Pabor ba kayo sa privatization ng public hospitals?

19 November Mobilization

Related Articles:

• Panukalang gawing gov't corporations ang 26 na pampublikong ospital inalmahan
• No to the Privatization of Public Hospitals and Services
• No to privatization of public hospitals
• No to privatization of health services

WARNING: PRIVATIZATION IS DEADLY!!!

“We are supposed to preserve and protect life among our patients but how can we do this when privatization of health service becomes the centrepiece program of the PNoy government?”, asked Benjamin Santos Jr., All UP Workers Union-Manila President during a protest action conducted by the health workers and patients outside the Out-patient Department (OPD) of the Philippine General Hospital (PGH) today.

In the protest action, Santos asserted that Article II, Sec 15 of the 1987 Philippine Constitution explicitly states that “The State shall protect and promote health of the people and instil health consciousness among them”. but with privatization of health facilities and services, the health of our Filipino countrymen is threatened because privatization kills.

A known ‘Ospital ng ‘Bayan, PGH implemented privatization schemes as seen by the establishment of UPMC-FMAB, a private facility within PGH. Besides accommodating the doctors clinic, the private facility also has a pharmacy, laboratory and other diagnostic service and renders out-patient surgeries. When laboratory equipments are not functioning and supplies are not available at PGH, patients are adviced to proceed to this private institution for their laboratory and diagnostic needs where fees are much higher compared even with other private laboratories outside of the hospital. Most often, patients are forced to come to this private facility to avoid the long and tedious wait of the services of PGH. Therefore, UPMC-FMAB profited from PGH inadequacies.

Lately, amidst strong protests from the All UP Workers Union, other health workers and patients, the University of the Philippines Board of Regents (UP-BOR) approved the scrapping of the ‘No Charge/NC’ rates for the laboratory and diagnostic procedures availed by a meager 11% Class D/indigent patients of the hospital after a strong recommendation from PGH Director Jose Gonzales.

“This revenue enhancement scheme is but a form of privatization”, Santos stressed. “UP and PGH resorted to this method to augment the hospital’s insufficient budget and to attain fiscal autonomy as expected of them from the PNoy government. PNoy’s government does not mean meaningful service to the Filipinos. It is not just reasonable to extract and squeeze more money from the poor, much more from the most poor. Health is a basic human right and PNoy should stand to that!, ” Santos added.

All UP Workers Union-Manila also denounce the corporatization of 26 public hospitals as this scheme would lead to privatization, the heart of PNoy’s Universal Health Care Program that runs under his Public-Private Partnership program, a condition set and dictated by International Financial Institutions. The union finds privatization as PNoy’s complete disregard of the people’s right to health and so it urges everyone to fight and oppose this unjust and anti-people policy.###

Reference:


BENJAMIN L. SANTOS, JR.
President, All UP Workers Union-Manila
0917-540-2263

Related Articles:

• AHW starts 1-M signature drive vs hospital privatization
• Health workers launch weeklong ‘kalampag’ vs privatization of health

Privatization: A Tool of Oppression

“The State shall protect and promote the health of the people and instil health consciousness among them.” 1987 Philippine Constitution, Art. II, Sec. 15

This is how explicit the Philippine Constitution is about the government’s responsibility regarding the right to health of the people. The Universal Declaration of Human Rights (UDHR) and other international covenants support this declaration. Article 25, of the 1948 UDHR states,

“Everyone has the right to standard of living adequate for the health and well being of himself and of his family, including food, clothing, housing and medical care.”

Privatization of health facilities and services, the abandonment of state’s responsibility to people’s health and allowing private business to take over which makes health a commodity for profits, is definitely an outright and blatant violation of the people’s right to health.

Privatization is a global phenomenon dictated by the monopoly capitalists as their solution to the crisis of the world capitalist system of overproduction and concentration of surplus capital. The neoliberal policies of globalization specifically privatization, deregulation, liberalization and labor-flexibilization were imposed by the monopoly capitalists on debt-ridden third world countries like the Philippines to provide for their expansion and control of markets where to dispose their goods and invest their surplus capital to stimulate the stagnation of trade and investments.

The monopoly capitalists are aided by their multilateral institutions namely the World Bank, (WB), International Monetary Fund (IMF), the World Trade Organization (WTO), the Asian Development Bank (ADB) also called the International Financial Institutions (IFIs). Through these institutions, the neoliberal policies like privatization have become an integral part of the state policies of many countries both developed and underdeveloped.

The IMF-WB imposed their Structural Adjustment Program (SAP) on heavily indebted third world countries like the Philippines to lessen government spending and allow entry of foreign capital through loans. Thus, export orientation was promoted, imports and foreign investments were liberalized, major economic sectors were deregulated and state-owned enterprises were privatized. All these provide the state involved to accrue funds for payment of their mounting external debts from these institutions and to usher in their surplus products and capital for investments.

Privatization, however, in the context of globalization and capitalists’ crisis is not simply a response to fiscal difficulties and not only to sell off state-owned enterprises. The challenge is to “redefine the role of the government”. Investment of surplus capital must find its way to the extent that globalization has encroached on state institutions and state responsibilities like social services for the people. Privatization has become an issue of sovereignty. The role of the International Financial Institutions (IFIs) – the World Bank (WB) and the International Monetary Fund (IMF) in the privatization process in the Third World countries clearly show how it undermines the sovereignty of these countries. In the Philippines, the bureaucrats and the local capitalists have their own specific roles in the continuing and deepening control of the monopoly capitalists on the economic, political and socio-cultural aspects of the country through their neoliberal policies like privatization.

History of Privatization of Health Care in the Philippines

Privatization as an official government policy in the Philippines gained foothold during Marcos’ time. His cronies incurred foreign loans for their businesses which went bankrupt due to personal interests and corruption. As guarantor, the Philippine government had to bear the losses and the responsibility for the loan payment. Eventually, foreign debts steadily increased with the concomitant payments which the IMF and the WB took advantage of and imposed their Structural Adjustment Program (SAP). To meet the IFIs demand, Marcos issued Presidential Decrees 2029 and 2030 which set the legal framework for privatization of government assets. Republic Act 5260 was enacted authorizing the sale of the Welfareville Property and the National Center for Mental Hospital.

Corazon Aquino was the first to implement privatization. When she assumed presidency, the Philippines had $28B external debt for which she did not agree of debt repudiation raised by some quarters. Instead, she signed Presidential Proclamation no. 50 which provided for the formation of the Committee on Privatization (COP) and Asset Privatization Trust (APT), the implementing arms for sale of government properties. A total of 287 enterprises worth Php 20.3 billion were privatized from 1987 to 1990.

Fidel Ramos, upon assumption as President submitted Letter of Intent (LOI) to the IMF-WB which contained further reduction of government subsidies for public services. Thus, more Government Owned and Controlled Corporations (GOCC’s) were lined up for privatization. His Social Reform Agenda (SRA), the expression of the Structural Adjustment Program (SAP) heightened the trade and industry liberalization and intensified budget cuts for public services to satisfy the lopsided conditionalities of the International Financial Institutions.

Through his program “Health in the Hands of the People”, Ramos approved the Local Government Code, the law which justified the devolution of public hospitals nationwide to the Local Government Units (LGUs). The 580 public hospitals were devolved to the local government units (LGUs) while the DOH retained control of nine specialty hospitals most of which are in Metro Manila. Included in the devolution are the 44,000 of the 78,000 health personnel nationwide. Policy-making and regulations remained with the DOH but health service delivery was transferred to LGUs to ensure primary to tertiary health care delivery.

However devolution and decentralization have caused the country’s health system to become fragmented with imbalances in the resource allocation due to the widely varying capacities of LGUs. Devolution spared the national government health budget allocation for the devolved hospitals and health services.

