A ‘tipping point’ at Tarlac Provincial Hospital

(First of two parts)

AT A TIME when we’re thinking of ways and means to convince our young doctors to go back to the provinces and work in government hospitals so they can help fill in the healthcare gap for Filipinos belonging to the marginalized sectors, the conflict between the doctors and hospital workers of Tarlac Provincial Hospital (TPH) in Tarlac City on one side, and the provincial governor on the other side, is indeed very discomforting.

If the same problem develops in our other provincial government hospitals, I’m afraid the lack of qualified doctors and personnel manning our government hospitals would be magnified ten-fold. We might end up with unmanned hospitals and long queues of sick patients being attended by volunteer nurses and midwives.

Doctors might again join the exodus from government service, and shift their focus to private paying patients, or perhaps try their luck abroad. Conflicts like this could be the tipping point, which could trigger a more widespread mass action.

Dr. Nitz de Pano, an anesthesiologist trained at the University of the Philippines-Philippine General Hospital (UP-PGH), went back to Tarlac City to practice her specialty, and offer her services to patients with no consideration if they could afford to pay or not. She and her co-workers at TPH are grateful though that PhilHealth has a small allocation for professional fees (PFs) which are pooled and distributed equitably to government doctors and other non-medical personnel.

She was happy about her job at TPH and had a strong sense of fulfillment of being in a position to earn a living and at the same time serve her less fortunate countrymen. All these seemed to have changed three months ago when she and her coworkers felt that of all people, their chief of staff in the hospital, allegedly upon instructions by the governor, have withheld their pooled PFs from PhilHealth and harassed those who complained about it.

All of a sudden, Dr. De Pano found herself in a tempest she could not turn her back to.

“This is not just about the ‘money’ but about principle, a right provided by law. To allow it to be taken without due process is a disservice to the democratic principles we all believe in,” she wrote in her e-mail to us.

“The pooled professional fees rightfully belong to the health professionals and non-medical staff because they are incentives for rendering utmost health services to patients, whether PhilHealth members or not,” said Dr. De Pano.

As a backgrounder, TPH is under the jurisdiction of the local government of Tarlac. As other government hospitals, this has been so since 1991 when the Local Government Unit  Code came into effect, which has devolved the delivery of all basic services including healthcare services from the Department of Health to the LGU.

Following the devolution, a major concern that has yet to be adequately addressed is that the quality and coverage of healthcare services have suffered in many areas, particularly in the rural and remote areas. A declining morale of government physicians and other hospital personnel has also compounded the problem.

The government physicians and other hospital personnel get augmentation of whatever monthly income they have from Philhealth funds coming from PFs for all medical cases admitted and treated in the hospital. These PFs are part of case-rate fees paid by PhilHealth, which has issued a circular mandating a 70:30-percent scheme, wherein 70 percent of the case-rate fees goes to the government hospital facility to help defray its operational costs, improve facilities and services while the 30 percent goes to the PF pool, which is distributed among the hospital personnel for the services they have rendered.

“Since time immemorial, the pooled PhilHealth professional fees at TPH are being distributed among health personnel, both medical and non-medical, based on DOH Administrative Order No. 42 s. 2001,” said Dr. De Pano.

The TPH personnel were taken by surprise starting on the first week of May of this year when Gov. Vic Yap, invoking the principle of devolution, has allegedly revised the manner of distribution of the pooled PFs which “the majority of the TPH personnel have actively or silently resisted.”

(To be continued next week)