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The Philippine The Philippine College of Physicians (PCP), the 8,000-member-strong national umbrella organization of medical specialists in Internal Medicine and its sub-specialty fields is cognizant of the chronic problems that beset the health sector of the country and the perennial attempts to solve them with little success. As an institution, it understands its role in maintaining the health of the nation not only as healthcare provider but most importantly, as a catalyst in effecting change in anything and everything that impacts health - whether positively or negatively. The Challenges Our healthcare system is in dire need of help, specifically in 4 major areas: 1. So much needs to be done to alleviate poverty and give access to healthcare to the majority of Filipinos. Resource allocation for health is limited not necessarily because the resources are scarce but also because health is viewed as consumption rather than investment. 2. The quality of care, including the efficiency of the health systems – both central and devolved – is inconsistent and unreliable. 3. Intervening social, economic, political and cultural factors in governance create conflicts that disturb the people’s understanding of what health really is all about. 4. To make matters worse, our healthcare providers opt to go to foreign lands to earn more, leaving behind a shortage of human resources that are mal-distributed across the regions. Everyone’s Goals
Surely, we want a country where all its citizens have easy access to a decent healthcare, where the quality of care that they receive - on time and from an appropriately paid and contented workforce - has scientific basis. We want a government that puts a premium on good governance and education, that tempers considerations for economic growth with considerations for the health and well-being of its citizens. We want a people who have the proper appreciation of good health, who take responsibility for their own health and that of their offsprings, and are ready to accept accountability for their decisions and behavior. What we all agree on All of these we wish for ourselves and for our country. These are the things on which we all share a common ground regardless of the differences in the manner to achieve them. There should be little or no disagreement on these things that we wish for. Regardless of the political party that we may belong to, or the health platform that the candidates are currently establishing , everyone has the same dream and wish : Equity in health and development; a healthy Why aren’t we there yet?
While healthcare resources are, indeed, limited, the availability of resources does not necessarily translate to the improvement in the delivery and quality of care. That is because putting together a viable healthcare program involves the participation of various shareholders in the health sector, each of whom has legitimate agenda to pursue and interests to protect. The Players in Healthcare The players in healthcare, by the nature of their respective self-interests, make the problem daunting. The healthcare providers – the doctors, nurses, pharmacists, midwives, etc – have diverse views and values – economic and otherwise - for which reasons many of them have left the country or have opted to crowd themselves in the major cities of the Disparities in the quality of care between government and private hospitals, as well as the fragmentation of care into sub-specializations, with premium on technological advancements, have begun to emphasize the inequities that define private versus public facilities, general versus specialized care, and rich versus poor. Third-party payors, insurers and funders of healthcare have to stay viable by putting up controls to minimize cost. Wasteful practices underscored by the inappropriate use of technology and the misuse and abuse of pharmaceutical products are borne out of unregulated relationships between the healthcare providers and the various business groups in healthcare. Healthcare delivery has evolved to mean state-of-the-art facilities and the belief that there is a pill for every ill. Be that as it may, morbidity and mortality rates of infectious and cardiovascular diseases as well as cancer have not shown any decline. That the insurers, funders and vendors have to protect their bottomline and ensure their growth is an important reality. Oftentimes, however, the partnership between healthcare vendors and funders and the healthcare providers forgets one important party - the patients and the public at large. “Big business” representing the ‘sin industry’ dilutes the messages on healthy lifestyles and create conflicts of values among the citizens. The images that portray certain lifestyles to be hip and pleasurable are far more compelling than messages that emphasize responsible behavior and accountability. Moreover, these entities have overwhelming influence not only in media but all the way up to the highest levels of government that formulate policies. In the name of attracting big investments in the Philippine economy, decisions are made that may put the people’s health in jeopardy. In addition, lobby groups and dominant institutions in society exercise evident power in preventing the passage of laws that run counter to their values in spite of the fact that these laws stand to benefit the silent majority by the options that these laws provide. Last but not least, the Filipino citizen, needs to assume bigger responsibility over his own health, to accept accountability for his behavior that puts him at risk of the diseases that nobody wants to contract. As it is, the government has limited resources for health that are better and more cost-efficiently allocated to disease prevention rather than treatment. Given that health is a right of every citizen that the government must protect, a responsible and accountable citizen, supported by an effective health education that presents to him/her the risks and benefits of the options that he/she can make, can go a long way in optimizing our health resources with greater impact. The Philippine Leader’s take on Health Whoever is going to be the next president of the Foundational Flaws that must be confronted. The realization of our vision for a healthy 1. Health is understood wrongly. It is seen as a cost center rather than an investment. If health defines life and its development, it therefore must be put up there as a priority in nation-building because all the plans for productivity and economic growth mean nothing without good health. In reality, that isn’t so. 2. Health is seen as an entitlement, a right that civil society must provide its citizens; the responsibility and accountability for one’s health are lost in the din of everyone’s demands for free healthcare. As a result, the government and the healthcare providers have taken up defensive positions to appease the citizenry. “Libreng gamot” and “libreng hospital” as well as medical missions that dole out free medicines that serve little benefit have become ‘solutions’ to the problem; the citizens meanwhile continue to act irresponsibly and assume no accountability for their behavior.
Is health a top priority in the presidential campaign? On March 16, 2010 at the PCP-sponsored Presidential Forum on Health: “What has health got to do with everything!”, we look forward to a substantive forum that takes off from this common ground that defines what we aim to achieve in Philippine healthcare. That the forum would be participated in by the 4 presidential candidates that the PCP membership has limited its choices to is a reflection of our respect for them as well as an expression of our hope that the next president of the country from among them fully understands what health is really all about. We all look forward to our presidential candidates to say the truth about the state of Philippine healthcare and our capacity to confront the realities head-on. We are not looking forward to promises; we want to know HOW they are going to lead and orchestrate the various players in healthcare and integrate health into the overall scheme of governance.
In other words, HOW are they going to orchestrate all the stakeholders in health to address the 4 major issues in health considering the 2 foundational flaws that undermine their resolution.
The PCP Commitment The PCP is committed to do its share, not only in providing care but also in health education as well as the training, distribution and mobilization of our growing membership. Where issues that affect health are not within our control, we will closely collaborate with the other healthcare players. All we pray for is a president who can lead effectively because he knows fully well that health has a lot to do with everything in nation-building.
EUGENIO JOSE F. RAMOS, M.D., FPCP |