With public hospitals devolved, Estrada issued his Executive Order 102 which redirected the functions and operations of DOH through re-engineering. DOH becomes a provider of specific health services and technical providers for health from being the sole provider of health services. The streamlining, according to DOH data, reduced 50% of 3,000 of DOH Central Office employees.

Estrada had his Health Sector Reform Agenda (HSRA) which pushed for privatization health facilities and services as per recommendation of World Bank. The main thrusts of the HSRA were:

1. to provide fiscal autonomy to government hospitals;
2. to secure funding for priority public health programs;
3. to promote the development of local health systems and to ensure their effective performance;
4. to strengthen the capacities of health regulatory agencies; and, expanding the coverage of the National Health Insurance Program (NHIP).

Reforms in the HSRA include corporatization of public hospitals, institutionalization of user fees in health services and facilities, and the integration of the four GOCC hospitals as Philippine Center for Specialized Health Care to cater to medical tourism. All these shift the government’s responsibility to its people’s right to health to the private sector.

HSRA claimed to be out to “increase access to health services especially by the poor and to reduce financial burden on individual families”. But this contradicts its promotion for the continuous upgrading of the regional and national hospitals into income-generating and financially viable health facilities by allowing them to collect, retain and allocate revenue from user fees and other forms of revenue-generating activities. These revenue measures include among others, increasing the number of pay wards and private rooms and expanding the health insurance coverage and the package of hospital services to be reimbursed by the health insurance system.

HSRA further laid down the strategy of privatizing public tertiary facilities by converting them into public corporations which it claimed to be the solution for the country’s deteriorating quality of health care. Thus regional and national hospitals are being upgraded to perform highly specialized curative and rehabilitative service to increase revenue-generating capacity and improve their financial viability. The downside, however, is the displacement of true indigent patients when these hospitals unload them to give way to pay patients to attain fiscal autonomy and financial capability.

Corporatization was the catch word of Arroyo’s administration. Her Fourmula One and the National Objective for Health (NOH) 2005 - 2010 were drawn up to complement and serve as the implementing rules of the HSRA. Fourmula One for Health program is consistent with and implements the neoliberal agenda of World Bank’s 1993 World Development Report – Investing in Health. Its focus is corporatization of public hospitals and promotion of medical tourism. The National Objective for Health 2005-2010 stressed on mobilizing private sector resources and expanding the health insurance program.

With Arroyo, plans came up to corporatize the 68 public hospitals and another attempt to sell the Welfareville Property and the National Center for Mental Hospital.

Benigno Aquino’s Universal Health Care and Public-Private Partnership The Aquino administration has the Universal Health Care or the Kalusugan Pangkalahatan, his version and implementation of HSRA. It focuses on three major strategies which are:

1. Financial risk protection through expansion of the National Health Insurance Program (NHIP) enrollment and benefit delivery;
2. Improved access to quality hospitals and health care facilities;
3. Attainment of the health-related Medium-term Development Goals (MDGs).

Aquino’s thrusts – Philhealth and Public-Private Partnership are all but privatization of health facilities and services.

1. Philhealth
   While Philhealth promises free access to health care it squeezes even more the people’s money by their out of the pocket expenditure for their health needs. The National Health Accounts of the National Statistics Coordinating Board (NSCB) estimates that if 5% of Gross Domestic Product will be allotted to health, Philhealth’s share to the Total Health Expenditures (THE) will be only 17%. On one hand, World Bank’s data regarding the out-of-pocket share from the private sector to the Total Health Expenditures in the Philippines is as much as an average of 83.5% from 2007 – 2010.
   
   The government allotted Php 12.6 Billion for 2013 for the beneficiaries’ premium under the National Household Targeting System which covers a miniscule 5.2 million households. This is aside from the Php 63.4 Billion total premium expected collection of the agency. These figures alone are assurance of the private capitals’ return of investment and eliminate the chances of any losses. Financial risk protection is just among the many incentives the state offers to attract private investor.
   
   With Philhealth, it has been observed that: 1) Utilization rates are highest among employed members and remain very low among state-sponsored members; 2)The highest share of reimbursements go to the rich, private institutions and clients; 3) It enhances inequity.
   
   Conclusion therefore could be that:
   1. Philhealth cannot make up for the significant role of the state to provide adequate funds for health.
   2. It cannot mitigate the damages caused by privatization.
   
   
   The profit orientation of Philhealth will further exacerbate the health problems of the poor. The politicians will simply use this for their political agenda.
2. Public-Private Partnership
   Public-Private Partnership (PPP) is Aquino’s centerpiece program for his Philippine Development Plan 2011 – 2016. There are two aspects which distinguish his PPP from that of his predecessors.
   1. The granting of regulatory risk guarantees, an innovation and vital development to the way privatization projects were handled in the past. These regulatory risk guarantees make sure that the government would pay the private sector the total cost in case external problems arise.
   2. The conscious and systematic inclusion of social services like health in PPP projects.

With PPP, research and development (R&D) in health has taken a new status. The government has never invested in R&D, now it is even at the forefront of advocating that private sector takes over this very crucial function. Rolled out for PPP programs are San Lazaro Hospital, Philippine Orthopedic Center, Research Institute for Tropical Medicine. These specialty hospitals will be transformed into research centers. This will erode the government capacity to develop knowledge for the good of the society such as technological breakthroughs in disease prevention and cure. Hospitals targeted for PPP have been under the government’s zero capital outlay policy and budget cuts.

Budget cuts for health are well-defined in the health financing scheme of the Aquino administration. By 2014 the Maintenance and Other Operating Expenses (MOOE) will be cut off totally. By 2020 the budget for Personal Services will have zero allotment. By then, DOH-retained hospitals are expected to be fully corporatized and autonomous and will not receive any subsidy. Health services will be through health insurance system which is a private enterprise specifically Philhealth. Aquino’s health plan is paving the way for private businesses to gradually take full control of the country’s health care delivery. Consequently, this will deprive even more the poor of their right to health.

What is privatization?

Privatization is the abandonment of the state’s responsibility to ensure people’s health and the operation of public health services and institutions into profit-oriented enterprises.

Privatization is a global phenomenon; part of neoliberal policies developed since 1970’s when the world capitalist system was under severe economic crisis. To solve the crisis, the world monopoly capitalists initiated restructuring formula on a global scale and imposed the neoliberal globalization at the core of which are privatization, deregulation and liberalization through their International Financial Institutions - the IMF, WB and Asian Development Bank.

Privatization is the key thrust of the Structural Adjustment Program (SAP) since the Marcos administration and subserviently and doggedly pursued by each succeeding administration. SAP is a serious attack on the people and its sovereignty by deregulating laws and diminishing the state’s capacity to protect the welfare and rights of its citizens. It focuses on integration into the dominant global capitalist structures of trade, finance and production. Its programs are based on short term, profit maximization methods that perpetuate poverty, inequality and environmental degradation.

SAP and other stabilization programs were imposed by the International Financial Institutions (IFIs) on the Philippines to ensure payment of its ever-increasing foreign debts particularly to IFIs themselves. This result in government’s cutting heavily on health budget and other social services and turning over public services and institutions to the private sector. This transforms health from being a basic social service or public good to a commodity traded in markets for profits. SAP further opens liberally the Philippines as market of the world monopoly capitalists’ surplus products and venue for their export capital.

Each administration allots a significant portion of the national budget for debt-servicing. In contrast, the government expenditure for health is just a fraction of the World Health Organization’s (WHO) recommendation of at least 5% of the country’s Gross Domestic Product (GDP). The 2013 budget for debt payment is Php 333.9Billion while health budget is a measly Php 56.8Billion.

This budget proves the government’s ironic move to privatize health care. Furthermore, despite the glaring economic incapacity of the majority Filipinos, they still have to produce out-of-pocket contributions for their health needs. The total out-of-the pocket health expenditures in the Philippines is as much as 83.5% average from 2007 to 2010 according to World Bank data.

