Healthcare without walls

On a small island off Tabaco, Albay, 15,000 of its residents can now access the local government doctor to receive quality healthcare on a daily basis through telemedicine. Whereas previously, the doctor was able to hold clinic in the island only once a week after getting off a banca ride, the alternative remote consultations now allow him to “see” an average of 30 patients a day through teleconsult.

What is happening in Tabaco’s San Miguel Island is part of a pilot program by an international company called CareSpan that now operates in the Philippines using its proprietary telehealth service.

The CareSpan clinic system has been ongoing since May 2021, a blessing that could have come earlier given the restrictions that this pandemic has brought upon the country.

Preliminary findings published through the Center for Global Development had tracked a shocking drop in PhilHealth claims for 12 diseases (stroke, cancer, gastroenteritis, pneumonia, chronic kidney disease, hypertension, chronic obstructive pulmonary disease, dengue fever, asthma, diabetes, ischemic heart disease, and tuberculosis) that account for about half of the total disease burden in the country.

These findings seem to support anecdotes of Filipinos increasingly foregoing regular consultations in clinics and hospitals either for fear of getting exposed to COVID-19 or because they have less money now to pay for doctor’s fees and medicines.

Deteriorating public health

While the country’s attention is currently riveted on news about jampacked intensive care units in hospitals that need to treat COVID-19 patients, another crisis is unfolding that certainly involves more people who are putting their lives at risk by not getting timely healthcare.

Stories about the tiresome – but understandably necessary – precautions adopted by hospitals in admitting patients not infected by the coronavirus for treatment of other ailments have discouraged many from stepping outside the boundaries of their homes.

Many of those who have co-morbidities that make them vulnerable to COVID-19 infection have either stopped seeing their doctors or discontinued medication, making them more at risk of getting sicker or even dying. Without doubt, public health is deteriorating.

Last year, for example, there was a noticeable increase in the number of deaths due to ischemic heart and hypertensive diseases, as well as from diabetes. The ongoing lockdowns and subsequent curtailment of exercise for many most probably added mental stress to worsen such medical conditions.

Adopting digital healthcare

Without doubt, the pandemic has exposed the deteriorating condition of the country’s healthcare system where the ideal number of doctors and nurses remains far too few to care for the population, where healthcare delivery is reactive, fragmented, and inconvenient, and where the cost is often difficult to predict and high.

The Philippines has only 0.6 doctor per 1,000 people versus the current 1.6 global average. This is even much lower in rural areas, where in some areas there is not even one doctor. Equally lacking is the number of barangay clinics, as well as government hospitals in municipalities and cities.

Even without lockdowns and this pandemic, the use of digital technology in healthcare delivery was already gaining rapid ground in both the private and public sectors. Developed countries, where internet access and penetration is highest, were however distinctly at an advantage compared to developing economies like the Philippines.

Still, digital healthcare where it could be adapted demonstrates significant advantages. In the case of Tabaco, Albay where CareSpan is piloting its telemedicine system, the local doctor was not only able to accommodate daily teleconsultations with the residents of San Miguel Island, but also was able to do more in-person consultations with city patients.

Telemedicine claims to reduce the cost of healthcare, and in the case of CareSpan’s integrated digital care technology, improves the quality of care through better data, thus increasing clinicians’ productivity and accessibility, and even empowering patients to take support care into their own hands.

In a move to hasten the adoption of telemedicine, the Department of Health issued a circular last year that required healthcare providers and local governments to implement integrated digital health systems by next year. To support this move, PhilHealth announced that it would start to pay for telemedicine services of local governments in 2022.

Early care

During these pandemic times, telemedicine remains an unexploited gem. Subscription to online consultations and treatment continue to be few, something that the whole country’s healthcare delivery system must strive to change soonest.

Right now, the Philippines registers less than one percent in telemedicine penetration compared to nine percent in China, and 12 percent in Indonesia. Of those that offer telemedicine, only one percent can claim to have a fully integrated digital platform which enables the most benefit in the telemedicine environment.

Telemedicine is also poorly exploited in the treatment of mild COVID-19 patients. We need the government to push for telehealth consultations, especially among individuals who early on test positive for COVID-19, to facilitate immediate prescriptions that can effectively arrest the virus progression, and subsequently, prevent them from queuing for hospital ICU care.

With more COVID-19 infections now being seen in younger patients, their better physical conditioning coupled with early treatment through telemedicine should make home care a better option.

Telemedicine has a track record in some developed countries for helping in government-coordinated containment initiatives to control the spread of infectious diseases, and in the case of this pandemic, to help in contact tracing.

Additionally, telemedicine could be valuable in establishing a credible vaccination record, something that needs to be seriously looked into as Filipinos continue to navigate life under the new normal.

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