Assignment No. 1 in Economics

By Rep. Satur C. Ocampo 
BAYAN MUNA Party-List
 
Privilege Speech delivered at the House of Representatives
2 October 2007


Mr. Speaker,

When I spoke to this body in September 2004, I already sounded the alarm that the provision of health services in government hospitals had reached critical levels. As we commence deliberations on the 2008 national budget tomorrow, I call the attention of this august body to a very serious concern that I have raised three years ago — and this is the dire crisis confronting our people’s health, no less.

A recent survey on the health services rendered by major government hospitals, conducted by the Kilos Bayan para sa Kalusugan, the Alliance of Health Workers, and other health organizations provides significant information about the dismal state of the country’s health care system.

The month-long survey was conducted from August 15 to September 15, 2007 among 1,005 patients in seven major government hospitals in Metro Manila that serve patients on a nationwide scope. These are the Tondo Medical Center, San Lazaro Hospital, Jose Reyes Memorial Medical Center, Quirino Memorial Medical Center, Amang Rodriguez Memorial Medical Center, East Avenue Medical Center and Philippine General Hospital (run under the Office of the President). The five specialty hospitals are the (National Kidney and Transplant Institute, Philippine Heart Center, Dr. Jose Fabella Hospital, Philippine Orthopedic Center and Lung Center of the Philippines).

Key findings of the survey show that for every 10 patients admitted to public hospitals:
? 6 were from families who are jobless and presently unemployed
? 3 worked as drivers, construction workers and peddlers
? 1 was a low-income professional
? 7 were not immediately admitted to hospitals because they either had no money, there were no available beds and no doctor was present to attend to them
? 5 were not able to do requisite “laboratory procedure” because they had no money to pay for the service
? 4 had to borrow money and sell property or a carabao to pay for their hospital bills
? 7 were not members of PhilHealth
? 9 did not receive any assistance from the hospital’s Social Welfare Assistance (SWA)

The survey pointed to a stark reality that poor patients were stripped of their self-respect as they were driven into begging and being hugely indebted because the country’s public hospitals can no longer provide for the health and medical needs of our numerous indigent countrymen and women.

Mr. Speaker, the crisis in people’s health is manifest in the following grim realities:

1. The national health budget has been shrinking.

Budget allocation for health has been consistently shrinking. Since its highest allocation of P 18.7 million in 1997, budget for health was significantly slashed to PhP11.56 B in 2007, constituting only 1.1% of the overall national budget. Roughly, this budget means the government provides for every Filipino a measly P132.90 yearly or a 36-centavo daily budget.

Although the health budget is proposed to be raised to P15.7 in 2008, this is a nomina; raise to only 1.3% of the total budget.

While allocation for health has been shrinking, budget allocation for debt servicing and military has been consistently getting the lion’s share of the national budget. Since 1996, debt servicing has eaten up 20% of the national budget. Since President Gloria Macapagal-Arroyo’s term in 2001, debt servicing allocation has shot up to 35% of the total national budget. In 2006, some P854.4 billion was allocated for debt servicing (interest and principal payment).

Meantime, budget for military spending has increased by 11% since 2001. In 2006, a total of P82.1 billion was given to the military budget (defense budget and other military spending hidden in the education (Philippine Military Academy), social services (military hospitals) and economic services (economic rehabilitation after military operations).

According to the research think tank IBON Foundation, total national government health spending of P253.00 per Filipino in 2008 will be 27.5% less than what was spent in 1997. (In fact, an additional P 8.6 billion would be needed just to return to the 1997 levels.)

Further, the supposed large overall increase in the government health sector budget from P11.56 billion in 2007 to P20.1 billion in 2008 has also seen the shrinking of the public health system. This is so because, as IBON stated, the increase in the proposed health sector budget for 2008 does not go to expanding the public health system in terms of expanding access to health or in increasing the number of doctors and nurses. The largest part is instead taken up by P1.2 billion in salary adjustments under a Miscellaneous Personnel Benefits Fund item, another P1.2 billion for family health including family planning, and P1.3 billion worth of capital outlays for a “Health Facilities Enhancement Program” likely to be accessible to those with the capacity to pay rather than to the poorest Filipinos.

One of many striking indicators of government priorities is allotting an additional P125 million in capital outlays for “Health Information Systems and Technology Development”, for a total of P130.0 million in 2008, while only a P6 million increase was granted for the implementation of the Doctors to the Barrios and Rural Health Practice Program that works with just P42.3 million.

There are cuts in the proposed budget that would effectively further hamper the efficient and affordable health services to the people:

� Cut by P10 M � Subsidy to Indigent patients: From P16.0 M (2007) to P 6 M (2008)
� Cut by P121.0 M � Operation of Special Hospitals, medical centers and institutes for disease prevention and control: From P2,700.4 M (2007) to P2,579.5 M (2008)
? E.g., Jose Reyes, East Avenue, Rizal, Quirino, Tondo, Fabella, Natl Children’s, Mental Health, Orthopedic, San Lazaro, Amang Rodriguez, Tropical Medicine
?
� Cut by P481.6 M � Operation of Centers for Health Development-Direct service provision: From P4,173.1 M (2007) to P3,691.6 M (2008)
? E.g. 55 hospitals and medical center nationwide

The downward trend in the allocation for direct public services has become evident since the 1990s, making health care more and more beyond their reach of the poorest Filipinos.