Forms of Privatization in the Philippine Health Care Delivery:

Privatization comes in several forms apparently to create an illusory cover to hide the real essence behind its intent. This is a grand design of the International Financial Institutions (IFIs) to generate super profits and to have firm control over the Philippines which has accumulated a whopping $62.9 billion debt for the first quarter of 2012 from these institutions. To accrue funds for debt payment and accommodate surplus capitals of IFIs the following the following are the modes to privatize government assets:

• Outright sale of a public asset - The Welfareville Property and National Center for Mental Hospital at the behest of the World Bank in collusion with DSWD, DOF, DENR, DOJ, COA is again up for sale.


• Privatization of operations and maintenance/outsourcing/contractualization - Examples of outsourced services are: janitorial, dietary, security services; the radiology facility Himex at Jose R. Reyes Memorial Medical Center (JRRMMC), and the HiPrecision laboratory at Tondo Medical Center (TMC) among others. The radiology services at JRRMMC and the laboratory services at TMC which were used to be free before the operation of these private-owned facilities are no longer available.
  
  The one year contract of RNHeals is an example of the massive contractualization in the public health institutions. These nurses receive a meager Php 8,000 monthly allowance and an additional but optional Php 2,000 from the employer which is either a public hospital or a local government unit.
  
  
• Public-Private Partnership (PPP) - This is the flagship program of the Aquino government and has lined up at least three (3) public hospitals for privatization and some plans which are:
  
  1. San Lazaro Hospital (SLH) – this is the country’s prime hospital for infectious diseases. Foreign private investors will transform the existing facilities into a clinical research center for infectious disease.
     
     • Approximate cost – Php 5.44 Billion/(USD 121.87Million)
     • Revenue opportunity – Income sharing; lease per treatment, clinical trials for research and data mining
  2. Philippine Orthopedic Center (POC) – this is the only specialty hospital for bone problems. This will be developed as the country’s center for bone diseases, trauma, rehabilitation and commercial production of limb prosthesis.
     • Approximate cost – Php 2 Billion/(USD45Million)
     • Revenue opportunity – lease fee per treatment for diagnostic equipment
  3. Research Institute for Tropical Medicine (RITM) – this is being developed for local production of Pentavalent vaccine (DPT, HepaB and HiB)
     • Approximate cost – Php .5 Billion/(USD 11.11Million)
     • Revenue opportunity – sales/revenue sharing
  4. Rizal Medical Center (RMC), the training of RMC personnel has been contracted out through a MOA with the Makati Medical Center Foundation chaired by Manuel Pangilinan.
  5. Establishment of a Multi-Specialty Center in Oncology, Neurosciences, and Stem Cell Research in DOH retained hospitals. 10 hospitals for upgrading and the needed equipment have been identified.
  • Cost – Php 2 Billion (US$45 Million)
  • Revenue opportunity – lease per treatment
  6. Open land area of Eversley Child Sanitarium in Cebu and the Western Visayas Sanitarium in Iloilo are also up for sale.
     • Cost – will depend on the identified operations established by the PPP partner.
     • Revenue opportunity – rent, income sharing
  
  The modernization of government-owned hospitals is meant mainly to cater to medical tourists, who are expected to take advantage of the skilled manpower, state- of- the-art technologies and relatively lower costs of health services.
  
  The development of POC as the Premier center for Bone Diseases, Trauma, Rehabilitation and Commercial Production of Prosthesis as well as the establishment of Multi-Specialty Centers for Stem Cell Research, Neurosciences and Oncology in DOH-retained hospitals are within the implementation of the Medical Tourism Program.
  
  These infrastructure projects are definitely business oriented. The revenue opportunities for each project clearly show that when private sector takes over health services from the government, people’s right to health becomes a commodity.


• Conversion of public hospitals into corporations – at present 26 hospitals nationwide are the targets of House Bills 6069 and 6145 and Senate Bill 3130 for corporatization. There were earlier attempts to corporatize 68 public hospitals which had been shelved. The poor will be marginalized further if these bills are passed.


• Integration/merging of public hospitals – the plan to integrate the GOCC hospitals: PHC, LCP, NKTI, PCMC and the East Avenue Medical Center is aimed at putting up the Philippine Center of Specialized Health Care. This is part of the medical tourism program which promises lucrative return of investment for the investors. DOH claims that its objective is to achieve world class health care. However, this will be for the well-off that can afford and will definitely deprive the poor who cannot.

The relatively cheaper rates for various procedures in the Philippines will surely attract foreign patients to the specialized health care center. In US, labaroscopic gastric bypass costs from $35, 000 to $52,000 while in the Philippines it is from $2,000 - $3,500. Kidney transplant ranges from $200,000 - 250,000 in US. In the Philippines it is from $23,000 to $250,000. The big discrepancies of rates in US compared with those at these centers will assure highly profitable business ventures and will attract local and foreign capitalists. Also, the center will be an open market for the western-made equipment as part of import liberalization.

On the other hand medical tourism will encourage the illegal organs sale which is becoming rampant among the poor Filipinos. A significant number of so called “donors” have been lured by fraudulent middlemen to sell their organs particularly kidneys. These brokers get the big portion of the sale while the donors receive only a small almost a token undeserved share.


• Conversion of a maternal and new born tertiary hospital into a women’s wellness center - this is what will happen with Dr. Jose Fabella Memorial Hospital, a maternal and new born tertiary hospital with 80 – 100 deliveries daily and home to some 300 mothers at a time. The conversion will displace the patients who are mostly from the poor families of Metro Manila to give way to a center for wellness and beauty enhancement of women who can afford to pay.


• Establishment of private entities within a public hospital - private health facilities and services have been put up at the Faculty Medical Arts Building (FMAB) of UP-PGH. Most often, laboratory equipment are not functioning and supplies are not available at PGH. Thus, patients are advised to proceed to FMAB for their laboratory needs where fees are much higher compared even with other private laboratories. Besides, to avoid the long and tedious wait at the Out- Patient Department, some are forced to proceed to FMAB for faster service they need and to shell out-of-pocket fees. No free services are available for the Class D patients.


• Revenue enhancement/user fees schemes – hospitals resort to fund-generating schemes to augment the hospitals’ reduced/insufficient budget and to attain the fiscal autonomy expected of them. Patients have to pay even for the most basic services and supplies like inserting of intravenous line, cotton balls, adhesive tape and the like which were free before. At the Philippine Heart Center (PHC) and the Lung Center of the Philippines (LCP), hospital premises are leased to private capitalists to raise revenues. The number of charity wards has been reduced to give way to pay patients. At the PHC from the 70% allotted to charity beds was reduced to 20%.

Privatization undoubtedly transforms state-provided health facilities and services into business. Allowing business ventures to take over the government’s responsibility will surely result to health and health services:

• Becoming an expensive commodity. It ceases to be a right;
• Being run with cheap labor resulting to underpaid, overworked health workers, contractualization, outsourcing, agency-hired job orders without benefits;
• Becoming affordable only for the rich and those who have money and inaccessible for the poor intensifying the latter’s deprivation and marginalization;
• Treating patients as clients.

The Effects of Privatization

The majority poor Filipinos will suffer the burden caused by privatization. Health will become more of a privilege and a commodity rather than a right of everyone to be provided by the government. Furthermore, it will result to:

1. Inequitable access to health facilities, goods and services. Increased fees for laboratory examinations and services have been noted at the National Kidney and Transplant Institute (NKTI). Last 2011, dialysis costs Php3, 000 per session. In 2012 it went up to Php 3,500 and no charity service is available. In other hospitals it is Php 2,500 or even less. The “no pay no hook” policy for dialysis is strictly implemented at NKTI. This means no session will be started before payment is made.

