PPPs in health threaten to make health care costlier – health workers - Bulatlat

Published on July 22, 2011
Bulatlat.com

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital.

By MARYA SALAMAT

Sidebar: Health workers blame Aquino’s PPPs for further crippling the Philippine Orthopedic Center

MANILA – After one year, healthcare in the country has gone from bad to worse — this is the assessment of the Alliance of Health Workers (AHW) on the Aquino government’s impact on health. In a series of protests held by its member unions in different public hospitals in Metro Manila, the group aired the various shocks of Aquino’s touted PPPs (public-private partnerships) on the services of public hospitals and the working condition of health workers and professionals in the country. The group challenged Aquino to stop the privatization “in any form” of public hospitals and to bail out public health by infusing it with a P90-billion ($2.09 billion) budget at least.

UP-PGH health workers urge their hospital management to revert to giving poorest charity patients free treatment. A mother brought out a child patient. (Photos by Marya Salamat / bulatlat.com)

During Aquino’s first year, the country’s main public hospital, the Philippine General Hospital (PGH), for example, has, for the first time in its history, resorted to charging fees even from its lowest ranked charity or indigent patients. In a memo issued last month, the PGH administration reportedly directed its hospital staff to charge the previously free diagnostic and laboratory examinations of “class D” patients. These are the patients who, according to the hospital social workers, belong to the lowest earners or the poorest of the poor among the four groups who qualify for “social service.” Class D used to receive full support (or full charity), while the other classes under social service get discounts, much like the socialized tuition fees being implemented in the University of the Philippines, explained Jossel Ebesate, AHW national president.

In the Philippine Orthopedic Center, fees have been drastically increased early this year, with some increasing more than twice its old amount.

Because of the budget cutbacks implemented by the Aquino administration in the budget for maintenance and other operating expenses of public hospitals, the previous shortages in medicines, supplies and other equipment have become worse, reported the AHW. The exacerbated shortage in turn prompted the administrations of public hospitals to increase fees and to charge fees on previously free items in the hospital menu of services.

“You go to a public hospital emergency room to have your wound cleaned, you have to first buy some cotton, wound antiseptic, and dressings, before you can be treated,” said Joel Bitanga, 40, an X-ray technician in San Lazaro Hospital. He added that if you were brought to their hospital and you can’t breathe, you have to buy the hose and other paraphernalia for your oxygen.

Health workers and a child urge the Aquino government to treat healthcare not as source of profit but as public service.(Photos by Marya Salamat / bulatlat.com)

Picketing in front of San Lazaro Hospital, then at Jose Reyes Memorial Medical Center and in front of the Department of Health, the health workers decried last Monday the increased fees also prevalent in the Philippine Heart Center, the Lung Center of the Philippines, the National Kidney and Transplant Institute (NKTI), the Philippine Children’s Medical Center (PCMC) and the East Avenue Center (EAMC). These are some of the hospitals retained by the national government after it implemented a devolution of health services in 1992.

The practice of charging and increasing fees which the majority of low-income Filipinos are already finding as tough, would likely worsen if the Aquino government pushes through with its planned PPPs targeting even government hospitals, the AHW warned.

Already, the health group noted that some private companies that were able to get concessions in public hospitals have been profiting from this public-private partnership. They cited as example Himex, which provides the radiology “services” of Jose Reyes Memorial Medical Center; the Carte-blance in Lung Center which profits from its dietary services; and Fabricare for Lung Center’s laundry. In PGH, the privately-operated Faculty Medical Arts Building has begun operations this year.

In public hospitals being operated by local government units, a measure of success is the increase in hospital income, which could be
had by adding “private” or “pay wards” and other services that charge fees. The biggest example, for having been the first to be declared as a corporatized hospital is the La Union Medical Center. Provincial hospitals are now trying to follow its example, after its local governments have sent their public hospitals’ directors and staff to “Lakbay Aral” (Study Travel) to learn from “successful” provincial public hospitals.

Up for starting new PPPs soon are the Philippine Orthopedic Center (POC), the San Lazaro Hospital and the Research Institute for Tropical Medicine (RITM). While the moves are seeking to improve and upgrade the said hospitals – something which the health workers’ union said they also wish to happen – they are decrying the fact that these have to be planned under a PPP setup. They urged the government instead to fund the needed development, rather than enter into partnerships with the private sector whose motives for entering health services are mainly for profit.

