here’s a new law that makes it illegal to detain poor patients who can’t pay their hospital bills. Framed by Sen. Pia Cayetano and signed by President Gloria M. Arroyo, Republic Act (RA) 9439, dubbed as the Patients’ Illegal Detention Act (Hospital Detention Act), was passed to permit indigent patients to sign promissory notes so they can leave the hospital, instead of staying in-house, while settling their payment obligations.

At a glance, RA 9439 is pro-poor and compassionately humane. It embraces our long-ignored ugly humiliation of detaining patients for non-payment of hospital services. A dead patient’s body is not released from the hospital morgue; certifications, medical records and burial papers are withheld for the same reason. We court our patients’ relatives to sell their homes and sacrifice their carabaos.

The new law, co-authored by Senators Manuel Villar and Serge Osmena III, now sets a jail time of six months and a fine of up to P50K for errant hospital officers and workers. But it’s unclear what legal avenues hospitals have for those who’re unable or refuse to pay.

It’s horrible to suffer hospital detention. Patients and their waiting relatives are at greater risk of catching hospital-borne diseases. Holding our citizens longer than usual, in places noted for contagion and cure, makes us wonder how we love our patients and respect their rights. Do we need a law which shields the poor from insults and exorcizes our conscience against the failure to deliver adequate medical care?

“The constitution assigns the government the responsibility of healthcare for its citizens,” said Dr. Santiago A. del Rosario, a former president of the Philippine Medical Association (PMA). With the rapid rise in population, he saw the alarming drop in the number of hospitals– from 2,000 in 1988 to 919 in 2005. Behind this huge attrition, our hospitals have been overbooked with patients, doctors and nurses have left for better jobs, and health services have faltered.
More than half of our hospitals have ceased to operate. Dr. Santiago blamed the closures to “absconding patients, taxes, expensive facilities, and high maintenance and labor costs.” With the new law, we run the risk of breeding patients who have little ability and incentive to pay. Hard pressed with the fight for survival, our hospitals will doubly labor on debt collection if we don’t instill fiscal responsibility to ourselves.

The Private Hospital Association of the Philippines (PHAP) through its spokesman, Dr. Rustico Jimenez expressed objection over RA 9439. As a protest and warning, the association planned a “hospital holiday,”—the deliberate slowing and cutting of hospital services if the Department of Health (DOH) can’t come up with acceptable terms of “IRR”—the implementing rules and regulations for the new law.

The PHAP is blurry and pessimistic about signed payment pledges. Even when guaranteed by mortgage or co-maker, the group believes promissory notes will not work because many patients pull back in their financial obligations. Only 10% pays payment pledges; others give wrong addresses and claim penury to escape payment liability.

Nicholas Gonzales, a private citizen, expressed his displeasure to RA9439 when he half-jokingly and half-seriously asked, “Will we allow hungry people to eat at any restaurant and submit promissory notes?”

“It places the blame on private hospitals instead of establishing an accessible healthcare system by allotting sufficient funds for public hospitals,” echoed Dr. Eleanor Jara, the director of Health Education Training and Services Council for Health Development (CHD).

According to Dr. Jara, only 0.1%, about P11.5 billion of the 2007 national budget of P1.126 trillion in 2007, is allotted to healthcare. The amount is measly. It translates to only P144.53 for every Filipino per year. That’s why poor folks go to private hospitals as charity patients rather than be treated in poorly-funded, crowded public healthcare facilities which just the same— charge their patients.

The stark inadequacy of the RP’s healthcare budget prompted Senator Pia Cayetano to push, without tangible success, for a raise in the national health budget, from one to five percent of the Gross National Product (GDP). The senator said the increase is advised by the World Health Organization (WHO) so that an effective health care delivery system could be achieved in the Philippines.

We have seen the worst and the most fearsome of our inequities. In the front burner, the new law puts forward problems in many surreal ill-defined forms which must be tackled by our government with public cooperation.

There’s urgency to raise our healthcare money; our leaders must heed the cries of the poor instead of wrangling over inane political issues which blur our vision. A sizeable portion of the national budget, pork barrels, valued added taxes (E-VATs) etc. are needed to sustain the viability of our health services. With sky-rocketing medical costs, we need more funding for insurance programs, health research, prescription drugs, preventive care, and medical aid for the poor.

We must act now to steer away hospitals from financial ruin by stopping fraud, encouraging patients to save, granting tax deductions, providing equipment upgrades and intensifying health education.

The insurance plans offered by the Philippine Health Insurance Corp. (PhilHealth) and other private insurance groups should serve as blueprints for our goal of universal health coverage for Filipinos. (Photo Credit: UP-PGH/ErnieUichanco) =0=


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