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Tuesday, September 13, 2005

Understanding Nation Building (Part 6)

We continue with our series on Understanding Nation Building. This is part six in our series and is an analysis/comment on the Blueprint for a Viable Philippines proposal.


On Heathcare

Blueprint recommendation: Reverse the decentralization of the primary health care delivery system, and install a real social health insurance system that improves people’s access to health services under affordable payment schemes. The government will prioritize three programs: (1) control of longstanding communicable disease problems (TB, malaria, leprosy, and HIV) as well as emerging new diseases; (2) immunization of all children against the major childhood killer diseases; and (3) reproductive health and family planning. Free up resources that can be used to rehabilitate government hospitals as well as to fund priority health programs. Form local health boards that can tap the participation of local communities in the provision of health services. Most urgently, the government will respond to the scandal of large-scale malnutrition by launching an extensive and sustainable feeding program of starving families throughout the country. Reduce the cost of medicines through price controls in the short term and through the expansion of domestic self-reliance in pharmaceutical production, in the long term.


Big Mango


I have some on the ground expertise on this since on both sides of my family has been in the heathcare business as practitioners or suppliers for the last two generations. In the past five years, I've had the opportunity to be immersed in this business, to walk both government and private hospitals to see the human condition on the patient and on the medical practitioner.


Blueprint suggests that we should reverse the decentralization of the primary health care delivery system. I simply do not know where they are getting this, since we don't have a decentralized primary health care system.


Government hospitals across the country rely on oversight and appropriation from the central office in Manila. In fact, the only decentralization that occurs is the managing of the day-to-day business--- everything else is decided on top.


Let us take Jose R. Reyes Memorial Medical Center. This is the flagship of the Department of Health. It is located just right beside DOH. Its daily business is doing all right, the money is properly managed, meaning bills get paid, some infrastructure development occurs through initiative from its management team. And amazingly enough, the officials are dead serious in their business and do no monkey business, which is the exception these days rather than the norm.


Let us take the Philippine General Hospital. Same case, the management team is doing an excellent job, given the resources at their disposal. I know for a fact that they are making money even with the charging they do--- because of sheer volume. How do I know this? Because we entertained business with them a few years back and I had the opportunity to see just how good business is.


Why are these hospitals not getting enough? In the first case--- at Jose R. Reyes Memorial Hospital, they only have enough to run the day-to-day affairs, and a wee bit on infrastructure development based on creativity by the management. In the second case, the money of the Philippine General Hospital is limited to the budget of the UP System, thus, when the time comes for budgeting on a national level, if UP's budget get slashed, PGH even gets a smaller bite of the pie, for obvious reasons.


Now we look at our patients. Most of these people don't have money. Some do. Some can't afford to pay the entire bill. What are we going to do with these people? Hospitals need to pay bills and improve infrastructure, and where are they going to get this money?


Blueprint rightly suggest on a method--- a national insurance system. But how can you ensure someone who have not worked, as most of these people have not contributed to the national system? Is this fair to the millions of office workers, I'm not talking about the rich businessmen who can afford paying. The Ordinary office girl, the messenger, the Security Guard, the sales man--- these people pay bills and pay the national insurance system, SSS or GSIS, the PhilHealth and the Home Development Corporation.


First off, the ordinary workers are already doing their contribution. Thats good. Here's my proposal, Local Government should foot the bill for those people who are indigent based on local statistics, and initiative and provide “a health card” for those indigent patients. This way, indigent can be determined by local social welfare and who knows they can determine other ways to help lift these people out of their predicament.

The problems of healthcare may be solved by devolution and perfect when joined with the idea of Federalism. This way, local governments healthcare officials can determine what kind of resources they need and meet them. Looking at it from a macro point of view isn't perfect. Each region, province, town have different needs. This way, proper resources can be delivered to them.


At the end of the day, the proper delivery of services will be determined by the proper management of what we have but never at the expense of people who pay for proper insurance however, we proper delivery of healthcare should also take into consideration the plight of the indigent.


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