Health groups blame US imperialist dictates for Aquino’s drive to privatize and commercialize healthcare.(Photo by Marya Salamat / bulatlat.com)

“What will happen to our mentally ill patients? Will they be abandoned on the streets?” asked Arman Palaganas, vice-president of the health workers’ union in National Center for Mental Health. This mental hospital and the Philippine Heart Center are up for bidding in a public auction set to be held under the Aquino administration, the AHW reported.

When all these upcoming PPPs happen, the AHW warned, health care will become even less accessible to ordinary Filipinos.

Killing you softly

Given the frequently slashed budgets, health workers’ wages and benefits have also taken a beating. In fact, the Department of Budget and Management itself has told public hospital administrators and even local government units that benefits being given to health workers are contingent on the hospital’s savings or on the availability of funds. The result, according to AHW, is either lacking or almost nil benefits especially for health workers under the local government units.

A PGH patient’s charity cards and papers attesting to her indigency could mean little now in terms of free or affordable treatment. (Photo by Marya Salamat / bulatlat.com)

For twenty years now, the country’s plantilla position for health workers and professionals have barely increased, despite the continued pressure of population increases. Worse, while the plantilla positions are being controlled, the AHW noted that the ranks of the country’s health workers are under attack and being reduced by bouts of retrenchment or streamlining through transfer, attrition and early retirement.

Instead of replacing the lost regular health workers, AHW noted that the government itself has been increasingly implementing “flexible labor arrangements,” a favorite under profit-oriented corporations. In the health sector, these arrangements range from contractualization, job-order employment (similar to project-based hiring), and the notorious “volunteerism” where the hospitals not only do not pay the health professionals who serve them but even make them pay for the “training” and “experience.”

As if to gag the health workers’ groups who have been criticizing and providing proofs of the government’s abandonment of its responsibility top ensure the people’s health, there are alleged moves from public hospital managements to bust the health workers’ unions, or else “deceive, divide and crush” the progressive unions under the Alliance of Health Workers. The AHW complained that the management of some public hospitals, such as the National Center for Mental Health, Jose Reyes Memorial Medical Center, Philippine Orthopedic Center and Philippine Children’s Medical Center, “do not recognize and even try to coerce the accredited sole bargaining unit.”

As such, judging from the way the government has been treating Filipinos as patients and as health workers, the health group charged that “the people has never been Aquino’s real ‘boss,’ as he had boasted, but the politicians, the local big landlords and the big local and foreign investors.”

The poor cannot survive under the Aquino government’s health agenda of privatization, the Health Alliance for Democracy said in a statement. The poor will get sicker and die sooner if the rate increases continued, said PGH nursing attendant Ellen Jamison in a picket protest in front of the PGH this week.

The health groups encourage health workers and the families of patients in public hospitals to join in protesting privatization and pushing for health as a human right.

PPPs in health threaten to make health care costlier – health workers - Bulatlat

Nursing Must Return To The Bedside

July 9, 2007 Courant.com/news/local

Last week, The Courant stated that by the year 2010, Connecticut will have 11,000 too few nurses. I assume that means 11,000 too few nurses who would be giving direct patient care.

UConn's board of trustees approved a proposal to help alleviate this nursing shortage ("hemorrhage" is more like it) by adding a master's entry-level program for nursing at two of its branches, graduating 64 new master's prepared nurses each year. Candidates need only a bachelor's degree in any major to be considered. There are two major flaws to this proposal. First, the obvious: 64 vs. 11,000 ... still hemorrhaging! Second, master's prepared nurses typically do not provide direct patient care.

During the last couple of decades, nursing became more focused on credentials and less focused on the patient. Nursing education itself became more academic oriented and less clinical or patient oriented.

All hospital-based schools of nursing closed; LPN's and nurse's aides lost their hospital jobs. We threw away our caps and white uniforms (except on TV), leaving a guessing game of who's who in the scrubs.

Hospitals initiated programs called "nursing ladders" where nurses could distinguish themselves. Individual portfolios were created to document meetings attended, committees joined and classes taken. The more non-nursing tasks documented, the further up the ladder you "climbed." Accordingly, your wages increased. Ironically, the further up the ladder you went, the further from direct patient care you were. There is no denying the benefits of continuing education. However, in our quest to be treated as professionals, we created an environment where a new generation of nurses run as fast as they can from direct patient care.

