Catastrophic hospitalization

After reading about  my three days in the ICU, a good friend sent me this email to share her family’s catastrophic experience with a private hospital:

“When my father recently suffered a stroke and was hospitalized, I saw firsthand the systemic failures that every Filipino family faces when serious illness strikes. So let me lay them out clearly, with the hope that this message reaches those in power.

#1: Outdated PhilHealth policies that undermine the spirit of UHC. When a patient is confined for an extended period due to a stroke and develops complications, the current policy is shockingly rigid: PhilHealth only pays for the illness with the highest case rate, ignoring all other treatments.

Imagine a stroke patient who also develops pneumonia and undergoes catheter placement, tracheostomy or dialysis. PhilHealth will only pay P76,000 to P80,000 – the case rate for stroke – even though each of those procedures has its own case rate. For long-term hospitalization of over two months that could cost P3M-5M, this is a devastating blow, similar to the experience of Supreme Court Justice Lopez, who revealed that PhilHealth covered only P50,000 of his P7M bill.

The Philippines has one of the highest out-of-pocket (OOP) health care spending rates in Asia – 45 percent, compared to the global average of 16.3 percent, Indonesia’s 28.6 percent and Thailand’s 7.7 percent. In our case, we didn’t just pay 45 percent; we paid 98 percent.

PhilHealth benefit packages are still grossly inadequate for catastrophic illnesses. What if PhilHealth allowed multiple condition claims and simply capped the total benefit – say, at P500,000 – to prevent abuse?

The PhilHealth circular no. 0031, S. 2013, specifically highlights that for patients with multiple medical conditions, co-morbidities or requiring multiple procedures per confinement, PhilHealth shall endeavor to pay for all admissible medical conditions and/or procedures subject to the limits as set by the PhilHealth Board. Therefore, the Board has the authority – it just needs the will.

#2: Fragmented, bureaucratic and politicized medical assistance. Financial assistance is technically available – from PCSO, DSWD, senators and congressmen. My family reached out to 44 legislators, submitting letters, medical abstracts and bills. The fastest help came from PCSO, which issued a P100,000 Guarantee Letter (GL). DSWD  couldn’t issue a GL because the hospital required an endorsement from a politician.

Why should access to taxpayer-funded assistance depend on political sponsorship? I’ve paid taxes for over 20 years. If I had kept that money, I could have paid my father’s hospital bill in full. None of the legislators we contacted could help.

Some said they only assist patients in government hospitals. How ironic that the private sector, which funds the government through taxes, is left to fend for itself.

A truly pro-patient system would be centralized, equitable and timely. Why not allocate these funds directly to PCSO or DSWD? And instead of forcing patients to line up at DSWD or wait for PCSO’s online slots to open, why not remove the 12 percent VAT on medicines and supplies?

Why not automate GL issuance through an integrated network? If a patient has a DSWD case file, they should automatically qualify for assistance – no political endorsement needed.

#3: Exorbitant price markups by private hospitals on medicines and supplies. Hospitals are not charities but when they charge patients three to 10 times more for medicines and supplies than retail pharmacies, it becomes exploitation, yet private hospitals seem exempt from scrutiny.

Private hospitals don’t allow patients to buy medicines or supplies from outside sources. For example, we were charged P226 for a single adult diaper that costs only P20-25 online. A branded ketoanalogue tablet was billed at P95, while it sells for P30 at Watsons.

Before discharge, we were told a nutritionist would explain dietary guidelines – a conversation that lasted 10 minutes and cost nearly P1,000.

What if the Department of Health (DOH) issued a directive requiring hospitals to honor the Cheaper Medicines Act? What if hospitals were mandated to allow third-party pharmacies to operate within their premises. Why should private hospitals be exempt?

#4: Inequitable support that burdens families. We discovered a social pension program for senior citizens. We thought my 80-year-old father, who depends entirely on us, would qualify. But because he receives a P14,000 monthly GSIS pension, he was deemed ineligible. This policy is blind to reality.

It assumes that because Filipino families often care for their elders, the government can abdicate its responsibility. It assumes that a 20 percent senior citizen discount is enough. But who bears the cost of that discount? Private companies. This is not equity. This is the state passing its burden onto families and businesses.

#5: Inconsistent and detached quality of care. Hospitals in other countries treat their patients with dignity, clarity and compassion. In contrast, our experience in a private hospital here was disheartening. Consultants were hard to reach. One billed nearly P100,000 but never personally updated us on my father’s condition.

When a prescribed medicine became unavailable, we requested a replacement Rx. A week later, we’re still waiting for a new prescription. None of the doctors left their contact numbers. And not one of them reviewed the PhilHealth case rate to ensure we received the appropriate coverage. We had to educate the billing department ourselves.

Doctors must not only stay updated on clinical guidelines, they must also understand PhilHealth policies to advocate for their patients. Perhaps the Professional Regulation Commission should require annual ethics and PhilHealth policy seminars for doctors.

It is infuriating that some doctors avoid paying taxes by asking patients to deposit fees directly into personal accounts, bypassing hospital billing and tax documentation.

We deserve better. We demand that our taxes work for us.

(Sadly, the patient passed away last week.)