misunderstandings and conflicts among national, provincial and municipal health facilities and the private as well affecting the overall effectiveness and efficiency of the health care delivery system. Thus, the integration of public health and hospital program has remained weak. The lack of integrated framework and mechanisms has largely contributed to this condition. As a result, the efficient and effective use resources both for clients and providers are not fully maximized. This decreased in spending for public health programs from 14.4 per cent in 2000 to 10.1 per cent in 2005. Conversely, a large share of government budget goes to tertiary hospital care (only to 72 hospitals). The double burden of diseases from infections and degenerative diseases has overloaded the health system, draining resources for health. The lack of fund becomes more evident in the low quality or unavailability of medicines and supplies in the government health facilities, the prevailing deterioration of equipment and facilities, and the migration of trained and capable health workers to other countries. These are factors greatly affecting the delivery of quality services to the people. These in turn have created social inequality and tensions that affected the legitimacy of political leadership. Nevertheless, on the whole, the system needs to work for the common good, to do this well and with foresight. The core values articulated by the primary health care movement three decades ago – the values of equity, integration of the system, community participation and comprehensive care are still considered to be radical by many stakeholders. Today, these values have become widely shared social expectations for health that increasingly pervade many – though language people use to express these expectations may differ from the Alma-Ata. It opens fresh opportunities for generating social and political momentum to move health systems in the direction of people, particularly who are affected with catastrophic diseases, want them to go. This calls the system from a purely hospitalization treatment perspective focused to financing mechanism to include political consideration on the social goals that define the direction in which to steer health system.
Health financing as brokers for health reform
Philippines’s social health insurance is considered as ‘prospective’ financing where funds are pooled in advance, mainly in the form of regular contributions from insurance fund members, employers and the government. It addresses inequities in health financing where ‘healthy pay for the sick’ and ‘those who can afford medical care subsidized those who cannot’. The review of health financing mechanism in the Philippines noted that PhilHealth’s membership has reached about 62.7 per cent in 2009, a decline from 81 per cent in 2004 achieved due to political vote gains. Despite many achievements, PhilHealth faces few challenges, first, in ensuring its members with highest financial risk protection and the highest standards of quality in health care. Second, none of the designated convergence sites have reached the 60 per cent enrollment target indigent for social health insurance scheme. Focus has been made on the enrollment under the indigent programme but the expansion of enrollment of individually paying members remained to be a gap. Sustaining the indigent programme, with the devolution, PhilHealth finds difficulty in looping local government units which do not see health as a priority plan. Education of local unit in addressing and supporting the catastrophic diseases and building the local units capacity is the need of the hour. 2
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