Public healthcare

DEMAND AND SUPPLY - Boo Chanco - The Philippine Star

If there is one lesson we should have learned from two years of this pandemic is our need for a good public health system. The virus tested the limits of our anti-poor, pay-as-you-go healthcare system and revealed how awfully inadequate it is.

Even in Metro Manila and Metro Cebu, many died in hospital driveways while waiting to be attended. Doctors and nurses were heroically doing the best they could, but even they suffered significant casualties. My cardiologist, Dr. Raul Jara, was among the first to fall.

Our testing facilities were inadequate. The statistics couldn’t be fully trusted. Frontliners often didn’t have adequate PPEs. We didn’t have the right health centers easily accessible for people to get initial attention or assistance. And cronies of powerful people were feasting on our treasury by selling overpriced and inadequate pandemic supplies to the DOH/DBM.

We have underinvested on health through the years. We were allocating only around 1.2 percent of GDP to healthcare, far from the five percent deemed sufficient by the WHO.

We should study the experiences of the healthcare systems of other countries to help us reform our own system. Being a third world country is not an excuse for not caring for our people’s health.

The inadequacy of our health system was featured in a recent issue of The Lancet, a respected international medical journal. The article focused on the unavailability of good diagnostics, which doctors consider central in providing evidence-based medical care.

The Lancet article noted that diagnostics are fundamental in any healthcare system. But our government has little appreciation of it.

Approximately 70 percent of health decisions are made after getting laboratory results. Our inadequacy has been highlighted by COVID-19, as limited testing capacity hampered a timely and effective pandemic response.

According to The Lancet article, under the primary care benefit package of the national insurance program, Filipinos are entitled to the following: complete blood count, urinalysis, fecalysis, sputum microscopy, fasting blood sugar, lipid profile, and chest x-ray.

“These tests, along with primary preventive services such as regular blood pressure assessments, are provided with the objective of diagnosing and treating leading causes of morbidity and mortality, including “anemia, dengue hemorrhagic fever, pneumonia, urinary tract infection, infectious diarrhea, pulmonary tuberculosis, diabetes mellitus, coronary heart disease, and pneumonia.”

But The Lancet article observed, “primary care facilities, especially outside urban cities, are ill-equipped to provide diagnostic services…”

Written by Filipino doctors, the article points out we don’t have a good distribution of diagnostic equipment and supplies around the archipelago, we lack medical and radiation technologists in far-flung areas, and our infrastructure is inadequate to properly house, power, and maintain diagnostic equipment.

“Diagnostic imaging is key to prompt diagnosis, treatment, and long-term surveillance of malignant neoplasms and various infectious diseases, which are rising causes of morbidity in the Philippines.

“Currently, there is a critical need to increase imaging capacity and address the uneven distribution of diagnostic imaging equipment… The inaccessibility of healthcare facilities effectively precludes access to essential diagnostics, especially for geographically isolated areas in the Philippine archipelago.”

The other problem cited by The Lancet is the need to improve national health financing. This, it said, is key to increasing diagnostic availability and accessibility.

“The prohibitive cost of diagnostics is a significant barrier to access, and consequently, to the diagnosis and treatment of the country’s priority diseases. This financial handicap is compounded by limited and variable coverage from the national health insurance program, resulting in high out-of-pocket expenditure.”

The Lancet article also mentioned financial incentives that encourage overdiagnosis, in urban hospitals. It suggested a national price monitoring mechanism to ensure the fair pricing of diagnostic tests and procedures.

The next administration should prioritize the improvement of our healthcare system. We need strategically located hospitals and treatment centers that are adequately staffed and provided with proper equipment.

We also need to overhaul PhilHealth to make it truly effective in providing the intended universal healthcare for every Filipino. Proper funding and effective anti-corruption safeguards are needed urgently.

Health is wealth, as the pandemic should have taught us by now. But I am afraid we don’t learn our lessons easily.

Gloria Tan Climaco

This year’s celebration of International Women’s Day was a sad one for many of us. We lost one of the pioneer women who broke the glass ceiling for business professionals and paved the way for women to lead in this field.

Gloria Tan Climaco became the first woman to head SGV, our leading accounting and management firm, as its chairman and managing partner in 1992. Even beyond her career at SGV, she contributed her expertise and boundless energy to help ferret out the truth in some of our biggest financial scandals.

Glo simply followed the numbers. She led the SGV team that probed the misreporting of the Central Bank’s foreign exchange reserves in 1983.

Glo also helped the team that worked with former Supreme Court chief justice Lourdes Sereno in a World Bank arbitration case over NAIA Terminal 3.

Indeed, I was exchanging text messages with her a few weeks ago when I was writing about the Central Bank scandal. She gave me a lot of leads, but true to her professionalism, she couldn’t give me more details because she considered herself still bound by the confidentiality agreement SGV entered into with its clients.

I have been privileged to join a select group of her friends over many dinners at her home to discuss the hottest issues of the day. Glo would share information on a background basis that helped me better understand stories I was writing.

I hope she wrote down most of her experiences because future generations should know how things happened and how we may avoid lessons of history.

The pandemic ended our regular dinners and we were just about to resume it when I got word that she passed away suddenly. I am still shocked that she left this world just like that.

I offer my deepest condolences to her family, and specially to her adopted son, Joaquin who she loved so much. She was the best. We will miss you, Glo!



Boo Chanco’s email address is [email protected]. Follow him on Twitter @boochanco

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