The following is a speech I gave at the Association of Health Administrators in the Philippine Government Service (AHA) Annual Convention last November 20, 2012 at the Heritage Hotel, Pasay City
To our medical directors and hospital administrators from our local and national govt hospitals led by AHA President Dr. Edmundo Lopez; Governance Commission for GOCC General Counsel Atty. Jaime Oracion; Former Marikina City Mayor Maria Fernando; Makati Medical Center Foundation President Ms. Conchitina Sevilla Bernardo, Dr. Julie Cagyat of the Community Medicine Practitions and Advocates Association, friends and guests. Magandang umaga po.
It is an honor to be invited to your annual convention. The issue of health and the state of our healthcare system, epecially our public hostpitals, is one of the main platforms of my party, Bayan Muna, and an advocacy very close to my heart.
I have been working with many organizations of health professionals and community health workers in crafting and pursuing a progressive legislative agenda in the House. I am a member of the Health Committee of Congress.
As many of you probably know, a substantial portion of our PDAF goes to our public hospitals to assist our indigent patients.
Since last year, we have expanded our efforts to helping our barangays in upgrading the equipment and facilities of our barangay health stations.
In my eight years in the House as a representative of the poor and marginalized sectors, the health issue has been a major, major concern. Every year, I have been the most stringent in demanding a higher budget for the DOH, especially our state hospitals. Sa isang budget hearing nga binatikos ko pa si Sec. Ona for accepting like a meek lamb the P38 billion reduction made by the budget department from their original request of P80 billion. Sabi ko, okay lang ba yan? Eh ok lang daw.
Among the top issues when we talk about public health is the state of our public hospitals, which play a very important role in providing free or affordable medical services to the poor. This is especially so in the Philippine context where the out of pocket expenses for medical services is among the highest, if not the highest, in Asia and possibly the world.
Let me be frank about this. In my visits and our constant dealings with public hospital patients, employees and administrators, the inevitable conclusion is that our public hospitals are as sick as their patients. Our hospitals lack medicines, facilities, equipment and health workers, gravely affecting the delivery of medical services to our patients.
Why is this so? Mainly, I think its a problem of the inadequate budget that is being provided by the government. I don’t buy the argument that our public hospitals are inherently inefficient. You can only be as efficient as the resources at your command. In the case of our hospitals, they can’t provide the services expected from them because they are not provided the resources to do so.
No once can deny the declining share of hospital allotment to the total DOH budget. From 60 to 66 percent in the years 2003 to 2006 (according to a study by Lavado in 2010), the share of our hospitals is now down to only 21.42% for 2013. Hindi pa po natin pinag-uuspan dito ang naganap na devolution noong 1990s na mas matindi pa ang naging pagliit ng budget ng mga devolved hospitals.
Since 2010, halos tinanggal na po ang capital outlay sa budget ng maraming public hospitals na administered ng DOH. Hindi pa rin pinopondohan ang mga mandated Magna Carta benefits ng ating mga health workers at propesyunal.
Ano ang solusyon sa maliit na budget? Eh di lakihan ang budget. If government can spend P45.3 billion a year in dole-outs to the poor – ito po yung conditional cash transfer na namimigay ng cash ang gobyerno sa mga mahihirap – siguro naman it can spend P20 billion for our public hospitals who cater to the same poor families.
But instead of substantially increasing the health budget, government has resorted to devolution, corporatization and privatization via public-private partnerships to address the problems of lack of budget and its resulting inefficiency.
What are our experiences on these policies? From where I stand, it doesn’t appear good.
The devolution of our health services under the 1992 Local Govt Code has, as one doctor I spoke to put it, “battered our hospitals.” The constant feedback I’ve been getting is that devolution has worsened the lack of facilities, equipment and supplies of our hospitals as well as the lack of job security, low benefits and salaries given to our health workers. There might be success stories, no doubt. But these would be the exception rather than the rule.
In fact, there is a very strong clamor among the LGU health workers for health services and manpower to be reverted back to the national office. Naiinggit daw sila sa mga teachers sa ilalim ng DepEd na hindi na-devolve and are now getting uniform salaries and benefits.
