For the last 17 years, Mario Maniego, 49, has been confined at the Philippine Orthopedic Center (POC). He suffers from a spinal cord injury, a lifetime disease he has to bear.
Before his injury, Mario was a caretaker in a piggery in San Miguel, Bulacan. He was about to leave work last March 29, 1996 when he slipped at a greasy part of a pig pen. He then went through a series of check ups in his home province of Cabanatuan but the pain in his foot kept getting more and more serious, as if his nerves were being torn apart.
In November 5, 1996, Mario went to POC and found out that there was a nerve lodged in his neck. After a few days, he underwent an operation and since then, he has not been able to move; he became bedridden and totally dependent of the care of the medical workers and his wife, Jesusa.
“If I did not take care of my husband, he would have died a long time ago,” Jesusa said in the vernacular.
Because of Mario’s near vegetative condition, he needs a respirator to breathe and other medical equipment to sustain his life. He did not expect to stay at the hospital for 17 years. They rent a respirator for P850 per day and add to that the vitamins, antibiotics and adult diapers his family needs to purchase for him once the hospital supplies run out and the costs are overwhelming.
All in all, the Maniegos have accumulated a total of P1 million in unpaid hospital balance that includes respirator fees and operational expenses.
They struggle to pay through donations and financial assistance from some politicians and the Philippine Charity Sweepstakes Office, but these are not enough.
Jesusa now fears what will happen next. She does not know what to do and where to go once the privatization of POC pushes through.
Though they want to go home, they cannot go anywhere because they cannot buy a respirator, oxygen tanks, generator and other equipment needed to sustain the life of Mario.
“I’m not in favor of privatization,” she told The Manila Times. “They said [POC will undergo] privatization and modernization—I’m in favor of modernization. But where will they get funds for that? Of course, they will get that from the patients.”
Mario is just one of the 90 percent of the patients who avail of free services provided by the POC. But this will soon change once a private corporation takes over the hospital’s management and operation.
The POC, the hospital that has the biggest spinal injury ward in Asia, is on the brink of being privatized under a build, operate, transfer (BOT) scheme. The winning bidder will operate it for 25 years with the option to renegotiate for another contract.
The project is dubbed as the “Modernization of POC” (MPOC), which seeks to use private capital and expertise to make the healthcare service more efficient and innovative. It will cost P5.69 billion, and P5.43 billion of this will be funded by the winning bidder.
So far, there are nine corporations that have expressed their interest in bidding for the project. The two most notable are Manny V. Pangilinan’s Metro Pacific Investments Corp. (which also owns the Makati Medical Center, Asian Hospital, Cardinal Santos Memorial Hospital and Our Lady of Lourdes Hospital) and Henry Sy’s Megawide Engineering Excellence and Strategic Alliance Holding Inc.
Other bidders include: Siemens Inc., GE Health Care General Electric Phil. Inc., Philips Electronic and Lighting Inc., Sta. Clara International Corp., Mount Grace Hospital Ventures and Data Trail Corp.
The bidders are now being evaluated and in May, after the elections, the contract will be awarded to the successful bidder. In June, the BOT contract will be awarded and by 2014, construction will be started which will be completed sometime in 2016.
MPOC is patterned after the Aquino Health Agenda seeking to strengthen the National Health Insurance Program through expansion of PhilHealth coverage. If successful, it will be the first hospital to be corporatized under President Benigno Aquino 3rd’s flagship project, Public-Private Partnership (PPP).
The new POC will be built at the National Kidney and Transplant Institute (NKTI) compound along East Avenue, Quezon City, and will be called as the “Center for Bone and Joint Diseases, Trauma and Rehabilitation Medicine.” The specialty center will have a 700-bed capacity, 13 floors and two-block building.
Once the POC is transferred to the NKTI compound, it will soon be integrated with other government owned and controlled hospitals, which includes: the Philippine Heart Center, Lung Center of the Philippines, NKTI, and Philippine Children’s Medical Center.
