Providing health care with an emphasis on 'care'

Hospitals and doctors have not had an easy time in Pinoy pop culture. From Lino Brocka masterworks to telenovelas, they’ve been used as an example of social injustice in the Philippines. Witness the standard scene in which the hero rushes to a hospital emergency room carrying a desperately sick woman, only to be turned away by the heartless receptionist because he can’t afford to pay a deposit. How did the medical profession become a stock villain in Tagalog tearjerkers?

“A lot of patients do get turned away at some hospitals,” says Dr. Cerissa Lynne Cruz Arroyo, medical administrator for Corporate Clinic Management and Occupational Health and Health Promotion Services of MEDICard Philippines, “because the hospitals don’t have the resources to treat everyone.”

MEDICard president Dr. Nicky Montoya gives this example of the situation at an unnamed hospital. “For instance, a patient required a frozen section, which is like a biopsy during surgery. When the surgeon got the sample, he called the watcher who was minding the patient and told him, “Take this and run to this institution (neighboring hospital), they have the frozen section.” So while the sample is brought to another hospital, the doctors do their rounds and the patient has to wait until the results come back.” This takes hours. Only then can the doctors proceed with the surgery. 

“One government hospital has its own laboratory,” Dr. Montoya adds, “but at one point the budget ran out and they could not buy the reagents they needed to conduct tests. So the patient would have to have the tests done outside the hospital.”

In this hospital where both doctors trained, they were accustomed to seeing patients who came to the hospital only when their condition had become serious and they were too far gone. “They were afraid to admit that they were sick, or they were afraid of doctors,” he says. “Before they consult a professional they try all sorts of pop remedies.”

As for the stereotypical heartless physician, Montoya notes that while there are doctors who overcharge ridiculously, there are also more who take their oath seriously and work for the good of their patients.  There are, in fact, government hospital doctors who have to bear the burden not only of treating the patient, but also of providing for the patient’s supplies and medication. “You write to charitable institutions yourself to ask for funds for the patient. You play Robin Hood. If a patient seemed to be well-off and he needed two bottles of intravenous fluid, we would ask him to buy four. The two extra we would save for indigent patients who couldn’t afford to buy their own.”

“Health Maintenance Organizations (HMOs) are helping government fulfill their responsibility of providing health care to people who can’t otherwise afford it,” says Dr. Arroyo. “The HMO is a mechanism for making health care affordable and available.”

What is an HMO and what is it good for? “An HMO is similar to an insurance company, except that you can use your card to avail of medical benefits,” Dr. Montoya explains. “You have a network of doctors you can consult. The HMO can tell you whom to go to, where to go, what to do. You can use your card at a hospital or at our network of clinics.

“If a cardholder feels unwell, he can go to our MEDICard coordinator at any hospital. He gets a check-up, and the doctor tells him what he needs to do—whether he needs to have tests done or to see a specialist or to get admitted to the hospital. If a specialist is required, our doctor will give him a referral. So the process is logical and organized. With insurance companies you’re on your own, they just reimburse you for your expenses.”

Getting health care for yourself and your family is a quick and easy process, Montoya adds. “With an HMO you can enroll and get the card today, and tomorrow you can get a check-up. We’re making it as friendly as possible. Our website can accept applications and payments.”

MEDICard has the advantage over other HMOs of being run by doctors. A pioneer in the HMO industry, MEDICard was founded in 1987 by a group of distinguished physicians. The founders, led by their first president Dr. Nicanor Montoya (father of the current president), were concerned that most Filipinos, even those with jobs, could not afford quality health care. The Philippine economy had been battered during the last years of Marcos rule: the cost of medical care had risen, but incomes had fallen. If a family member fell ill or had an emergency, there were no funds for hospitalization and medicine.

 There was a desperate need for affordable health care. The elder Dr. Montoya had a simple solution. If a person could set aside just P3.00 a day, he could afford health care.

 MEDICard was born of this simple premise. The goal of its founding doctors was to provide quality comprehensive health care services to as many Filipinos as possible, at a price they could afford.

 The following year they began marketing the MEDICard scheme. Recruiting members was slow until the founders realized they could reach more people faster if they enlisted companies that employed large numbers of people. Company executives quickly saw the advantages of the HMO, and made its benefits available to their rank and file. By 1990 MEDICard had opened offices in Cagayan de Oro, Cebu, and Davao.

 “This is what makes MEDICard different from other HMOs,” Dr. Nicky Montoya points out, “the fact that it is prescribed by doctors and run by doctors.” Having medical professionals in charge means MEDICard is more aware of the changing needs of its clientele as well as the latest developments in medical science and the health and wellness industry. It is more service-oriented. “MEDICard has taken the lead in providing innovations that reduce the cost of health maintenance without compromising quality,” Dr. Montoya adds.

 MEDICard provides a comprehensive health care program including emergency care, hospital confinement, preventive health care, dental care and out-patient consultation services. It guarantees all the member’s medical expenses, including hospital deposits.

 Today MEDICard has about 500,000 members, two-thirds of them from member companies. It has a network of more than 500 hospitals and clinics and 10,000 doctors and dentists nationwide.

 Still, a lot remains to be done before every Filipino can avail of affordable quality health care. Health care is simply not a priority of most Pinoys. “Economics has a lot to do with it,” the younger Dr. Montoya avers. “I think Pinoys would rather buy cellphone loads than save money. We still prefer to deal with health care expenses out of pocket. It’s not in the culture, I guess.”

By his estimate not even 10 percent of Filipinos are covered by insurance or HMOs. PhilHealth, which employers are required to provide for all their employees, is a form of government HMO, but its coverage is limited. Employers are not mandated to provide health cards, with the exception of BPOs and call centers. “Anything preventive is difficult to sell,” Dr. Arroyo notes. “And the services we offer include preventive health care.”

Apart from its HMO service MEDICard also manages corporate clinics, operates its own outpatient clinics, and offers TPAs (third-party arrangements) for member companies. “Companies don’t have to pay a premium, we just manage the availment of our health care network,” Dr. Montoya explains.

 “Some major companies have always run their own clinics. They accredit selected hospitals and open credit limits with these hospitals. If an employee gets sick and goes to one of these hospitals, the company pays for the hospitalization. There are terms, the company only covers until a set amount, but basically the company has to keep track of the employee’s health benefits. So part of the company’s Human Resources has to be involved in medical concerns. They employ doctors to evaluate what ailments the company has to cover and so on.

 “Instead of the company having to devote an entire department to taking care of the employees’ health benefits, they can outsource it to us. You will still pay for the employees’ medical care, but we’ll advance it for you. You don’t have to pay a premium, just an access fee—a minimal revolving fund.” For TPAs the risk lies with the employer, for HMO the risk is passed on to MEDICard. MEDICard also operates ten standalone clinics in key cities.

 “A lot of the negative ideas about HMOs come from what people hear of American HMOs,” Dr. Montoya declares. HMOs in the US are different from the local HMOs. “What they do is, they assign a doctor and pay him, say, US$100,000 for the year and assign 1,000 patients to him. That amount takes care of all the bills for all the 1,000 patients. Whatever is left, the doctor keeps. So the doctor scrimps on the treatments in order to retain a larger part of the fund.”

MEDICard operates differently: doctors are not given a set amount, but are paid each time a member consults them.

“When my father started MEDICard his idea was to make health care more affordable,” Dr. Montoya says. “A lot has changed since then, but our goal is the same. When our members require medical attention, we take care of everything so they don’t have to worry about money. All they need is their MEDICard ID.”