At the Lung Center of the Philippines (LCP), a Php 10,000 deposit is required before admission. At the Philippine Children’s Medical Center, until 2011 when it was exposed in Congress, it was reported that patients who cannot pay the bills are forced to mortgage whatever valuable they have like cell phones, electric fan, wrist watch etc. so they could be discharged.

The number of patients who cannot afford the privatized health care will increase which will result to further deterioration of the country’s health situation.


2. Increased out-of-pocket share of patients reaching as much as 83.5% of total Philippines health expenditures according to World Bank data. Philhealth does not shoulder the entire bills of the patients. The paying members benefit more than the sponsored members. It specifies only some kind and number of diseases and the amount it covers for hospitalization. It requires a minimum of 9-month maturity of membership premium for member to avail of its service. In far-flung areas where Philhealth accredited health facilities, necessary medicines and worse when even health professionals are absent, the insurance is certainly an ineffective and frustrating proposition.


3. Prevalence of user fees, services for a fee, and revenue enhancement schemes in public hospitals. The previously basic free services and supplies are now charged. This will make health care more inaccessible for the poor. The reduction of charity beds to give way to paying patients will displace the true indigents.
   
   Some public hospitals have upgraded their facilities but fees have increased tremendously. As comparison, at Dr. Jose Fabella Memorial Hospital chest x-ray for PA is Php 100, at PGH it is Php 340. At Philippine Heart Center it is Php 415 and at the National Kidney and Transplant Institute it is Php 485 at OPD with PF of PHP 185. For In-pay it is PHP720 with Php 250 PF, for In-private, it is Php 895 with Php 310 PF and for In-suite, it is Php 1,085 with Php 370 PF.


4. Upsurge of medical tourism which will marginalize the majority poor Filipinos. This will further encourage the manipulative organ sale which prejudices the donors’ health that get a scanty amount relative to the broker’s share. The donors are mostly from the country’s impoverished urban and rural communities.


5. Health care based on the ability to pay clearly and inevitably undermines the health needs of the poor and deprives them of their right to health. The increase in number of pay wards, the upgrading of health facilities for paying patients and the prevalence of user fees schemes and other for- a- fee services contradict the very principle that health is a social good and not a commodity. Medical tourism is the most revealing proof of health becoming a commodity.


6. Privatization policies have led to the closure or dissolution of government units and hospitals which were at the forefront of providing secondary and tertiary health services. The number of public hospitals has decreased from 1,794 in 1999 to 1,361 in 2005. Most of the hospitals that were closed were district hospitals. The number of Rural Health Units (RHU’s) also decreased from 2,335 in mid-1990’s to 1,879 in 2001. The closing down of community and emergency hospitals in 10 towns in Isabela after the provincial government decided to merge them with bigger facilities has affected 300,000 people living in poor areas far from urban centers.

Impact of privatization on the health workers will have a significant toll. There will be standardization of functions which will result to massive retrenchment of regular employees. To soften the blow, the affected will be offered early retirement plan. Medical and physical examinations will be conducted and those who fail will be the priority in subsequent retrenchments.

Privatization will mean reorganizing the human resources. This is a major threat to health workers’ security of tenure. For those who will survive the retrenchment, it will result to downgrading of the employees’ ranks which will definitely affect their salaries. The contractuals or job order workers will replace the retrenched regulars to cut on expenses. At present vacated plantilla positions either through retirement or death of the employee are permanently left unfilled. At the Philippine Heart Center, there are 50 RNHeals employed for one year and 487 contractuals and all are without benefits.

The workers’ economic and democratic rights and benefits prescribed under the Magna Carta of Health Workers or RA 7305 will be forfeited. These gains will not be recognized under private institutions. This is more than curtailment. It is disregarding all together the health workers’ gains under RA 7305 which are fruits of their persistent and concerted struggles.

At the Lung Center of the Philippines (LCP) disallowance of benefits amounting to almost P200, 000 per employee is being implemented. These are charged upon retirement which divests the employees their retirement benefits. In a number of cases, the health worker had to pay his entire retirement benefit for his disallowances.

There could be more negative effects of privatization on health workers and the patients we are serving. This should be a motivation for everyone to vehemently expose and oppose the schemes of the International Financial Institutions and the conspiring local capitalists and the bureaucrats. Upgrading and improving the health care delivery are a must for it to be appropriate and responsive to people’s needs. However, if these are left to the private business, health care becomes business for profit. The people’s right to health becomes a commodity for sale.

Our stand against privatization

We believe inefficiencies in government-run health facilities and institutions are but results of the systemic neglect on health. The tell tale sign is the government’s non-priority in allocating appropriate health budget and its subservience to the impositions of the monopoly capitalists supported by the scheming local bureaucrats and capitalists. Health budget gets a measly sum compared to debt servicing and the military. As a result, our health care delivery system is very much wanting in quality of both in its services and in management. The prevailing political influence/patronage and corruption at every corner of the bureaucracy worsen further the country’s despicable health care situation.

Privatization of health facilities and services is geared toward serving the medical needs mainly of those with ability to pay. Corporatized hospitals will increase the number of their pay wards, will upgrade their facilities to cater to fee-paying individuals seeking medical and health-related services. The Aquino government is vigorously promoting medical tourism touted to improve efficiency and quality of services. On the contrary, this is against the principle of health being a social good. Medical tourism is the apex of health as a commodity. The well-off patients seek the cheapest price for a service while the providers making the most profit out of that service. The poor, on one hand are increasingly marginalized by the system.

The government and advocates claim corporatization is not privatization. However, corporatization is privatization of public or government-owned assets and/or services no less. The board of trustees which takes over the management is mandated to enter into financial transactions it believes will make profits to attain fiscal autonomy and viability. This is clear in the DOH Health Financing Scheme which states that by 2020 all DOH retained hospitals will be fully corporatized and will not receive subsidy. The transformation of the service orientation of public hospitals into profit-driven venture and the shift of health care from the state to private entities is clearly privatization.

The profit orientation of public health care turns public hospitals into business. If the 26 public hospitals are corporatized, the huge “savings” will be an enormous amount for the debt payment to the IFIs, and a guarantee of private investors’ lucrative return of investment at the expense of the people’s welfare.

Analysis

Privatization of government-run facilities and services is the state’s ultimate disregard of the people’s right to health in spite of the clear mandate from both national and international covenants. It is an eloquent testimony of the state’s abandonment of its responsibility to the people giving utmost priority and preference the interest of the monopoly capitalists and the colluding local capitalists and bureaucrats. This vividly illustrates the subservience of the ruling elite to the dictates of the IMF-WB at the expense of the people. Worse, they use the people’s welfare and interests to justify their oppressive and exploitative programs imposed through the neoliberal policies by the foreign capitalists primarily the US controlled IMF-WB.

These policies are encroachment on the democratic and sovereign rights of the people and the country. This will ignite and stoke the sentiments of progressive individuals and groups who could not just allow the situation to continue on its rampage. In health care system, relegating its delivery in the hands of the private capitalists, the people’s right to health ceases and instead becomes a commodity for profit. This will worsen the health condition of the majority of the Filipino people while enriching further the bureaucrats, the local and the monopoly capitalists.

At present, the Philippines needs a radical change of the socio-cultural, economic and political systems in order to develop a health care delivery system relevant and responsive to the people’s needs. People’s health can only be guaranteed in a society that is free from the domination of neocolonialism and dictates of monopoly capitalism. Health must be free, comprehensive and progressive provided by the state for it to be truly pertinent and responsive to the health needs of the people at any given time. It must be part of the state’s centralized and comprehensive planning together with national industrialization and genuine agrarian reform program under a truly democratic and sovereign government.

Our Calls:

1. Unite and fight to stop privatization!
2. Junk PPP, corporatization and all forms of privatization!
3. Immediately allocate Php 527 Billion for health!
4. Fight for a free, comprehensive and progressive health care!

