Bakit hindi lahat ng Filipino na may sakit o gustong magpatingin sa doktor ay natitignan ng doktor? [Why is it that not all sick Filipinos or those who want to see a doctor are not attended by a doctor?]
Ano ang bulok o MALI sa sistema --- kung may sistema man? [What is wrong with the system --- if such a system exists?]
Where is the GAP? Is it the health budget? Our politicians or legislators? Is this government incapacitating us to deliver basic health services to every Filipino?
Or maybe, there is also something wrong among us medical practitioners? Those physicians who treat their pockets more than they treat their patients illness? On the other end of the spectrum, do we have overworked, underpaid health care workers, who in turn, can't give ideal health service? What about the Philippine Medical Association? Yeah, what is its role in all of these?
What about our patients? Is it really just about the extreme poverty in this country that prevents our patients from seeking health services or is it MORE than that? Like skewed priorities? ~ MerryCherry, MD
Every Filipino has an answer what ails Philippine healthcare (yes, I'm one of those medbloggers who simply can't agree there is a 'system' that exists).
Ask them and they will certainly answer any or all of the following: no money, low budget, low salary, graft and corruption, no doctors, no medicines, no facilities, poverty, overpopulation, no efficient family planning method, expensive hospitalization, expensive medications, ignorance, etc, etc. True enough, every answer is correct. Worse, two or more of the said factors may be present in one place, and may all be contributing to the horrible health situation.
In Medicine, we use stages to describe the severity of a medical condition. Stage I is the mild stage while Stage IV or Stage V usually connotes a dire clinical condition. To use the analogy, I'd say Philippine healthcare is hovering somewhere between Stage III and Stage IV.
If I were the attending physician of this 'patient' called Philippine healthcare, I think the condition is not that hopeless yet, but as social problems pile one on top of the other, or as surprise epidemics and unexpected calamities occur and join the fray, I am very, very bothered about how my patient teethers on the brink of death everytime.
Another source of my extreme bewilderment is WHY the 'patient' isn't being moved to the ICU (intensive care unit) yet?
Why the seemingly cool nonchalance by almost everyone?
Everyone says there is something wrong. Everyone knows there IS something wrong. Everyone agrees something must be done. Yet, nothing we can describe as a "great solution" or a "curative approach" is being implemented as soon as possible.
To illustrate, I'd like to ask the following questions:
1. What has happened to the Cheap Medicines Bill? - every hour or every day that passes without this law means thousands of sick Filipinos suffering from lack of needed medication. Lack of medication = poor clinical outcome. One need not be a doctor to realize this, right???
2. Is the Senior Citizen Law being strictly enforced? - every doctor knows that geriatric patients constantly need a steady, uninterrupted supply of maintenance medication for their varied medical conditions. Clinical management especially for outpatients become problematic when old patients come to us and complain that big and small pharmacies only extend senior citizen discounts on pharma products on a limited basis (once a week or twice a month ONLY!). Nowhere is it enumerated in RA 9527 that there will be limited offers of senior citizen benefits.
3. Is the Tobacco Regulation Law being strictly enforced?- the premise has always been that most diseases are preventable. If we prevent one vital risk factor like smoking, there is a great chance that we can see less people getting sick.
4. Before we embark to promote massive medical tourism, why not show the world first that we can take care of ALL our people by providing them with world-class quality healthcare? - 'Just asking. I'm not really against medical tourism. I would just like to know why we can't prioritize our people first before our visitors? I think it will be good marketing for tourists if they see how well we take good care of our own.
Another analysis I would like to pursue is to analyze the behavior of the main cast of characters involved in this never-ending problem of Philippine healthcare:
1. Government - always blamed but because it is working with a very limited budget on health, whatever the DOH is doing is not enough to correct all the problems present. Its poverty-alleviation projects focus more on dole-outs rather than self-sufficiency. As a result, people are conditioned to be always dependent on government help.
2. Government Physicians - feeling they are not taken care of, choose to leave their posts and work abroad as nurses. While these doctors can't be blamed, it also means no one capable or trustworthy will be manning the provincial hospitals anymore.
3. Private Physicians - most charge sky-high professional fees for their quality care extended to patients. Discounts and free services are strictly reserved for close family relatives and best friends only.
4. Pharma Companies and Pharmacies - no move to drastically reduce drug prices (it's a business, after all). Sure, there are discounts, but still, most Filipinos still cannot afford to even complete a full-course schedule of antibiotics or be on an uninterrupted supply of maintenance medications.
5. Hospitals - private hospitalization is still better quality-wise than being confined in a charity ward of a government hospital. 'Problem is, it is also VERY, VERY expensive. So expensive, one can end up being discharged cure of his ailment but with a mountain of debt problems or worse, bankruptcy. Both government and hospital administrators have not really moved to improve the quality of health services in the charity sections. Why? There's no income there.
6. Patients - the unwitting victim of #1 to #5. It is not only the poorest of the poor who die without the benefits of hospitalization. I have witnessed very sick middle-class patients opting TO DIE instead of being hospitalized or be seen by a private doctor. Their relatives agree and sometimes even decide with a heavy heart to go with the fatal option rather than suffer a lifetime of debt or debt servicing. It is often a sad --- terribly sad scenario.
The alarming reality is that quality healthcare in the country exists, but they are reserved for the select few who have extra money to burn. The middle-class, the poor, and the very poor --- who comprise the bulk of the population --- must content themselves to half-quality service or NO service at all. Former Health Secretary Juan Flavier used to say, "Bawal magkasakit!" [It is forbidden to get sick] in one of his TV commercials. For most sick Filipinos, this admonition takes a different color. It becomes a rule and law for them. Because if they get sick, their options become very limited --- either they get better or they choose to die as quickly as possible to prevent expense and more worry for their loved ones.
The more alarming reality and diagnosis is the growing apathy about the whole situation. Everyone seems to accept that this is fast becoming the new norm.