Rejoinder to the ‘tipping point’ at TPH

(First of two parts)

We have received a lot of feedback concerning our two-part column on the conflict between the provincial government and the medical and other nonmedical personnel of the Tarlac Provincial Hospital. (“A ‘tipping point’ at the Tarlac Provincial Hospital,” 8/22, 29/15)

I received this week an exhaustive letter from Governor Vic A. Yap, explaining his (the LGU’s) side on the controversy. In the interest of fairness and objectivity, we’re printing salient points in his letter. Due to limitation of space, we cannot print his letter in full.

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Thank you for calling attention to the situation in Tarlac regarding the provincial government’s plan on utilizing the revenues from PhilHealth. In my mind, this has always been a question of how best to allocate and share government revenues that will benefit as many constituents as possible—not just in the health sector—and certainly, not for the exclusive benefit of a few.

Allow me then to discuss three points on this matter of sharing: its legal, financial and social dimensions. In doing so, I will touch upon issues raised by those who oppose the provincial government’s efforts at a more democratic way of sharing the hospitals’ revenues.

Legal

First, following their devolution from the Department of Health, LGUs are deemed owners of all government hospitals and as such, are the LGUs’ arm in providing the basic healthcare services needed by their constituents.

Under the Local Government Code of 1991, the LGUs, as owner of all government hospitals, have the power and authority to manage PhilHealth professional fee (PF) payments. Their authority to pool and distribute such funds is supported by the implementing rules and regulations of the PhilHealth Law (Republic Act No. 7875, as amended by RA 9241 and RA 10606).

Thus, as owner of the facility, the LGU has the authority on how to share hospital revenues. The management of the facility, in this case the chief of hospital and his management team, may recommend, but the final decision is with the provincial government.

Second, the law refers to “salaried public providers.” Who are they? What does this term mean in the context of the issue on pooling and sharing revenues?

“Salaried public providers” are workers with existing employment contracts with the provincial government. As such, the LGU, through the healthcare facility, receives the PF revenues because it had already provided for the salaries of its medical providers. Nowhere in the salaried medical providers’ employment contract is it stated that the provincial government, as employer, authorizes the distribution of the pooled funds exclusively for the medical and nonmedical personnel. There is also no document stating, legal or otherwise, that the pooled funds are incentives that the medical personnel are entitled to.

Third, in the case of the Tarlac Provincial Hospital (TPH), there is a mistaken notion of using the pooled funds for “incentives,” a term that suggests additional compensation based on output and performance. In the recent past, there has been no particular increase in the performance measurements, thus providing “incentives” is improper.

A most basic indicator of performance—passing of resident trainees in their specialty boards—shows that fair performance was not met, so how could they be incentivized? In anesthesia, for example, none of the resident graduates who took the specialty board exam in the past five years, passed and qualified to become Diplomates in Anesthesia.

The increase in revenue was mainly due to the increase in the utilization of PhilHealth (or in the number of patients that now have PhilHealth, as base number of the people who would likely go to TPH, through the efforts of the provincial governor. In short, the increase in the number of patients who have availed of PhilHealth insurance benefits has increased the amount of revenue received by the hospitals.

Fourth, previously and prior to the intervention of the provincial government, the decision on how to distribute the pooled funds was made by a small number of people whose identification remains unknown. The process for the distribution of the pooled funds remains a mystery; there is no quantifiable or legal basis for such distribution. The former chief of hospital at TPH and the chiefs of the district hospitals certified that there were, indeed, no guidelines being followed in the distribution.

Financial management

Allow me to digress before going into a discussion on the management of the pooled funds. When I discovered how PhilHealth-derived revenues retained by the provincial government were being distributed, I discussed the matter with the different sectors in the health institutions.

I proposed a 50-50 scheme where 50 percent would go to the personnel and 50 percent would be used to improve the health services of the public sector as stated in Section 34, third sentence, RA 10606. The previous chief of hospital agreed that he would draft guidelines on implementing the 50-50 scheme. The guidelines were never completed; the 50-50 scheme was rejected by the doctors and other hospital personnel at TPH.

I was left with no choice but to rethink the LGU’s position and implement a more equitable scheme that considers the perspective of the health personnel while still ensuring that the high quality of medical and hospital services in the public sector is maintained.

A handful of medical personnel have opposed the idea of allocating funds for improving health services by investing in the service delivery network (SDN) espoused by the DOH based on an effective referral system (ERS). I believe that this can bridge the gap between the poor patient in the barrio and the specialist at TPH. It is well known that poor patients tend to seek medical consultation only when the illness is already at an advanced stage because they cannot afford the fees for consultations and checkups.

(To be continued next week)