26 PUBLIC HOSPITALS FOR CORPORATIZATION

• LUZON:
  1. Cagayan Valley Medical Center (Tuguegarao City, Cagayan Valley)
  2. Veterans Regional Hospital (Bayombong, Nueva Vizcaya)
  3. Baguio General Hospital and Medical Center (Baguio City)
  4. Ilocos Training and Regional Medical Center (San Fernando, La Union)
  5. Region l Medical Center (Dagupan City, Pangasinan)
  6. Dr. Paulino J. Garcia Memorial Research and Medical Center (Cabanatuan City, Nueva Ecija)
  7. Jose B. Lingad Memorial Medical Center (San Fernando, Pampanga)
  8. Batangas Regional Medical (Batangas City)
  9. Bicol Medical Center (Naga City, Bicol)
  10. Bicol Regional Training and Teaching Hospital (Legaspi City, Bicol)
  11. Quirino Memorial Medical Center (Quezon City)
  12. Jose R. Reyes Memorial Medical Center (Sta. Cruz, Manila)
  13. Rizal Medical Center (Pasig City)
  14. Amang Rodriguez Medical Center (Marikina City)
  15. San Lazaro Hospital (Sta. Cruz, Manila)
• VISAYAS:
  16. Vicente Sotto Memorial Medical Center (Cebu City)
  17. Eastern Visayas Regional Medical Center (Tacloban City, Leyte)
  18. Corazon Locsin Montelibano Memorial Regional Hospital (Bacolod City, Negros Occidental)
  19. Western Visayas Medical Center (Iloilo City)
• MINDANAO:
  20. Northern Mindanao Medical Center (Cagayan de Oro City, Misamis Oriental)
  21. Southern Philippines Medical Center (Davao City)
  22. Zamboanga City Medical Center
  23. Cotabato Regional and Medical Center (Cotabato City)
  24. CARAGA Regional Hospital (Surigao City)
  25. Davao Regional Hospital (Tagum, Davao del Norte)
  26. Mayor Hilarion A. Ramiro, Sr. Regional Training and Training Hospital (Ozamis City, Misamis Occidental)

References:

• “PPP: Profits over Public Welfare”, IBON Facts and Figures, 15 & 31 July 2011.
• “Health for Sale”, Ibon Special Release, 30 Oct. 2009.
• “Chronically Ill: An Overview of the Philippine Health Sector”, Ibon Books
• “Privatization Corporate Takeover of Government”, Ibon Databank and Research Center
• “Pagsasapribado ng Serbisyong Pangkalusugan: Kamatayan ng para sa Mamamayan” AHW Update, April 9, 1996.
• Remigio Mercado, “Privatization of Specialty Medical Centers, a Cause for Concern”. College of Public Health, UP Manila, Feb, 1996
• “PPP Projects for the Health Sector”, Enrique T. Ona, MD, FPCS, FACS, Department of Health, Nov. 18-19, 2010, The Manila Marriott Hotel, Pasay City Philippines
• “2013 Budget Message of President Aquino”, SONA, July 24, 2012
• “Devolution and Corporatization of Health Services”, Second of three parts, Special Report, Aubrey SC Makilan
• DOH Health Care Financing Strategy – 2011-2020 DOH Website
• “House Bill no. 6069”, Rep. Anthony Golez, HB no. 6145, by Rep. Raul Daza, and SB 3930 by Sen Drilon
• “Memorandum of Agreement – Makati Medical Center Foundation and Rizal Medical Center”, June 19, 2012
• “Makati Med launches pioneering “adoption” program of gov’t hospitals”, PDI, July 15, 2012
• Agence –France –Presse, June 26, 2012
• ABS-CBN News, May 3, 2012
• Executive Order no. 102
• “Health Sector Debt and Defense Budget 1986-2011” PD’s 2029, 2030, 673
• www.icanservefoundation.org.fees, june 2011
• “Health and Wellness” Local government of Quezon City website
• AHW Position Paper on Aquino Health Agenda, 2011
• NOP Unity Statement 2012

Institutionalizing the Policy of Privatization – Abandonment of State’s Responsibility to Peoples’ Health

A position paper on the 2013 budget for health of the Aquino administration (14 September 2013)

The 2013 national government budget for health of the Aquino administration reflects the state’s increasing abandonment of responsibility to people’s health while giving profits and incentives to the private sector. The proposed health budget reinforces the policy of healthcare privatization and perpetuates the sugarcoating of anti-people programs through token reforms.

Contrary to the pronouncement of “Greater Focus on the Social Contract”, the alleged “Empowering Budget” neither empowers nor fulfills the social obligations of the present dispensation to the people.

The deliberate misrepresentation of “Greater Stakeholder Participation” as “Public-Private Partnerships for Social Service Delivery” reveals the true purpose of the Aquino regime: to turn health care from a public service into a private enterprise via Universal Health Care, Public-Private Partnerships as major components.

This position paper exposes the inherent flaws of the 2013 health budget through a critique of the national government’s historical failure to provide for the health needs of the people as reflected in its appropriations for health. This paper also puts forward what the Aquino government should be spending for, not on what is willing to spend, if it is in the least bit interested in the lives and welfare of the people.

The practice of deceptive “increases”

At first glance, the national government budget for the Department of Health (DOH) seems to be increasing. Yet government share in total health spending has not gone beyond 1-1.5% of Gross Domestic Product and the DOH budget over the last six years has been a mere P 21.7 billion (Table 1). Currently, government’s share of total health expenditure is just over 23%, which is why out-of-pocket spending is still around 55-60%. This means that Filipinos still pay more than half of their health expenses [¹].

A significant amount of P12.612 billion (32%) of the 39.497 billion budget for the Office of the (Health) Secretary will actually go to the Philippine Health Insurance Corporation (Philhealth) as payment for the “subsidy for health insurance premium of indigents under the National Household Targeting System for Poverty Reduction” of the Department of Social Welfare and Development (DSWD).

One-fourth of the health budget amounting to P 10.325 billion is allocated for the “Universal Health Care Program”. This “program”, however, is nothing more than a collection of programs already being implemented by the DOH. The only new item is the P 15.600 million “Social Protection Package for Former Rebels, which is even questionable as a health program.

The other items under the “Universal Health Care Program” are programs that have no significant increase since last year: “Tuberculosis Control” 1.021 billion (in 2012 and 2013); “Non-Communicable Disease Prevention” from P 68.766 million (2012) to P 70.764 million (2013); and the “National Pharmaceutical Policy Development” from P 1.0 billion (2012) to 1.038 billion (2013).

The only two items that actually increased are “Family Health and Responsible Parenting” from P 2.280 billion (2012) to P 2.539 billion (2013), and “Other Infectious Diseases and Emerging and Re-emerging Diseases including HIV/AIDS and dengue” from P 223.797 million (2012) to P 321.951 million (2013). But this is increase is because of the rush to meet up with Millennium Development Goals by 2015 where the government is lagging behind the targets to reduce maternal mortality ratio (which shoots up from 160 to 221 per 100,000 population), cases of HIV/AIDS and dengue.

In contrast, the budget for “Elimination of Disease as Public Health Threat (e.g. Malaria, Schistosomiasis, Leprosy, Filariasis)” actually decreased from P 594.926 million (2012) down to P 520.443 million (2013).

In short, the “Universal Health Care Program” or Kalusugan Pangkalahatan is merely a lip service that offers nothing substantive in form and content.

Questionable allocations that strengthen privatization

In the last six years, the budget allocation for “Health Facilities Enhancement Program” (HFEP) grew logarithmically. From P 1.656 billion in 2008, it doubled to P 3.252 billion in 2010, and doubled again to P 7.144 billion in 2011 (Table 1). This is partly because the total capital outlay allocations of DOH-retained hospitals were removed and lumped together under this item. For 2013, this amount further balloons to P 13.558 billion, which is equivalent to one-third of the entire health budget although it is now separate from the DOH budget.

