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Why healthcare isn’t completely free

If I had a peso for every doctor bashed in social media, I’d be rich. But kidding aside, health is no laughing matter, and if one would look closely at the root of the problem, it is our imperfect health system and the common lack of understanding of how to properly avail oneself of healthcare services that lead to unfortunate bashing.

First off, since the passage of the 1991 Local Government Code, health services have been decentralized: The maintenance and operations of district and city hospitals are now dependent on local government units, except for a few specialty hospitals retained by the Department of Health. This has created a very wide disparity between Class A municipalities that can afford top-notch facilities and services and poor municipalities that are unable to meet the health needs of their constituents, let alone improve their dilapidated facilities.

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These contribute to the people’s lack of trust in the primary healthcare system, and the effects are in extremes: Either they resort to alternative or folk medicine, or flock to overcrowded tertiary hospitals for the simplest ailments. This leads me to my next point: how every patient at the Emergency Room (ER) wants to be seen instantaneously.

I remember that as a medical intern, I saw about 50 patients in an hour at the ER triage area. A very insistent giant of a man raised his voice and was getting ready to clobber me while I helplessly noted more patients coming in through the door. I had to explain that his patient’s case was nonurgent, and could therefore wait while I tended to the patient with a stab wound in the chest.

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Most hospitals follow a triaging system like the Canadian Triage and Acuity Scale to classify or prioritize a patient as A, or in need of resuscitation (seen immediately); B, an emergency (seen within 15 minutes); C, urgent (seen within 30 minutes); or D, less urgent (seen in 120 minutes). The next time you show up at the ER at 3 a.m. to seek treatment for sore throat and fever, don’t be surprised if the doctors attend to other patients first.

Not all cases are admissible. Assess if the situation requires a visit to: A, the barangay health center (for blood pressure taking, for example); B, an out-patient department or doctor’s clinic (for stable patients who can walk); C, the ER (for serious illnesses that need treatment right away). Even for a patient seen and assessed at the ER, doctors follow clinical practice guidelines and decide if it is necessary to admit him or her.

Healthcare isn’t completely free, even with PhilHealth’s “no balance billing (NBB) policy.” Here is the fine print: To qualify, one must be either an indigent, sponsored member, or “kasambahay.” It covers all case rates (a specific amount allotted per disease/condition), including leptospirosis, TB, outpatient malaria, animal bite, voluntary surgical contraception, HIV-AIDS, SARS, avian flu, and IUD insertion. But the NBB policy does not apply to private hospitals, and even private rooms in government hospitals.

Most people cannot seem to fathom that even if a government hospital receives an annual budget, this does not completely cover the maintenance costs, other operating expenses, and personnel salaries
to keep it running. The hospital also
needs to earn its own income to fulfill its budget requirements.

Sometimes it all boils down to our attitudes. Take having a baby, for example. It takes months for the parents to prepare, but some just decide to show up at the ER with the baby’s head about to come out, and without a single ultrasound or lab test or prenatal checkup. I can understand why tempers would flare.

For a doctor, this situation can be so frustrating. But rest assured that we still do our best. I always make it a point to explain to the patient: The success of your treatment is only as good as your preparedness and cooperation. In an imperfect health system, let us be partners.

Thaddeus C. Hinunangan is a resident physician in pathology at the Philippine General Hospital.

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