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Surprise hospital bills

DEMAND AND SUPPLY - Boo Chanco (The Philippine Star) - January 20, 2021 - 12:00am

One big source of economic insecurity in our country has to do with health care, and Rep. Joey Salceda of Albay is doing something about it.

Salceda cited figures derived from the Family Income and Expenditure Survey (FIES) from 2012 to 2018, which shows that up to 200,000 families per year fall into poverty because of out-of-pocket medical expenses. That’s very bad.

“Millions of families are just one medical bill away from poverty. It is deeply immoral that the one bill that could send your family into poverty is inflated with opaque costs,” Salceda said.

With the pandemic going on its first year, this is one issue that surely resonates well. Government hospitals find it difficult to provide proper healthcare specially during a pandemic. Our pay-as-you-go private hospital services are increasingly unaffordable for the middle class.

I have a first-hand experience on the matter. Over the last six weeks, my 97-year-old mother-in-law had been hospitalized for four of those weeks. What started as a urinary tract infection cascaded in a variety of other problems as organ after organ started to act up.

Before long, she had eight consultants looking after her, one for each organ. Money was flowing freely, so we had to terminate a placement to cover bills, and it isn’t over. But it is all for Mommy and everything that would make her comfortable and extend her life is worth it.

I look at what’s happening to her and I wonder how much we need to fund our own future potential health needs. I had health care coverage while I was working and didn’t need it. The only time I used it was when I was forced by HR to take the Executive Check-up because it was already paid for.

The year I lost my health coverage upon retirement was the year I started to need it the most. If I were in Canada or any of the Scandinavian countries, I wouldn’t have reason to worry. The state takes care of health needs.

Here, there is supposed to be universal health care by law. But the little that is supposed to be available had been stolen by the bureaucrats and some medical practitioners. There were scandals after scandals on fake dialysis and cataract operations claimed by doctors and paid for by PhilHealth.

So, we are left to the tender mercies of the local for- profit health care system. If you are close to the poverty line, you simply cannot afford it.

My mother-in-law is luckier than most. She started with ample savings. But that had also been affected by her kind and generous heart. She innocently lent a large sum of her nest egg to someone she met at a prayer meeting of supposedly born-again Christians. If she only asked me, I would have told her that person was a bad credit risk.

What Salceda wants is simple, yet inadequate to meet the need. But it is a good start. Rep. Joey has filed a bill mandating rules against “surprise medical billing,” or patients receiving unexpected bills at inflated prices and opaqueness in the prices of medical services.

Salceda was incensed by reports of increasing cases of inflated and non-itemized medical bills at the height of the COVID-19 pandemic.

“COVID-19 has increased medical bills for other medical services, primarily because of demand and lack of personnel and rooms. But there are also obvious instances of inefficiencies.

“Some hospitals are charging inflated prices for PPEs even when we already gave incentives to keep their prices cheap. There are regular rooms in medium-sized hospitals costing upwards of P10,000 a day. And you don’t find out until you get sick and are given the bill,” Salceda said.

Under Salceda’s bill, the Department of Health (DOH) will be mandated “to require hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format.”

That’s well and good. But when your loved one is in the emergency room, you are not likely to quibble over hospital charges, reasonable or not, transparent or not. In the end, the bills must be paid and that’s when the descent of middle class folks to poverty begins.

Rep. Joey’s bill also requires transparency in health insurance benefits, particularly for preventative care.

“There is plenty of opaqueness on the coverage of insurance for pre-existing conditions. It is unimaginable for a family to invest thousands every year on health insurance, only to be told during an emergency that their plan does not cover the emergency due to pre-existing conditions,” Salceda said.

It has come to the point that a diagnosis of cancer or some dreaded disease is like a death sentence. You may have a chance to get cured if you have the cash. But for most Filipinos, the battle for life ends with a near empty wallet.

I know we are not a rich country that can afford the socialized medicine of some Western countries. But we could be like Cuba. Better yet, improve on Cuba.

Providing for affordable health care should be the challenge for our leaders – both in and out of government. We have enough financial wizards who should devise health plans that respond to the needs of our working class. The health plans available today are far from adequate, even those that they claim are designed for senior citizens.

It should be possible for PhilHealth, SSS and GSIS to have health plans that provide for optional coverage for additional premiums to those willing to pay for it.

I get bombarded by emails, text messages, and social media posts from the likes of ManuLife, SunLife, PruLife, but none of them offer useful medical plans. PruLife is supposed to have a P1-million health plan that covers cancer, but that is laughably inadequate even for one chemo session.

There is a real need and I believe a real market for a good health plan. The professionals must just think out of the box to produce one that truly helps people.

 

 

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter @boochanco

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