Unpaved road to UHC

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.

Top Nine Questions This 2019

It has been a great year. I cannot thank enough the people who have been part of this amazing 2019!

reinerlorenzo

In the past, I wrote top lessons I learned during the year. For this year, I will have to put them aside and share with you nine questions I had in 2019 that remain unanswered (or partially answered). I hope to find answers in the coming new year.

  1. Can the healthcare system achieve both equity and efficiency at the same time? Or are the two concepts contradictory in healthcare? Should one be achieved before the other?
  2. How can we make the procurement process be more flexible and less corrupt while being strict on the quality of materials procured?
  3. What incentives could eventually reconcile self-interest and social interest?
  4. Should state-funded health care be rationed? How should the government ration health care to meet the current demand? How does rationing of care contribute to universal health care?
  5. Does the current national social health insurance program increase or decrease the efficiency of the use of scarce resources?  Is ‘access’ rather than ‘utilization’ of health services a better measure of equity in health care?
  6. Do patients’ preferences affect the supply of health care services? Or are variations in the supply of health care services in various settings simply a response to high levels of patient demand? If not, how much do patients’ preferences contribute to utilization of health care services?
  7. How do we go about the Filipino culture of putting too much trust on one’s doctor to the extent that we lose exercising our right to participate in decision-making?
  8. Do we cast our nurses as “global goods” rather than “domestic providers” of health care, implicating them as sources of remittance income rather than for their potential contributions to the local health system? Is this kind of trade (trade in health services/providers) not only motivated by the desire for revenue, but also by the desire to cope with overproduction and lack of opportunities for nurses in the Philippines?
  9. Do people’s preferences and tastes change in situations where there are very few choices? Or do they develop an acquired taste/preference because of limitations posed by societal inequities?

Pen Point 44

We don’t usually depend on what others say about us or how they see us because we need to own our truth. But, up to which point do we continuously neglect the truth, as perceived by others? They, too, are mirrors to our truth.

Ampatuan Massacre Promulgation

It took ten years to reach this point; a manifestation of the slow, inefficient process of our Justice System.

Court’s decision today on ‘Ampatuan Massacre’, however, gives us hope that justice is not entirely elusive. Even those who cling to power cannot evade justice.

Justice will only be truly served when our journalists and other members of the press can continue to tell the truth without fearing for their lives. There is more that needs to be done.

Call for fair and adequate hazard pay

How much is the price of upholding the rights of nurses in the country? For some, it costs nothing.

Nurses are at the frontline of the health care delivery system. They become the first and last health workers in contact with patients and their families. As such, nurses are exposed to low- and high-risk hazards during their working hours. Exposure to these hazards could result in discomfort, illness, and even death. It is imperative, therefore, to provide additional compensation to nurses performing their jobs in hazardous work areas.

Through Republic Act No. 7305 or the Magna Carta of Public Health Workers, the State recognizes the need to provide extra compensation to nurses for performing duties that expose them to potential health hazards. However, recent reports slap us with the reality that some nurses in the country receive little to no hazard pay.

We aspire for fair and adequate hazard pay for nurses in the Philippines. Fair in the sense that all nurses are well-compensated considering the health risks associated with the nature of their work. Adequate in the sense that it follows the rates set forth by the law. Fair and adequate hazard pay ensures the protection of nurses who relentlessly offer their lives to the service of the people. Fair and adequate hazard pay puts premium on the lives of both the health care workers and the patients they serve.
While we recognize the financial limitations being experienced by many local and provincial government units, this should not restrain the government from exercising its lawful duty to protect health workers from the dangers associated with the delivery of health care.

I call on the Department of Health (DOH) to look at the undocumented issues surrounding the non-payment of hazard pay experienced by nurses in various parts of the country. Moreover, I call on the local and provincial government units to (1) review its annual budgetary allocation and bring back health at the top of its priorities and, (2) ensure that nurses are compensated hazard allowances equivalent to the appropriate percentages as specified by the law. Finally, I call on Congress, DOH and the Department of Budget and Management to revisit the Magna Carta for Public Health Workers, specifically the provisions on salaries, hazard pay, and other forms of allowances.

The right to health is not limited to a privileged few. The government carries the burden of ensuring that this right is upheld as a human right equally enjoyed by all Filipinos. The promises of universal health care cannot be realized when the primary drivers of the health care system, our health care workers, are left at the brim.