2. Poverty-related diseases are on the rise.

In a poor country like the Philippines, diseases brought about by poverty are still rampant. Communicable but preventable diseases such as tuberculosis, pneumonia and diarrhea remain as the leading causes of morbidity and mortality. These diseases can be prevented if people could live in sanitary and decent living conditions. Most diseases are curable if only the people have access to basic health services.

For example, incidences of tuberculosis are on the rise. Fifty years after medications for the treatment of TB were discovered, more and more people still become infected and die from this disease. Every year, close to 100,000 Filipinos become infected with TB. An estimated 75 of these die.

Since 2000 up to2006, the government has allotted only P154 million for its TB prevention and control program. This year, the budget was further slashed to P139 million. The DOH supposedly provides free TB drugs through the health centers. But the health centers can only provide for a one month supply of anti-TB drugs, if there are supplies. If we are to divide the P139 M to the number people who contacted the disease, each TB patient can only be allotted P1,390. With the TB medicine alone, the said amount will not even be enough to sustain the six months TB drugs therapy which amounts to not less than P7,000.

3. Majority of the country’s population has poor access and cannot afford health services.

Since the Health Sector Reform Agenda (HSRA) implementation in 2000, the people’s access to important health services has become almost nil as public hospitals were closed down and the number of Rural Health Units, decreased.
� The number of public hospitals decreased from 1,794 in 1999 to 1,361 hospitals in 2005. Most of the public hospitals that were closed down are district hospitals.
� Number of Rural Health Units also decreased from 2,335 in mid-1990′s to 1,879 in 2001.
� Patients and employees of Corazon Locsin Montelibano Regional Hospital in the Negros Province reported the hospital’s “no bed, no admission policy”. The policy refers to the “adjustments” resorted into by the hospital management to solve its bed capacity problem. Many patients “bringing their own beds” are normal sights in the corridors of the said hospital.
� The lots occupied by three specialty public hospitals namely, the National Center for Mental Health, Tala Leprosarium and the Fabella Hospital are up for bidding. There are no clear plans as to what will happen to the employees and patients of these hospitals.

Latest available figure in 2002 shows that 67% of Filipinos die without medical attention. In 1990, this figure was at 59%. These days, more and more people can hardly rely on public health services because public hospitals now charge even indigent patients with various fees such as emergency room fee, out-patient department fee, operating room fee, etc. Under the HSRA, the DOH allows up to 20% increase in user-fee hospital service charges.

� For example, the Philippine General Hospital, the country’s premiere public hospital is charging P1,500 for operation room fee. Jose Reyes Memorial Hospital charges P3,500 for the same fee.
� Patients at the NKTI lament the “no pay, no hook policy” � referring to the hospital management’s policy of not providing dialysis treatment to patients who cannot pay the procedures. One dialysis session at the NKTI costs P2,700 � and on the average, a patient with serious kidney problem has to undergo two dialysis sessions a week.

Yet instead of decisively solving the people’s health crisis � the health budget for 2008 remains far below the World Health Organization (WHO) recommended 5% of the Gross National Product. Even by the Health Secretary Francisco Duque’s own admission during the budget hearings here at the House of Representatives, the country’s health concerns need some P60 Billion.

Out of 192 countries worldwide, the Philippines ranks 174th in terms of percentage share of the national health budget to Gross Domestic Product. In terms of general government expenditure on health, the country ranks a dismal 156th.

For the past 11 years, the health budget has declined by about 40%. For this reason, we in Bayan Muna are urging the members of the 14th Congress to endeavor to raise the appropriations for health until it approximates the WHO prescription.

In conclusion, I cite a number of the specific “prescriptions” by our various health organizations now here with us in the gallery:

1. Health care must be made accessible, affordable, and appropriate to the needs of the people. Specifically, an increase in the national health budget should provide adequate amount for the maintenance and operations of public hospitals. Budgetary allocation for the Magna Carta of Public Health Workers must be provided, and Internal Revenue Allotment allocation for health must be increased.
2. The public health care delivery system must be strengthened. Preventive health care and public health must be given emphasis. Health care infrastructure (hospitals and equipment) must be improved.
3. Medical and nursing practice in the country should be made viable options again. More than just the issue of adequate compensation, health professionals, health workers, and even health students should feel that there is a future for them and their family if they stay and serve here.
Improvement in the socio-economic conditions of Filipinos is integral to improving our people’s health. Living wages, food, land and adequate housing are basic requisites for the people to attain good health.
Ultimately, collective action and political will remain vital in bringing about meaningful social changes that will redound to the people’s benefit. Your earnest support to this endeavor can, in a very literal sense, save lives.
Thank you.#
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When reading the text, identify the following and where they occur:

• How does the text relate to the three key questions that are at the heart of the 'economic problem'?
• What are the opportunity costs involved in deciding on appropriate levels of health care?
• What parts of the text are positive statements and which are normative? Explain your answer.
• How does the text suggest that there may be alternative answers to the issue of the provision of health in the our country?