Now, they say the bigger problem is not enough teachers to teach nursing. My guess is the 64 who received their master's in nursing will teach. They have the right credentials. My question is, how will they teach without any experience? Here is my solution. Let nurses teach based on their years of experience, not just credentials. The nurses with 15- to 20-plus years of bedside experience, whose backs are killing them, may not want to write for nursing journals, but they do know how to take care of patients. So, who better to teach? Second, increase compensation to nurses who give direct patient care, twofold. Make good old-fashioned bedside nursing desirable to the next generation of nurses. Perhaps then, even more men will join us. Last, for the nurses calling the shots, but not giving the shots, build in a few clinical hours into their schedules. (Doctors do!) We must remove the focus of this hemorrhaging profession away from the credentialing scorecard that it's become, and return it back to the patient, where it belongs.

Kate Dunn Scott, RN, Portland

Copyright © 2007, The Hartford Courant

Mga Sirang Batayang Kagamitan: Prayoridad ba ng Administrasyon?

Sa paghahanda kaugnay sa Sentenaryo ng PGH, maraming mga kagamitang medikal ang nasa prayoridad sa pagpapatupad ng “modernization” subalit hindi maitatanggi na ang mga ilang batayang gamit ng ospital ay luma na at dapat mas nasa proyoridad ng pagkumpuni o pagbili ng bago tulad ng generator, elevator, chiller, autoclave, PABX at CBC machine

Ito ay ilan lamang sa nagiging paksa sa diyalogo noong ika-2 ng Hulyo 2007 sa pagitan ng Unyon at PGH Administration.

Dinala ng Unyon ang isyu kaugnay sa mga sirang batayang gamit dahil sa malaking implikasyon nito sa ating serbisyo sa mamamayan at sa ating kalagayan sa paggawa.

Ang ating dalawang pangunahing generator ay puro sira na at may pondo na para sa pagbili ng mga piyesa (ang iba ay bibilhin pa sa Singapore).

Ang mga sirang elevator naman sa Central Block Building ay may inilaan nang pondo para sa pagbili ng bago.

Ang mga chiller plant (3) naman sa DEMS ay puro sira kaya parang pugon sa init ang ER. Kagyat na pinapahanapan ng pondo sa Budget para sa pagkumpuni.

Ang autoclave sa CSR na puro sira din ay kinukumpuni na at may plano ang Administrasyon na ikabit sa CSR ang isang nakatiwangwang na Autoclave Machine na kasama pa sa DEMS Modernization Project, at bibili pa ng karagdagang unit, para pamalit sa madalas masirang unit.

Samantalang ang local telephone exchange system (PABX) natin ay sinabing may nakikita ng pagkukunan ng pondo para sa pagbili ng bago.

Inaasahan natin na ang diyalogong ito ay magpapabilis na maibalik sa normal na operasyon ang mga batayang gamit - para sa maayos na serbisyo sa mamamayan at upang magaan na magampanan ng ating mga kapwa kawani ang kani-kanilang mga tungkulin.

Sabi nga ng marami sa atin: “Anong silbi ng modern medical equipment tulad ng MRI kung ang mga batayang gamit sa ospital tulad ng standby generator, telepono, elevator, aircon at autoclave, kung hindi madalas masira ay di na talaga magamit?

Masusi nating susundan ang mga ipinangakong ito.

PGH: Hospital for the Poor No More: Employees, health groups oppose hospital fee increases

The management of the country's premier public hospital said that there is a need to increase fees to have funds for improving facilities and services. Various groups, however, argued that increasing fees will be done at the expense of the poor who are supposed to be the main beneficiaries of public health services.

BY AUBREY MAKILAN
Bulatlat

The University of the Philippines-Philippine General Hospital (UP-PGH) community and other health groups last week said that there is no reason for increasing fees of PGH's services, arguing that it is being done at the expense of poor patients.

Rate increases

In a Feb. 8 dialogue with PGH-based health groups, UP-Manila Chancellor Ramon Arcadio and PGH Director Carmelo Alfiler said that they will push through with the imposition of the operating room (OR) fee of P1,500 ($31.05) despite protests from various groups. In the past, the use of the OR was free.

Present in the dialogue included representatives of the UP Manila Coalition against PGH Rates Increases, All-UP Workers Union (AUPWU), All-UP Academic Employees Union and the associations of physicians, nurses, nursing attendants and utility workers.