Yet the history of increasing appropriations for HFEP has not translated to anything tangible in terms of improving access to health care. The last six years has been notable only in the continued absence of any substantial improvement in government-run hospitals and health facilities. Based on the DOH report on the status of HFEP [²], only 16% of 1,230 infrastructure projects were completed in 2011, although 100% of the 755 projects in 2012 were allegedly completed. Even the 2,200+ rural health centers and 400+ district hospitals that are supposed to benefit from the 2013 budget are largely questionable because there are more barangay health stations, primary care centers and hospitals in dire need of funds. Since there is no clear-cut basis for the use of funds under this item, the concern is that the item is being used either as a milking cow or as additional government “equity” for entering into public-private partnerships (PPPs). It can also be used as political capital, especially since 2013 is an election year for local government officials.

Another questionable budgetary allocation is the P 1.2 billion earmarked for the “Community Health Team” (CHT) program. In 2012, this program allegedly promoted health by delivering 12 Key Messages to some 646,000+ households across the country and deploying some 62,000 personnel/CHTs. However, a cursory look at the Key Messages will raise not a few eyebrows. These include “Keep your promise to stay healthy”, “Practice proper hygiene”, “Use your Philhealth card”, and “Go to the health center when you have been coughing for two weeks or more”. These messages are either obvious (and therefore do not require repetition) or part of what should be routinely informed of patients by the health center staff.

So why is another P 1.2 billion needed for next year, on top of the almost P 1 billion budget already allocated for the same project this year, for something that should be part of routine work by health center staff members? Will this huge amount be used to oil a high profile promotion of the UHC and the PPPs while covering up the ill effects of privatization?

The practice of intentional neglect

The Magna Carta of Public Health and the Nursing Act of 2002 are two laws that are meant to improve the conditions of health personnel. However, the national government has intentionally overlooked the implementation of these laws and has instead promoted the outmigration of the Filipino health workforce.

The Aquino government’s report of its touted deployment of nurses through RN HEALS conveniently forgets that the nurses only have a 6-to-12 month contract and are given a salary (P 8000 per month) that is way below that mandated by law (Salary Grade 15 or P 24,887 per month).

For 2013, the DOH is asking for P 2.799 billion to deploy 22,500 nurses through RN HEALS (P 2.16 billion), together with 221 doctors under the Doctors to the Barrios Program (P 188 million) and 4379 midwives under the Rural Health Midwives Placement Program (P 315 million). By computation, the P 2.16 billion translates to 22,500 nurses allocated only P 8,000 per month for 12 months. This means that the DOH will still be giving much lower remunerations to health personnel than what is required by law.

In terms of government hospitals, several studies have already noted that the DOH is not providing adequate budgetary allocations for these hospitals to function efficiently. According to the study by Lavado et al. in 2010, “The share of hospital allocation in the total DOH budget has been declining”, “There appears to be no clear allocation criteria for hospital budget”, and “Poorer regions are not receiving higher hospital subsidies” [³].

For the past two decades, state-run hospitals have been given budgets not based on what they actually need or spend. Instead, they are given incremental increases that are but a fraction of what they actually need to provide the services required of them. This practice is still reflected in the 2013 budget.

Thus, for example, the budget allocated for Jose Reyes Memorial Medical Center (JRMMC), the flagship hospital of the DOH, is largely insufficient for its 400+ bed capacity. Similarly, like most DOH-retained hospitals, the 700-bed Philippine Orthopedic Center is usually given around 30-40% of what it actually spends per year.

The government purposely encourages government hospitals to implement revenue enhancement programs to generate income which paves way to the entry of private sector/business.

In contrast to DOH-retained hospitals, the two hospitals under the Department of National Defense have been given budgets that are more proximate to their actual needs (Table 2). From 2008 to 2012, the annual Maintenance and Other Operating Expenses (MOOE) of Veterans Memorial Medical Center (VMMC) was four-times that of JRMMC. In the same period, the MOOE of the Armed Forces of the Philippines Medical Center (AFPMC) was almost equal to the combined MOOEs of JRMMC, San Lazaro Hospital, Jose Fabella Memorial Hospital, and Tondo Medical Center, even though the total patient capacity and amount of services provided by the four DOH-retained hospitals are more than twice that of the AFPMC.

Furthermore, unlike the DOH, the DND has been allocating an annual budget for the provision of Magna Carta benefits to its health personnel since 2011 (Table 3). This does not only involve personnel in its two hospitals (VMMC and AFPMC) but also those in its three major services (i.e., Army, Navy, and Air Force).

Similarly, the Philippine National Police has allocated P 3.850 billion every year from 2011 to 2013 for the provision of Magna Carta benefits to its health personnel. This raises the question of selective, if not outright biased implementation of the law. With this, it is clear that the government cares more for the military and neglects the health workers.

Implementing token and deceptive programs to cover up neglect and abandonment

Aquino’s Universal Health Care boasts of the PhilHealth as one of its pillars emphasized “the need for making PhilHealth membership a must for every Filipino”. The DOH intends to realize compulsory membership by “working with other government agencies to enforce mandatory PhilHealth membership for all Filipinos.” Mechanisms to this effect include making PhilHealth membership a requirement for school enrolment, licensing of business, renewal of drivers’ license and other government transactions.

PhilHealth which the DOH described as a “financial risk protection” is in essence a program which passes to the people the burden of paying for their health needs and medical emergencies. With the P100 monthly premium (P200/monthly by October 1, 2012) collection from every member, the DOH so easily deceptively points to PhilHealth program and coverage every illness and health emergencies one encounters.

In the 2013 Budget, the government allotted P12.6 Billion for PhilHealth. This is in line with the 2011-2015 Philippine Development Plan and UHC target to enroll 5 million poorest families by the year 2015. DOH Undersecretary Teodoro Herbosa announced the plan to phase out the charity wards in government hospitals. Curiously in the 2013 health budget, there is no longer a budget item for charity wards in government hospital.

The growing dependence of the DOH on role of Philhealth for healthcare delivery manifests a very myopic approach to decades-old problems besetting the Philippine healthcare system. No access to healthcare? PhilHealth will help you. Cannot afford to buy drugs? PhilHealth will help you. Being plagued by dengue or leptospirosis? PhilHealth will help you. No doctors or nurses in your areas? PhilHealth will help you. Based on the pronouncements of DOH officials, PhilHealth is the new “wonder drug” cure-all for the chronic ills of the health sector.

But PhilHealth cannot cover-up the continuing failure of the Aquino government to provide long-term solutions. For one, Philhealth has its own problems. Its numbers regarding coverage, for instance, is highly suspect because Philhealth has no reliable number of its total members. What Philhealth projects as its percentage coverage are mainly estimates and because of this, many of the real poor will continue to be denied the health care they need. PhilHealth as a social health insurance has many limitations and restrictions.

Moreover, PhilHealth coverage is useless if the public healthcare system remains neglected. For instance, its program of “No Balance Billing” only applies for sponsored members who are confined in accredited state-run hospitals, suffering from selected 23 medical & surgical conditions. Many provincial and district hospitals are not even equipped to provide service for these cases.

Worse, PhilHealth cannot mitigate the effects of privatization. A recent study based on Philhealth’s own projections shows that even if Philhealth pays out all of its funds (P 103 billion) in 2015, this will only account for only 20% of total health expenditure [1]. And since government share will continue to decrease due to privatization, Filipinos will still pay for more than half of their health expenses.

Selection of PhilHealth’s members under its indigency program will continue to be used for political purposes. The distribution of Philhealth cards, usually with only a one-year lifespan, was once associated with the Arroyo regime. Yet the Aquino government is not beyond continuing this EPAL-practice. It will not be surprising when the distribution of PhilHealth cards will once again be used to increase the political stock of candidates running in the 2013 elections.

