Below is an excerpt from a note we wrote after a discussion with a fast rising local government executive, sincere in his desire to serve his constituency, and aware of the problems happening in many local government hospitals. There is a lot to learn from public hospitals in the Philippines that are run well in the service side and the finance side, and we have to accept that the two cannot be separated:
We got to reflect about our exchange of concerns on government hospitals. We try very hard to be frank, as it is one way for us to help our local government partners succeed. It is no exaggeration that success in health care governance in any part of the country is good for us, Sunfu Solutions.
Many politicians, great, or good, or just plain bad, think of the poor, the poorest, and instinctively, they want to give them health care for free. What can be more gratifying and popular? I agree 100 percent although our General Manager’s former classmate in PGH, now head of finance in PGH (a very bright eye specialist) would say that her biggest frustration is many politicians have spoiled us Filipinos so much, people are not willing to shell out even P100.00 for the P100,000.00 service and medicine they got. People do not realize that good health care systems in the world rely heavily on its capacity to gather funds from patients so that the system could renew itself, without exploiting or over charging patients. To be able to communicate this to the community is the biggest challenge.
Outside the physical office of any local executive are some of the most trusted civil servants of any given local government executive. Is the policy for these city hall employees “free everything” or “they will get their Philhealth, some discounts, but will have to pay something within their bracket, even salary deductions spread out for the year.” Actually, the biggest consumers or users of local government hospitals are city hall employees, and in two cities we studied closely, we have seen that eventually these city hall employees in these two particular cities had relatives, distant relatives, uncles, cousins, in-laws, in-laws of their in-laws, even those who are not residents of the city, using all the hospital facilities for free. We have seen city parking attendants ask their relatives to come to Manila from far-away provinces for CT scans, said to be great diagnostic machines that must be taken advantage of, even if not needed. As we had suggested to a local official trying to serve well, that he and his family should use the facility the government built for something like their executive check-up, and to make sure they pay the fees, just to get the message across that this is cheap, good, even great service, but it is not absolutely free.
In two cities we had observed and we love to cite as examples, they made an “ADMIT ALL” policy of allowing anyone who comes in to be served for free, especially if they drop the right names. The hospital cashiers always ask for the minimal payments for services rendered, but many people are already “trained” that just dropping the right names is enough. “I am the nephew of the barangay captain, and he said I should not pay.” But this will bleed the city, when hospitals can now actually earn money. The simple point is Philhealth can be a great opportunity for hospitals and patients, but a hospital and patients need more than that, as public hospitals need to educate the communities about their responsibilities as well, as patients want a sustained and sustainable public health system.
The next challenge is to find and retain good doctors, not just a good medical director. To have a pool of good doctors, retain them, or even have them give up their private practice, needs a dynamic earning ability of the hospital, and a good working and serving atmosphere. With the Bureau of Internal Revenue harassing medical doctors, not realizing this is one of the few countries in the world where doctors become nurses in order to work abroad (not everyone has a practice, and business, like dermatologist for the stars Vicky Belo), there are genuine possibilities of attracting great doctors to serve full-time in government hospitals.
In the end we believe a hospital can and must earn, while serving well all its various constituencies, especially the poorest of the poor. But if we start with “ADMIT ALL,” and “Free for ALL,” we don’t believe any hospital can survive and unfortunately, once these very generous and flawed policies are in place, they are difficult to reverse.