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The presence of charity wards in Philippine hospitals, whether public or private, has been a quiet issue. Those who are aware of the existence of this ward are the ones that cannot afford regular wards or those that prefer the services given in the charity wards.
Most hospitals that offer their services through the means of having charity wards often have different elements to be paid for. The basic elements are the medical materials used, professional fees, and hospital fee. Often times the patients confined in these wards are the ones that provide the basic medical materials needed. There are also instances wherein professional fees of doctors are either waived or discounted for, while the hospital fee is rarely waived.
One cause of conflict can be how the hospital prioritizes which patient should be attended to first; there are some hospitals that select paying patients before those who are not able to pay and sometimes they forego the triage system. The triage system is the system in which hospital personnel determine the level of priority of each patient based on the patient's current physical condition. Of course, charity wards consist of only a certain number of beds and so charity patients may only be accommodated depending on availability and the hospital's capability to handle his or her case.
This issue raises questions such as how do paying wards affect patient care and accommodation in charity wards? Do hospitals charge paying patients more than the actual cost of care? How are they [hospitals] able to afford for the continuous upkeep of charity wards? What is the government's involvement regarding this issue? And lastly, is the charity ward beneficial to all stakeholders?
The charity system of service was first practiced in St. Luke's Medical Center and was established by American Missionaries in 1903. By 1910, St. Luke's increased bed capacity in the hospital to 52, catering dominantly to charity patients. In 1946, the University of Santo Tomas opened their pay and charity wards at the newly opened facility in Espana, Manila. More hospitals would follow suit with their own respective charity wards and as with St Luke's and UST, they funded themselves through the paying wards. It has been cited that in UST, their charity wards have solely been funded via the paying wards and never through government subsidies nor through the tuition fees of students enrolled in medical and allied medical courses. This may show that charity wards, now known in a more politically correct term of service wards, are not black holes for hospitals; they do not necessarily exhaust medical facilities of revenues, supplies and such. It also shows that hospitals charge more than they really should but since it is for a good cause, it may well be worth it. It has also been general knowledge that in charity wards, medical interns and students are often allowed to handle patients while they have very limited patient in pay wards. It is something that hospitals will not publish but it is a widely accepted act. Also, faster and better service can obviously be found in pay wards and not in charity wards.
Despite the fact that certain hospitals can afford having a fully functional charity ward, government subsidies are always welcome things for them as, according to UST Hospital, it can cost upwards of P115 million per annum to run their charity facility, which is at a 65% occupancy rate. Of USTH's patients, only 25% have PhilHealth coverage but even then, patients still have to pay as much as 50 centavos for every peso of treatment cost. It can cost significantly more for the Philippine General Hospital which has a total of 1,500 beds for pay, charity and special patients as compared to USTH's total of 443 beds, and a 95% occupancy rate for charity ward as compared to USTH's 65%.
According to the 2007 National Health Accounts, a study done by the National Statistical Coordination Board, the Department of Health along with the financial assistance of the Department of Health Office of the Secretary (DOH-OSEC), Dangerous Drugs Board (DDB), Philippine Heart Center (PHC), National Kidney Transplant Institute (NKTI), National Nutrition Council (NNC), Lung Center of the Philippines (LCP), Philippine Children's Medical Center (PCMC), and Commission on Population (PopCom) allotted P20.3 billion for the budget of various health programs and institutions. From the P20.3 billion, only P15.4 billion goes to personal and public health care, namely government hospitals and the like. The breakdown of the budget under personal health care is P13.4 billion which is then directly transferred to government hospitals, while in public health care only P1.9 billion is allotted.
The involvement of local government units (LGUs) in the financial assistance for public health care has been significant in contrast to the Department of Health; the LGUs had substantially allocated P13.7 billion according to the 2007 Philippine National Health Accounts. According to the An Analysis of the President's Budget for Fiscal Year 2007 conducted by the Congressional Planning and Budget Department, the total budget of the Philippines in that year was P1.126 trillion and from that P329.4 billion was allocated for social services. Of that, P14.5 billion or 1.3% of the national budget was specifically allocated for health.
For 2007, hospital services get the biggest share amounting to 7.1 billion or 65% of the total budget. Public health gets only 14% of the budget, 2 percentage points lower than administration function receives. Regulation gets 5% of total budget for 2007." (Congressional Planning and Budget Department, 2007, p.103)
It was also stated that in the pattern of budget distribution of the Department of Health since 2003 up to 2007, no change has been made.
"Hospital services continue to get the biggest chunk ranging from 65% to 71%. Budget allocation for public health and administration during the period get from 14% to 16% only. Regulation is given the least share ranging from 2% to 5%." (Congressional Planning and Budget Department, 2007, p.103)
Even if there is a recognizable amount in the allocation of the national budget regarding health care, it is not sufficient in helping to defray the costs of necessary health care. Those in the marginalized sector, earning a minimum wage, often seek the services offered by the charity system available in government and public hospitals. However, there are some instances that these individuals may not be able to afford the costs that are followed in being confined in these said wards. Indeed, charity wards are supposed to be affordable, most especially to those who need it the most, but is does not necessarily mean that the services offered will be free.
According to the newspaper article, title How charitable are charity hospitals?, a patient confined in the charity ward of a university-based hospital found out that their hospital bill reached P16,000 just for a week's confinement. Now if that patient were just earning minimum wage and works for six days a week, he would just have earned P2,424 and that will not be enough to pay for his hospital bill. That only covers hospital fees and the medicines used during procedures done; it does not include post-operative or post-hospitalization care and maintenance. The implementation of the Philippine Generic Drug Act 1988 which requires the use of generic labeling and advertising of drugs have somewhat helped in making necessary drugs and such to be readily available to the public but that still adds to the expenses of the already strained household budgets of our lower class sector. According to The Prices People Have to Pay for Medicines in the Philippines by the Institute of Philippine Culture in Ateneo de Manila University, the Philippines is one of the countries that have problems with drug accessibility for the public. According to their study, which cites the World Health Organization, less than 30% of the population has regular access to important medicines. This may be attributed to the costs of medicine taken in relation to the average income of the working classes.
A 2007 statistical study titled Trends and Characteristics of the Middle-Income Class in the Philippines: Is it Expanding or Shrinking?, showed that the lower classes are in the bottom 76.7% of families living in the Philippines. This lower class group has an annual income bracket of P5,000 to P242,228 with an average annual income of P109,580. This does not include indigents and the truly poor.
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