In terms of showcase programs, nothing exemplifies the politics of palliatives more than the Pantawid Pamilya Program of the DSWD. This intends to cover up neglect of services, pacify the poor and creates dependency among them. Rather than provide jobs or land to the tillers, the Aquino government preferred to expand this dole-out program. But rather than “tide over” (pantawid) the poor, the program has increased their numbers in the last three years. As such, from a budget of P 39.445 billion in 2012, the DSWD is asking for P 44.256 billion in 2013. This amount is bigger than the entire DOH budget.

Neither universal nor adequate health care in the 2013 health budget

The 2013 health budget is replete with the same infirmities that afflict all previous national government budgets. These have intensified the already moribund state of the government-run healthcare delivery system.

Instead of sustainable development anchored on the people, there is the business interest and the push for privatization and corporatization. Instead of the value of service, there is the desire for profit and revenues. Instead of people as patients or as partners in health, they are viewed as clients and communities as markets. Instead of health as a social obligation of government, health has become a commodity being sold to the highest bidder.

Ideally, the national government budget for health should reflect the highest priority being given by that government. Instead, it has become a constant reminder of the exact opposite: the obstinate refusal of the Aquino regime to address the fundamental problems faced by Filipinos. The chronic ills that have affected the healthcare system are being perpetuated, or worsened, by the same level of thinking that has brought about such problems in the first place.

The 2013 budget, like the previous ones before it, embodies the manifest effort to make the neoliberal, market-driven framework of health more acceptable while hiding its innate bankruptcy. Token reforms are used as tools to deceive, if not coerce, the people into accepting privatization. What is obvious is that the Philippine government’s blind obedience to policies being peddled by the World Bank, International Monetary Fund, World Trade Organization, Asian Development Bank and various so-called development agencies, has only made the lives of Filipinos more miserable. From the structural adjustment programs of the 80s to the WB’s “Investing in Health” in the 90s to the “health sector reforms” and “universal health care”, these policies have only enriched the ruling elite and maintained the exploitative conditions imposed on the majority of Filipinos.

Our demand for an adequate health budget

The Aquino government’s health spending should not be less than P527 billion. This is based on the computation that public sector share (both national government and the local government units) of total health expenditure should be 5% of Gross Domestic Product in order to substantially decrease the out-of-pocket expenses of Filipinos.

This amount will have an immediate impact on all Filipinos as it will cut out-of-pocket spending. The funds can easily be raised by the Aquino regime if it has the political will to do so.

The P 527 billion health budget will be broken down as:

• 35% or P 184.5 billion for improving the public healthcare delivery system
• 30% or P158 billion P billion to fund health human resource maintenance and development
• 35% or P184.5 billion for preventive and public health programs, and health promotion

HEAD believes that the health budget being proposed is a step meant to ensure that the right to health is guaranteed and fulfilled by the Aquino government.

The health budget being proposed also challenges the current policy of healthcare privatization and the corporatization of government hospitals. Nonetheless, a higher budget for health is only an initial measure. The demand for a free, comprehensive, and progressive health care for Filipinos remains a continuing call.

Most importantly, the needs of the Filipino people cover a broad range of social determinants that impact their health and lives: jobs, land, homes, and rights. Genuine land reform and national industrialization, together with genuine freedom and democracy, remain imperative.

References: [¹] Paterno RP. “How do we finance universal health care?” Institute of Health Policy and Development Studies. 10 May 2012 (powerpoint presentation) [²] Department of Health. National Expenditure Program 2013 Budget Briefer. August 2012 [³] Lavado RF et al. How Are Government Hospitals Performing? A Study of Resource Management in Government-Retained Hospitals. PIDS, January 2010

ANNEXES

Table 1.
Comparison of DOH annual budget per specific line item (2008-2013)(in millions of pesos)

	2008	2009	2010	2011	2012	2013
PS	5,833	6,727	6,867	7,710	7,633	8,866
MOOE	10,643	10,585	11,317	15,192	25,995	30,413
Capital Outlay	2,436	6,355	6,466	8,927	8,528	218
Health Facilities Enhancement Program	1,656	2,073	3,252	7,144	5,0781	(13,558)2
Amount to PHIC	---	---	---	3,500	12,028	12,612
NG budget for DOH	18,912	23,667	24,650	31,829	42,156	39,497 (53.055)
Actual DOH budget3	17,256	21,594	21,398	21,185	22,050	26,885

(Source: DBM GAA 2008-2012, NEP 2013)

• ¹Aside from the P 3 billion as PPP equity.
• ²Set under the “Priority Social and Economic Projects” (see Special Provisions no. 1 of 2013 NEP of DOH) and is not found under the budget of the Office of the DOH Secretary. It is mentioned in the NEP 2013 budget briefer of the DOH.
• ³NG budget minus (HFEP + PHIC).

Table 2.
Comparison of NG budget between DOH-retained hospitals and
DND hospitals (2008-2013) (in millions of pesos)

	2008	2009	2010	2011	2012	2013
Jose Reyes Memorial Medical Center
NG budget	292.199	363.603	367.281	368.288	389.315	465.266
MOOE	68.355	73.855	80.815	71.515	76.446	105.914
PS	220.844	254.642	256.466	296.773	312.869	359.352
CO	3.000	35.106	30.000	---	---	---
San Lazaro Hospital
NG budget	269.137	343.389	313.536	322.079	315.681	398.813
MOOE	104.712	103.012	112.180	105.680	105.680	165.112
PS	164.425	190.077	191.356	216.399	210.001	233.701
CO	---	50.300	10.000	---	---	---
Tondo Medical Center
NG budget	102.441	157.692	131.898	136.159	138.316	177.081
MOOE	22.229	26.071	27.729	27.729	29.115	46.966
PS	80.212	92.987	93.669	108.430	109.201	130.115
CO	---	38.634	10.500	---	---	---
Jose Fabella Memorial Hospital
NG budget	257.411	294.478	299.801	325.889	367.787	390.180
MOOE	50.778	51.778	55.436	53.436	53.436	77.709
PS	201.633	232.650	234.365	272.453	264.351	312.471
CO	5.000	10.050	10.000	---	50.0	---
TOTAL NG budget	921.188	1,159.162	1,112.516	1,152.415	1,211.099	1,431.34
TOTAL MOOE	246.074	254.716	276.16	258.36	264.677	395.701
TOTAL PS	667.114	770.356	775.856	894.055	896.422	1,035.639
Veterans Memorial Medical Center
NG budget	629.334	718.423	689.443	820.151	808.868	829.102
MOOE	309.515	318.857	328.644	371.589	386.294	395.482
PS	319.819	358.566	360.799	395.562	389.574	433.620
CO	---	41.0	---	53.0	33.0	---
AFP Medical Center
NG budget	713.339	850.099	923.534	1091.493	1098.104	1163.694
MOOE	405.102	517.530	588.808	727.242	756.895	772.676
PS	306.237	332.569	334.726	364.251	341.209	391.018
CO	2.0	---	---	---	---	---

Table 3.
Annual budget for Magna Carta of Public Health Workers (RA 7305)
benefits by different DND branches and the PNP (in millions of pesos)

	2011	2012	2013
Army	15.855	15.855	15.855
Navy	26.543	26.543	10.175
Air Force	13.702	18.232	15.036
VMMC	22.768	---	---
GHQ (w/ AFPMC)	62.611	63.578	63.578
TOTAL	141.479	124.208	104.644
PNP	3.850	3.850	3.850

(Source: DBM NEP 2013)

Note:

• DND, Department of National Defense;
• PNP, Philippine National Police;
• VMMC, Veterans Memorial Medical Center;
• GHQ, General Headquarters;
• AFPMC, Armed Forces of the Philippines Medical Center

Conference Against Privatization of Health Care

About 250 leaders from hospital unions, health professional organizations, community leaders, academics and other health activists were gathered yesterday (July 18, 2012) at the Social Hall of the University of the Philippines Manila to share ideas on current issues besetting the country's health care delivery system, formulate a unity statement and a general plan of action. Essentially, our call to the Pnoy government: provide adequate funds for health care, no to privatization of public hospitals and health services. The conference was organized by the Network Opposed to Privatization of Health Services, in which the Alliance of Health Workers is among the convenor.