In end-January, the planned rate increases for blue card acquisition and medical certificate releasing were deferred. The payment for the blue card 'which every patient should have to transact with PGH' was supposed to increase by 114% from P7 to P15 ($0.14 to $0.31). On the other hand, the "fast-lane" payment for getting a medical certificate was proposed to be increased by 400% from P20 to P100 ($0.41 to $2.07).

The UP-PGH's rate increase proposals were made immediately after the UP Board of Regents' (BOR) approval of the tuition increase for incoming freshmen students.

During the BOR's 1216^th meeting on Dec. 15, the highest policy-making body of the UP did not only approve a 233-percent hike in tuition and miscellaneous fees. The BOR also ruled that "tuition will be subsequently adjusted annually based on the national inflation rate."

At whose expense?

With the proposed P1,500 ($31.05) OR fee, the administration would not give up the projected annual income of about P16 million ($331,228.65), said Jossel Ebesate, president of AUPWU and secretary-general of the Alliance of Health Workers (AHW).

According to Ebesate, the administration claimed that the income will be allocated for the development efforts of the hospital.

"Profit at whose expense?" he asked. "Hindi tama na ang development efforts to improve facilities and services ay kukunin mo sa patients na dapat ay sineserbisyuhan mo." (It is not right that development efforts to improve facilities and services will be sourced from patients whom you are supposed to serve.)

PGH has 500 pay beds, 800 charity beds and 200 special beds or for the intensive care unit (ICU). PGH accommodates about 1,500 patients every day in the out-patient department (OPD) and 350 patients every day in the emergency room (ER). Most of these patients, Ebesate said, are charity patients.

At first, the PGH management claimed that only holders of the Philippine Health Insurance, Inc. (PhilHealth) card would be required to pay the OR fee. However, since 70 percent of patients undergoing surgical operations are not covered by PhilHealth, Ebesate said that everybody will now be affected by the imposition of the OR fee.

In case of non-PhilHealth coverage, patients will be assessed by the hospital's social service which will then find donors to help them. If no donor is found, Ebesate said that the OR fee would be waived. His group, however, doubt if this will be implemented.

In many cases, Ebesate said that nurses and physicians shoulder the charges passed on even to poorest-of-the-poor patients. "Wala pa nga 'yung OR fee, hindi na kaya ng mga pasyente 'yung mga (simpleng) bayarin. Paano pa kapag nagtaas na?" (Even now that there is no OR fee, patients cannot afford basic fees. What more if the fees increase?)

Wrong priority

Ebesate, chief nurse of the PGH nursing service, said that it is not true that there is no fund available for health services. "Mali lang ang priority," (The priority is wrong) he said, citing misappropriations in the national budget as a result of higher allocation for debt service and military expenditures.

Since 1983, Ebesate said that the PGH budget for personnel services (PS) and maintenance and other operating expenses (MOOE) has never reached P1 billion ($20.7 million). Their actual computations showed that they need about P2 billion ($41.4 million).

He said that the PGH has been generating income to augment the government's meager budgetary allocation. From three percent in the past, Ebesate said that PGH has been earning 30 percent of its total budget at present.

To show their firm opposition to the rate increases, Ebesate said that all groups of the UP-PGH plan to stage mass actions at the offices of concerned government agencies like the Departments of Budget and Management (DBM) and Finance (DOF). Bulatlat

(Computation of dollar equivalents based on an exchange rate of P48.305 per US dollar)

Reign of the Kleptocrats

by: Perry Diaz
PerryScope
January 19, 2007

The recent indictment of former Justice Secretary Hernando "Nani" Perez by the Sandiganbayan brings, once again, to the forefront of debate the issue of corruption in the top echelon of the government. Cabinet members, who are charged of implementing the policies and programs of the government, are supposed to represent the best and the brightest in government service. They are supposedly the models of good moral conduct to be emulated by their employees.

Those were days when government officials were the cream of the crop, and when government service had a mystical appeal to the idealists who truly wanted to make a difference. Indeed, what we used to know as "good governance" is now transformed into "kleptocracy." The public service-oriented government functionaries of yesteryears are gone. Although there are still those in government who are honest and incorruptible, what we have today is a breed of greedy opportunists who use their positions in government to enrich themselves. They are the "kleptocrats." Wikipedia defines "Kleptocracy" as a pejorative, informal term for a government that is primarily designed to sustain the personal wealth and political power of government officials and their cronies.

