Almost every day I see patients (or their relatives) looking for stretcher beds as there are no longer available beds in the emergency room. This scenario, I suppose, will persist even when hospital renovations are finished this year. While increasing the hospital’s bed capacity potentially decreases waiting time for patients, no amount of beds will ever suffice. The neverending influx of patients in the Philippine General Hospital is a result of the increasing demand for health care among poor Filipinos amidst rising health care costs. The same is true, or even worse, for other government hospitals.

PGH is a microcosm of the Philippine health care system. Our experiences in this hospital mirror big challenges that the country will continue to face while implementing the universal health care law. First, poor gatekeeping at the primary care levels will allow patients to seek care at higher level facilities even when lower level facilities are capable of handling their medical conditions. This, coupled with patients’ poor confidence of primary care health workers, encourage them to flock in tertiary level facilities which results in overcrowding.

Second, chronic lack of manpower and other resources delay necessary care. Patient waiting time is high for common radiologic procedures (e.g. x-ray, ultrasound) because there are only few machines available for hundreds of patients. Nurses, faced with high patient workload, leave out essential care elements to meet only the urgent physiologic needs of their patients. Our study on nursing care rationing in PGH showed that 45% of nurses kept a patient who rung for a nurse waiting longer than five minutes. More than half of respondents disagree that there are enough nurses to get the job done or to provide quality care. More than half of nurses also reported a physician did not come or took a long time to arrive after a call.

These are few of the challenges that patients and health care workers in PGH continue to face. While we strive to be a model of health care delivery, our current set up is far from what we all have dreamed of – a hospital that transforms lives through excellent care, education and research. I cannot imagine how other hospitals and health workers deal with poorer work conditions.

The road to UHC is quite long. PGH is a reflection of the government’s failure to adequately lay concrete interventions that will make our journey smooth. Gatekeeping at the primary care level and provision of adequate human resources for health are two key elements that will drive the realization of universal health care.