Campaign against privatization of public hospitals intensifies

Bayan Muna Rep. Teddy Casiño urges his fellow lawmakers to withdraw support from privatization of public hospitals.

By INA ALLECO R. SILVERIO
Bulatlat.com

As the House of Representatives starts its 16th congressional session later this July, apprehensions are rife that it will push for the complete privatization of public hospitals in the country, leaving poor patients at the mercy of corporate interests.

Bayan Muna Rep. Teddy Casiño is appealing to his colleagues to withdraw support to bills that aim to corporatize the country’s public hospitals. He said lawmakers should realize that House Bill 6069 or “An Act Creating National Government Hospital Corporations,” has dire, if not life-threatening implications for the country’s poorest citizens. He said hospital corporatization and the government’s Public-Private Partnership scheme will result to higher hospital fees.

“This bill and its counterpart measure Senate Bill 3130 or the National Government Hospital Corporate Restructuring Act, will make healthcare services inaccessible for poor families all over the country,” he said.

House Bill 6069 is authored by Bacolod City Rep. Anthony Golez while Sen. Franklin Drilon is behind SB 3130.

Casiño is actively campaigning against public health privatization saying that privatizing government hospitals will only worsen the already considerable problems the hospitals are already facing. He said many public hospitals are already charging exorbitant fees for their services.

He said the corporatized Philippine Heart Center (PHC) and the National Kidney and Transplant Institute (NKTI) already charge as much as P415 ($9.65) to P430 ($10.23) for a chest x-ray while the Jose Reyes Medical Center and the Rizal Medical Center, both of which are among the 26 hospitals being targeted for corporatization charge only P290 ($6.90) to P310 ($7.38) for the same service.

An ultrasound procedure that many women need in the course of their pregnancy costs only P750 ($17.85) at the Jose Reyes Medical Center. The NKTI and the PHC charge P1,650 ($39.28) and P1,800 ($42.85) respectively for the same procedure.

Casiño said the poor in the country’s poorest regions will have to pay higher rates for the same procedures.

“Of course it becomes more expensive for those procedures and other health care services in the provinces. For instance, Negros Occidental has only 80 hospitals. Only 18 of these are government hospitals, and they will all have to cover the health service needs of the local 2.4 million population. The poor’s access to health care is extremely difficult. Government hospitals should still be service-oriented, not profit-oriented that is why no one in his right mind would want to increase hospital fees at the Corazon Locsin Montelibano Memorial Regional Hospital. The only thing that should be increased there and all government hospitals is the government budget for medicines, infrastructure and the health workers’ and professionals salaries and benefits,” Casiño said.

The Corazon Locsin Montelibano Memorial Regional Hospital was only given P262.32 million ($6.23 million) in the 2012 national budget.

“It is the government’s responsibility to provide its people with quality health care, especially the poor. It is not the role of government to give its health assets to private schemes. This is why we should nix the corporatization of government hospitals,” Casiño said.

In a related development, the Alliance of Health Workers (AHW) on the occasion of President Benigno Aquino III’s second year in office last June 30 said health statistics continue to worsen, along with the problems faced by health workers. The AHW said that the Aquino administration’s privatization policy has failed to improve people’s health. It joined a protest against the administration’s public-private partnership program held in front of the Philippine General Hospital.

Deteriorating health of Filipinos

AHW president Jossel Ebesate argued that even the Department of Health has admitted that the country has failed to lower the national maternal mortality rate of 221 deaths per 100,000 live births in the period 2006-2010 compared to 161out of every 100,000 in the period in 2000-2005.

“Contrary to the Aquino government’s claim that it wants universal health for Filipinos, health services are becoming more inaccessible to the poor majority. The Aquino government is continuing the privatization program that was begun in the 1990s. The fee-for-service in public hospitals and hospital budget cuts are designed as a privatization measure under the ‘Kalusugan Pangkalahatan’ program of the administration that was launched in September 2011,” Ebesate said.

Kalusugan Pangkalahatan is being spearheaded by the DOH. Its main aim is supposedly to provide financial risk protection for all Filipinos, especially the poor, by ensuring universal PhilHealth coverage and improving the benefits of PhilHealth. In a statement, the DOH said ” the PPP initiatives are designed to help PhilHealth encourage more and more people to become part of PhilHealth and to assist PhilHealth in improving its services for its members.”

DOH Secretary Enrique T. Ona, who also serves as the Chairman of the Board of PhilHealth said the agency is “hellbent in achieving universal coverage in three years” in accordance with the the National Health Insurance Law that mandates that all Filipinos must be members of PhilHealth.

Ebesate said despite the claims that the Kalusugan Pangkalahatan program will democratize health services by making them more accessible to the poor, the opposite is happening as rate of services continue to increase.

“The public birthing hospital Dr. Jose Fabella Memorial Hospital now charges some P3,000-P5,000 ($71.43 to $119) for normal delivery, while the Tondo Medical Center now charges a minimum of P1,500 to P2,000 ($36 to $48) for normal delivery. The PGH will also be charging indigent patients for selected diagnostic and laboratory procedures. These hospitals used to provide free obstetric delivery and other health services before the revenue enhancement program was implemented by the government,” he said.

Patients and the public unite against privatization

The Network Opposed to Privatization (NOP)also is actively fighting against the privatization of public hospitals. It makes the rounds of public hospitals encouraging hospital workers, medical professionals and the public to stand against all attempts to transform the hospitals into corporate entities. The group has already held simultaneous protest actions in front of the PHC, Jose Reyes Memorial Medical Center, the PGH, the National Center for Mental Health, National Children’s Hospital, Tondo Medical Center. Members of the network posted posters and streamers against privatization.

Sean Velchez, a registered nurse, president of the union in the National Orthopedic Hospital and NOP convenor said government hospitals have been put up on the auction block via the government PPP program.

“Privatization proponents say that privatization efforts will serve goals of modernization and efficiency, but they say nothing about the severe impact on patients and the rest of the public. Among the affected hospitals of the privatization scheme are the Philippine Orthopedic Center (POC), San Lazaro Hospital (SLH), the Research Institute for Tropical Medicine (RITM), and 25 other public hospitals across the country,” he said.

Dr. Gene Nisperos, NOP Convener, also said that already, various forms of healthcare privatization are being implemented by the Aquino government at the expense of Filipino patients.

“Already there’s the University Physicians Medical Center, a private health facility operating within the PGH compound. Basic hospital services, like radiology, are also being sub-contracted. The government is also selling the Welfareville property in Mandaluyong City where the National Center for Mental Health is. The area is being cleared to make way to a new mall and high-end residential buildings,” he said.

Nisperos said the entry of private business groups in the public health care delivery system directly heightens the in-accessibility of health care in the country. The cost of health services, becomes even more prohibitive than it already is.

“Patients not only have to contend with diseases, but also the highly expensive costs of the cure. Many ordinary Filipinos are pushed into deeper destitution," he said.

The NOP said the provision of free, comprehensive and progressive health care is a responsibility of the Aquino government should not be allowed to evade.

“Privatization is clear proof that the government is abandoning its responsibilities to the people. It means depriving Filipinos not just the healthcare they need but the decent life they deserve,” it said.
[Repost from Bulatlat.com]

Related Articles

1. Laying the foundations for the privatization of government hospitals