22 April 2008

Diagnosing Philippine Healthcare: When Dying Becomes The Better Option

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.  

11 reactions:

MerryCherry, MD said...

The Blog Rounds 6th Edition, UPDATD, here. Thanks for joining Doc! This one is really extensive. It covered everything!

Aice Nice Concepts said...

very well said post
i guess we have to put in our minds that "prevention is better than cure here in Philippines!"
mahirap talaga magkasakit lalo na kung nasa Pilipinas ka!

mesiamd said...

A very enlightening piece! But when will we start solving the problem?

What are the numerous doctor associations and medical specialty groups waiting for? What are they doing to help solve the problems of the deathly ill Philippine Healthcare?

I believe doctors have untapped resources to influence the healthcare budget, guide the direction of care, and push for innovative solutions.

For example, doctor groups can lobby with the president, the senators and congressmen to increase the healthcare budget. They can push the issue as a national priority right in the consciousness of all Filipinos.

We all need to come together for solutions. We can't expect leadership from those who don't know. Or we can't just wait for people to die. Doctors must be in the forefront in correcting the ills of healthcare.

Dr. Emer said...

Thanks, Dr MC!

Short-term thinkers focus less on prevention, Aice.

Physician groups are doing something, MesiaMD. But they are too minuscule to be felt as significant solutions to the growing problems. Big problems need big solutions. It must also be sustained over the years so that we can feel concrete results.

Jet said...

nakakalungkot talaga Doc. it is unfortunate that as far advanced as humanity has come in everything else, the hard and fast rule is still survival of the fittest. you would think that a 'better life' brings with it a more gentle existence. I guess not.

mesiamd said...

The American Medical Association is a very big lobby in the US legislature. Many medical specialty groups and allied health professions follow, in concert to push or contradict some agenda.

With the government, health orgs tackle contentious issues on patient care, budget allocations, doctor service payments, medicare/medicaid planning etc. which cover do-lists and goals for the present and future.

I'm glad to know RP organized medicine is doing something. You're probably right about the "miniscule" part. Maybe it's one reason why I rarely read about their advocacies. But aren't most of them belonging to the cause-oriented groups? I think we need more work and participation.

What bemuses me are the news that often cover our yearly meetings, conventions, and school homecomings.

Mec said...

apathy is the worst of all... ambivalence always means inaction, so the wound festers and we lose limbs...or in this case, lives... and quality in our lives

ian said...

very interesting, enlightening post, doc. there's a lot of challenges, but there are lots of great things about the RP as well =] hope to hear your take on a "mission" i've set up for all of us for The Blog Rounds 7. details are in my blog =] hope you can join!

Dr. Emer said...

JET - But hope springs eternal in the hearts of those who really want improvement. It need not be like this or "survival of the fittest," as you described it. Something can be done. Something must be done. It is only a question of when and how. The biggest obstacles remain to be indecision and absence of a unified effort from all the concerned sectors.

MESIAMD - Sometimes I wonder what those local groups here lobby for. There's so much to be done.

MECSY - True. And if we remain this way, many more of those unfortunate and poor people will suffer and die. Who knows? Perhaps in the future, they'll describe the resulting apathy as a solution for overpopulation, huh?

mesiamd said...

I think there's miscalculation among us that the last people who get affected by healthcare's decline are the doctors.

We have seen the barren wasteland of medical payments and reimbursements because people can't simply afford. We have seen the deterioration of our schools. The government allocates a measly budget on health that's way below the minimum prescribed by the UN.

But we rarely join hands to correct this stark mistake. We're just as apathetic as the poor patient waitng in corridor.

edgar said...

Due to expensive medicines and hospitalization, manypoor people resorts to other inconventional way of seeking medical relief.I heard that some people are even drinking urine to ease their suffering and end up paying more in the hospitals due to infections and complications.We cannot blame them though look around you many poor people rely more on prayers than to spend on their medicines, a money that will suppose to feed their family.It is quite alarming that nobody seems to be doing something exept for some kindhearted people who dedicated their life and career in helping the poor but they seems to be overwhelmed by the people in need.We have the bright boys in politics who are strangely enough still debating on how to help these people in dire need.