Into the twilight

Those hoping to have a long life should also work to make it a healthy one.

Caring for my mother as her mind and body deteriorated from Alzheimer’s drove home to me the inadequacy of public health coverage for the elderly.

It also reinforced my perception that drugs and other medical supplies in the Philippines are overpriced compared to other countries.

Even if you’ve been paying premiums for decades, private medical insurance coverage typically stops when you enter your twilight years, which is normally when you need it most.

In the final year of her debilitation, when she lost her ability to walk, my mother was in and out of the emergency room and doctors’ offices in the biggest hospital near our home.

At 89, she had no more private HMO coverage. Doctor consultations are not covered by the Philippine Health Insurance Corp. PhilHealth also covered only a fraction of the ER bills, although the coverage was larger in the wound treatment section.

For the four days of hospital confinement before we brought her home from the palliative care floor just hours before she expired, PhilHealth covered only about 10 percent of the bill.

The bill items included the ambulance ride from the hospital to home – a distance of less than five kilometers – which cost about P12,000. It was a state-of-the-art ambulance in which she remained strapped to an oxygen tank, so at least she was transported in relative comfort as I fulfilled her final wish before she stopped responding to us: to be brought home.

All items for home palliative care are out of pocket, from IV fixtures to oxygen tanks. You need either six tanks, at P12,000 each, with refills daily at P900 each, or one tank plus one oxygen concentrator costing P30,000 to P40,000 on average.

A medicated wound dressing for bedsores, which she needed regularly, cost P1,000-plus each in the leading drug store chain, and it was so hard to find a branch that stocked the item. Fortunately, we discovered the exact same imported brand online, at just one third the price.

Why is the markup in the drug store chain so large? Surely the price at the online retailer already carried a profit margin.

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Many years ago, as Congress was deliberating on the passage of the Generics Law, I had written that I bought Claritin in London – where everything seemed to be 10 times more expensive than in the Philippines – at just a third of the price in the leading Manila drug store chain. I couldn’t believe branded medicine was cheaper in London than in Manila.

It wasn’t a complete surprise, though, since for a long time, among the biggest contents of balikbayan boxes from the US, apart from corned beef and Fruit of the Loom shirts, were medicines and vitamins, which cost just a fraction of their price in Manila.

I use antihistamines a lot so I am familiar with the price of Claritin. Sometime later, the drug store chain brought down the price to London levels.

Filipinos who have visited India, myself included, are also stunned by the price disparities in medicines of the same brand and of generics in the two countries. Several years ago when one of our colleagues had a critical medical emergency on the way to the Taj Mahal in Agra, we also found out how much cheaper hospital treatment is in India – and the health care is topnotch.

I guessed that this could be because India has a robust domestic pharmaceutical industry, with a lot of universities focused on medical and related courses. When I visited Chennai City, for example, the roads including the strip parallel to the 13-kilometer-long, scenic Marina Beach facing the Indian Ocean were dotted not with retail shops or restaurants but with educational institutions focusing on various medical specializations. For every human organ and affliction, it seemed, there was a school dedicated to its care.

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In our country, even if youths dream of entering the medical and related professions, the cost of education can deter the realization of the dream.

Tuition, which is free in the public school system, is just one component of medical and nursing school expenses. Also, except for the University of the Philippines system, most of the best medical schools are privately owned, with links to major hospitals, where tuition and miscellaneous expenses are beyond the reach of millions of households.

Among the biggest items in my mother’s hospital bills were doctors’ professional fees.

There are now doctors specializing in geriatrics who make regular house calls – a boon for the wheelchair-bound elderly like my mother – but the professional fees are steep. There are also nurses who assist in home care, dropping in regularly for tasks such as attaching IV tubes for medicine and feeding, for example. But again, such services don’t come cheap.

As for pharmaceuticals, a student needs solid grounding in the sciences to pursue a career in Chemistry. Much as I loved the sciences, I can’t imagine how I survived high school Chemistry. I took an experimental course in socio-environmental concerns to escape Chemistry in UP.

Republic Act 6675, the Generics  Act of 1988, helped bring down medicine costs, but the law may need to be revisited for enhancement in attaining its objectives.

Since my mother’s passing, people have been sharing with me their experiences in caring for their elderly loved ones, with some asking for advice on dealing with the problems.

We all get older with each passing day, and we also share stories about preparing for our twilight years. By the time we enter that stage, let’s hope elderly care will already be much improved and more accessible.