One mayor put the problem very simply – when the national government devolved the function of health services to the local governments it forgot to devlolve the budget.
With regards to public-private partnerships, well, this is not a new thing and has already been implemented in various public hospitals. Did these help the hospitals and patients? Based on the 2010 COA findings, the revenue sharing scheme entered into by at least 4 public hopsitals were found to be disadvantageous to the government. In effect, it prevented the hospitals from the benefit of earning additional income from the said scheme. This is on top of the fact that previously free hospital services like xray and laboratory procedures for poor patients now require them to pay. But of course, most hospitals have to bite the bullet. Kung walang pambili ng dialysis machine or laboratory equipment na talaga namang kailangan ng isang ospital, then of course outsourcing would be the alternative.
How about corporatization? As you know, I am opposed to the measures now pending in Congress to convert the 26 DOH-administered tertiary regional hospitals into government corporations. More than anything else, the objective of corporatization appears to be to ensure fiscal autonomy and facilitate public-private partnerships.
Stripped to its essence, corporatization is meant to equip the hospital management with the structures and mechanisms needed to raise revenues to make up for the small budget coming from the national government. In other words, it is government’s solution to the dwindling budget for state hospitals.
What is our experience with our existing GOCC hospitals? In fairness to them, they are trying to serve the indigents despite the very limited government subsidy. But what happened? (1) government subsidy further declined; (2) needed facilities and equipment could not be procured, in fact PHC and PCMC are requesting our intervention as congressmen for additional govt subsidies; (3) so many indigent patients could not be accommodated or operated on because patients could not afford the patient share or because facilities that could otherwise have been used by indigent patients were being used to service paying patients. In fact, corporatization has been used to justify cuts in government allocations.
Basically, my main concern with this rush to corporatize our public hospitals and enter into PPPs is the impact on the cost of hospital services and health care in general. Even Sec. Ona in previous budget hearings have admitted that the enrty of private corporate entities in the system will raise prices. Pero may Philhealth naman daw so okay lang.
However, in my dealings with various public hospitals, I have been repeatedly told that Philhealth patients account for less than 40% of patients. So any increase in rates will most likely still come from out of pocket expenses of the patient and his family.
Is there another solution to the problem? I think there is. Our proposal is the following:
One, bigger allotment for public hospitals. I can’t see why P12B in public funds should still be poured into Philhealth next year when it has reserve funds of more an P105B and still growing by the day, especially with its planned 100% increase in premiums. The proposed P12B budget for PhilHealth should be realigned to public hospitals instead, which will benefit all indigent patients and not only the 5.2M households targeted by DSWD, many of whom will not avail of their benefits anyway.
Two, the allotment of at least P3B for Magna Carta benefits of health workers in the GAA. If we want to professionalize our health system, we should treat our health workers as professionals as mandated in the magna carta.
Three, we should create additional plantilla positions especially for nurses with adequate funding for Personal Services. While the RN HEALS appear good on paper, in fact it reduces our nurses to mere trainees and providers of cheap labor.
Four, government should heed the recommendation of the WHO that 5% of GDP be allotted for health to provide for adequate supplies, medicines, equipment and health workers for better services to the people especially the indigents.
Do we have the funds to do this? I think this is a matter of political will. As I said, government will spend P43.5 billion worth of dole outs and P8-10 billion worth of pork barrel for congressmen and senators next year. Ano ba naman ang bawasan ito ng kauanti para sa health sector?
The direction public hospitals should lead to is to provide the best services we could offer to our patients, especially those who are poor and marginalized. Quality and excellence is not necessarily the domain of the private sector. Public hospitals and the government can also attain this.
I remain hopeful that since your hearts as physicians beat for the health and lives for our patients, we can see through our patients suffering from the high cost of services in our public hospitals, which even our PDAF could not fully cover.
If we work together, along with our health workers and patients and the rest of the Filipino people for an adequate health budget, we can move closer to our goal of truly and fully serving our people.
I am on my last term in Congress but rest assured that whatever happens next elections, whether I make it to the Senate or not, you will always have a friend and fellow advocate in me.#