The Perez corruption case is one of the most despicable corruption cases because, as the chief guardian of the law, he brazenly broke the law that he swore to protect. He was responsible for the prosecution of law-breakers and now he is prosecuted for breaking the law. The Ombudsman, Merceditas Gutierrez, filed charges of graft, extortion and falsification of public documents against Perez -- her former boss -- in connection to the extortion charge of former Manila Congressman Mark Jimenez.

In 2003, Jimenez was extradited to the US where he was tried and convicted to 27 months in prison for tax evasion and conspiracy to defraud the US and commit election financing offenses. Upon his return to the Philippines after serving time in a US prison, Jimenez filed a complaint against Perez with the Ombudsman, claiming that Perez extorted $2 million from him in February 2001 in exchange for dropping him as co-accused in the plunder cased against deposed President Joseph Estrada.

The Jocelyn "Joc-Joc" Bolante case is another high-profile corruption case involving the fertilizer scam during the 2004 national elections. To avoid prosecution, Bolante disappeared for a while only to surface in the US in 2006. Upon his arrival in Los Angeles, he was arrested because of an expired visa. Bolante is now being held in a US jail while his case is pending in a court in Chicago. Coincident -- or was it? -- with the arrest of Bolante, President George Bush announced the escalation of the war on kleptocracy, denouncing "high-level corruption by senior officials, which is robbing the people of many poor nations of their future." Although he did not name the Philippines, he probably had the Philippines in mind when he said that.

In 2002, a report titled "The Eight-Point Comprehensive National Anti-Corruption Strategy" was released by then Ombudsman Aniano Desierto which stated that as of December 2001, "the high ranking officials with criminal charges filed in court included 62 armed forces and national police officials, 523 mayors, 18 governors, 6 congressmen, 2 ambassadors, 17 cabinet members, a former vice president, 2 former first ladies and a former president." I wonder if any of these high-ranking officials had been convicted?

In the same month, the report says, "the Office of the Ombudsman had a combined workload of 13,585 criminal and administrative cases. The number of cases disposed of totaled 9,324 out of which 1,374 was recommended for criminal prosecution, while administrative sanction was imposed on 390 cases." What is wrong with the picture? It's either the prosecution staff were incompetent or the accused were too smart for the prosecutors. Clearly, the wheel of justice is slow as a sloth.

In 2004, Transparency International released a list of "what is believed to be the ten most self-enriching leaders in recent years." In the order of the amount allegedly stolen in US dollars, they are: 1) former Indonesian President Suharto ($15 billion - $35 billion); 2) former Philippine President Ferdinand Marcos ($5 billion - $10 billion); 3) former Zairian President Mobutu Sese Seko ($5 billion); 4) former Nigerian President Sani Abacha ($2 billion - $5 billion); 5) former Yugoslav President Slobodan Milosevic ($1 billion); 6) former Haitian President Jean-Claude Duvalier ($300 million to $800 million); 7) former Peruvian President Alberto Fumitory ($600 million); 8) former Ukrainian Prime Minister Pavlo Lazaarenko ($114 million - $200 million); 9) former Nicaraguan President Arnoldo Aleman ($100 million); and 10) former Philippine President Joseph Estrada ($78 million - $80 million). It is interesting to note that the Philippines is the only country with two of its presidents -- Marcos and Estrada -- on the list.

There was a story during the Marcos years about how Marcos selected the Chief of Staff of the Armed Forces. There were two candidates who vied for the coveted position -- Gen. Fidel V. Ramos and Gen. Fabian Ver. Marcos interviewed Ramos first and at the end of the interview he asked Ramos, "What is ten divided by two?" Ramos quickly answered, "Five!" "Very good," Marcos said, "I'll let you know my decision tomorrow." Next, he interviewed Ver and asked the same question at the end of the interview, What is ten divided by two? Ver paused and scratched his head. Then he said, Five, sir! Five for you and five for me. Excellent, Marcos said, "the job is yours."

Today, the kleptocrats are having the grand "shopping spree" of their lives, filling their shopping carts as fast as they can because they don't know how long the "shopping spree" is going to last. It is sad that the "spirit of service" that predominated during commonwealth years and early period of the republic is gone. What we have today is kleptocratic governance which subordinates economic growth to the avaricious personal interests of the kleptocrats.