Gov. Yap’s rejoinder to the ‘tipping point’ at TPH

(Conclusion)

We’re printing the remaining salient points of Tarlac Gov. Vic A. Yap’s letter explaining the LGU’s side in their current dispute with some doctors and nonmedical personnel at the Tarlac Provincial Hospital (TPH).

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I believe that the LGU-managed service delivery network (SDN) and effective referral system (ERS) will allow early consultation for poor patients, thanks to PhilHealth. By strengthening the outpatient services of the hospital and improving access to it for patients through an ERS from barangay health workers (BHWs) and rural health units (RHUs), the hospitals will be able to provide preventive healthcare and reduce the need for more expensive hospital care.

Invest in PhilHealth

As early as 2002, as executive assistant to the governor (then), I decided to invest in PhilHealth as part of the health program of the provincial government of Tarlac, in order to subsidize the nonpayment of the hospital charges by marginalized families. I campaigned for more people to obtain health insurance, steadily increasing the number of PhilHealth-insured constituents in Tarlac through the PhilHealth sa Masa program.

By 2013, we launched Point-of-Care (POC), where patients for admission who are not Philippine Health Insurance Corp. members are automatically enrolled in PHIC. As a result, PhilHealth utilization in TPH reached an all-time-high of 89 percent. Consequently, hospital revenues were able to cover expenses.

Yet the provincial government continued to subsidize hospital operations, resulting in a ballooning of the pooled PHIC professional fees (PF), reaching up to around P100 million, distributed among the medical and nonmedical staff with casual and permanent plantilla items. This exclusive arrangement left out other healthcare employees like the job orders (JOs) who make up 60 percent of employees in TPH. The BHWs, too, who bring patients to the hospital, have never received such “incentives” from TPH.

From 2010 to 2015, an average of 2,200 patients per month are accepted at the TPH. In 2010, only 36 percent had PHIC cards, but now (2015) 89 percent already have PhilHealth cards. Now that the hospital revenues can cover its expenses, the provincial government wishes to reallocate its subsidies for TPH to other healthcare programs.

Cost efficiency

Tarlac province has limited resources to address the needs of all its constituents.

In the case of TPH, the problems of wastage, pilferage and overstaffing have to be addressed not only by the hospital’s top management, but also by department heads and employees. By maximizing revenues and optimizing cost efficiencies, the hospital can realize operating margins from which a true performance-based incentive scheme can be awarded to efficient hospital units.

With its mandate to promote public health and safety in its jurisdiction, the provincial government implements comprehensive health programs beneficial to all its constituents, including the marginalized sector.

One of these healthcare services is the proposed SilipSakit program (diagnostic program) of TPH. It is said that patients in a government hospital have only a 50-percent chance of surviving. Why? Because the patient is unable to afford private medical care and the government health facilities do not have the diagnostic capability. So the disease progresses to an advanced state and by the time the patient is admitted, all modalities of treatment will no longer help.

The SilipSakit program will make it possible for diseases to be diagnosed early or even be prevented. BHWs will identify patients needing care, and refer them to the RHU and the hospitals as needed. Transport of patients to TPH will be facilitated, and the diagnostic and therapeutic capabilities of TPH will be upgraded so it can serve as the referral center of the province. More difficult cases can be referred to the regional and national hospitals as deemed necessary.

In summary:

1. The provincial government of Tarlac, like all other LGUs, is within its legal prerogative to manage and operate all government hospitals.

2. As owners of government hospitals, the LGU has the responsibility to manage its revenue-generating assets much like any private enterprise. In the case of the TPH, the health facility is now generating sufficient revenues to cover its operating costs, thanks to increased patient load, higher revenues and sound financial management.

Social programs

With the TPH operation now sustainably profitable, the previous subsidies from the provincial budget may now be utilized in other social programs, not just in health services or in the hospital. The challenge for each LGU administration is how to generate sufficient revenues and balance the use of such funds for its many programs.

Finally, how can everyone benefit from the PF-pooled fund? In this case, I believe the wise course of action is to consider what’s best for the greater good, not the interest of a few. Public good must triumph over private interest.

The doctors who disagree with the guidelines on sharing the PHIC PF pool are aware that their shares from the pool will be reduced, that is why they are objecting to the idea of sharing. Yet, the same dissenting doctors—who, by the way, have their own salaries and continue to earn from their respective private practices—seem to ignore the fact that the idea behind sharing is to provide a similar cash benefit to the other health workers who have never received a single centavo from the PF pool. The provincial government wants to share the PF pool with many more health workers, not just a few.

In addition, the PHIC PF pool will support an efficient SDN that will bring patients from the barangay to TPH, allowing them to have access to specialist care. Increased patient load will lead to greater financial stability and robust sustainability of TPH, allowing the provincial government to reallocate erstwhile hospital subsidies for other health projects. Is this too much to ask from the dissenting few?

As governor, I want to leave a legacy of a robust health ecosystem in Tarlac where “ang duktor ng mayaman ay duktor din ng mahirap.”