Affordable health care still a dream

ALL OVER the country, we hear cries of patients who could die because of insufferable hospital and doctors’ fees sooner than from their ailments. There is this joke which has passed on to reality of people surviving their hospitalization but dying after a heart attack upon seeing the bill.

Except for the PhilHealth program, which is still sorely inadequate because money for it is being diverted to low priority political expenditures, we do not see any systematic approach to ensuring competent and inexpensive medical care for Filipinos who can least afford it.

Will somebody, in or outside the government, please make a sustained great effort to rein in the money motivation of hospitals and doctors? Somebody has to put an end to the horror stories of the sick fearing hospital confinement because of the expected exorbitant fees.

Add to the likely culprits, the Health Maintenance Organizations, whose business somehow reminds us of the college assurance program that went awry some years back after operators collected premiums from trusting parents then failed to deliver at enrolment time.

Public health is a prime responsibility of the government since it holds (hides?) the billions meant for caring for the people and since it is supposed to be organized for systematic approaches to problems affecting the masses. What then is the government doing?

As we started to write this, José Cortez of Manila whose 98-year-old mother Leonila has been confined for pneumonia in a medical center in Parañaque said in a text message with reference to previous Postscripts on the soaring cost of hospitalization:

“You hit the nail on the head! Government may be inutile as far as hospital charges are concerned. Enlightened consumer organizations may be able to do it, but you need leaders to organize and make it their advocacy to check on these unwarranted pricey medicines, procedures and unchecked doctors and hospital fees.”

COMES now the Association of Health Maintenance Organizations of the Philippines Inc., in the person of its executive director Carlos D. Da Silva, explaining an HMO coverage issue in an email (edited to fit):

“Reference is your Postscript of Dec. 29, 2015, titled ‘HMOs deny coverage to senior citizens’ on House Bill 6348 (Anti-Healthcare Age Discrimination Act) by Rep. Roman Romulo.

“Most HMOs would likely have only one or two major products in the market – the traditional ‘Individual’ or ‘Family’ plan; and the traditional ‘Corporate’ plan (or a variation thereof under an ‘Administrative Services Only’ or ASO program). Some HMOs do not have individual plans and only cater to corporate accounts. However, others offer a variety of products for different target markets.

“Many factors are taken into consideration by HMOs in pricing their products or services, e.g., the prevailing medical costs in the industry, the attained age of an individual applicant or the median age for a corporate account, risk assumptions on existing health profile/s of the individual or group, occupational or environmental hazards of the applicants, industry classification they belong to, past history of program utilization (for renewing accounts), medical or lay underwriting results, if any, marketing and selling expenses, if any, competition in the marketplace, the company’s administrative loading, the many benefits of the program including latest modalities of treatment, tailor-fitted benefit inclusions per client requests, medical network including specialists, point-of-service privileges, etc.

“All these are taken into consideration in order to price correctly the risks involved and the cost of doing business with a particular client.

“Admittedly only a very few HMOs have taken the risk on geriatric care plans for senior citizens as a target HMO market primarily on account of the fact that geriatric care encompasses a more holistic approach to cope with aging and its effects, not to mention the onset of the inevitable failing of mental and physical health – health risk conditions some HMOs may not be organized to assume nor prepared to undertake.

“Just like any business organization, HMOs package their products and services according to their capacity to assume risks based on their risk-based capitalization, not to mention expertise and technical knowhow in service delivery.

“To be forced to provide healthcare packages to a market it is not prepared to undertake would be against their rights as corporate citizen of the Philippines, not to mention the possibility of a failed business venture that will not only affect the ‘seniors’ among their planholders, but all their planholders in general, not to mention leaving a lot of unpaid bills with affiliated hospitals and accredited doctors in case of their closure.

“We fully agree with you that HMOs should not discriminate against senior citizens especially in the light of increased benefits for our senior citizens – in particular, in the area of healthcare. But let it be the decision of the HMOs concerned to offer plans for senior citizens and if ever they do, at a price equitable to both parties.” –Federico D. Pascual Jr., Philstar