The integration will become the Philippine Center for Specialized Care, a part of the medical tourism industry that is still being developed by the government.
POC will serve as the “lab rat” of the government to see how PPP will materialize in the health sector. There are 26 other hospitals in line for privatization, including the Research Institute for Tropical Medicine, the San Lazaro Hospital and Dr. Jose Fabella Memorial Hospital.
Healthcare for sale?
Health Undersecretary Dr. Teodoro Herbosa made it clear that the PPP project is not privatization but a step towards more efficient and quality healthcare service by tapping the private sector’s expertise.
“Most of the poor go to government-run health facilities in their time of need and they deserve no less than the best care from these public facilities,” he said in a statement.
Out of 700 beds, 420 of these will be allotted to PhilHealth-sponsored patients under a ‘no balance billing’ policy and another 70 beds for indigent patients.
Herbosa’s statement was echoed by economist and former National Economic and Development Authority (NEDA) Director-General Dr. Cayetano Paderanga.
“It’s more efficient services,” said Paderanga. “The approach is this: in general, we try to attain the financing by strengthening PhilHealth. And in fact the government has started to pay the contributions of the lowest 20 percent and I think, right now the target is to increase it to 40 percent so we will have universal healthcare.”
“There is a significant public service component of the privatized hospitals,” he added.
However, POC nurse and National Orthopedic Hospital Workers Union President Sean Velchez said that the MPOC project is clearly state abandonment of healthcare services in the guise of “partnership” between the government and the private sector.
“Fiscal autonomy is nothing but state abandonment,” he told The Manila Times, adding that Aquino’s PPP is designed to push for public hospitals’ fiscal autonomy which will result in lesser state subsidies, just like what is being done to state universities and colleges.
Moreover, under the provision of the bidding documents, the winning bidder will control and manage the whole operation of the hospital; from the procurement of medical materials and equipment to providing and hiring the “appropriate qualified staff.” Meaning, even hospital workers and staff are under threat of being removed.
Velchez also noted that once a private company controls the POC, 90 percent or around 150,000 to 250,000 of the indigent POC patients will be affected and forced to pay for higher hospitalization costs. For example, in the NKTI, a forearm x-ray costs P665 whereas in POC, it costs only P250. It was much lower in 2011 when the cost was only P100.
Most of the patients admitted by the POC are workers and farmers who come from the poorer sectors of society, added Velchez. These are the ones who are more prone to accidents, like falling from high places including buildings and trees because of their jobs.
According to Sonny Africa, Executive Director of the local think-tank IBON Foundation, PhilHealth will not stop the rising cost of medical services once a public hospital is privatized.
Once a private corporation acquires a hospital, its first goal is to recover the cost of its investment. Once it is involved in seeking profits, it will control the costs of medical supplies and equipment used by the patients, doctor’s professional fees, the rate of rooms, and others. If the prices of these components increase, PhilHealth coverage contributions will also rise as the only way to cope with the increasing charges.
“It [PhilHealth] will never work,” Africa told The Manila Times. “What’s really the best solution is to implement a tax-based public health system where the government is directly funding healthcare services.”
With PhilHealth, one main problem also lies on the fact that not all Filipinos, especially those in the outskirts of the country, are members. Privatization will automatically deprive the poorest sectors of the Philippine society from the access to healthcare, Africa said.
PhilHealth is also limited and restrictive; it cannot cover long-term illnesses like Mario Maniego’s spinal cord injury. It can only cover the first 45 days of bone-related illnesses, and beyond that it should be shouldered by the patient.
Furthermore, PhilHealth’s ‘no balance billing’ policy does not cover orthopedic cases. It only covers major illnesses like dengue, malaria, pneumonia, hypertension and asthma.
“Orthopedic care is one of the most chronic care conditions, it requires long-term treatment. A bone heals usually two to three months, and that is how long our patients usually stay here,” Velchez said.
‘Where do we go?’
Where will people like Mario, who are doomed to live with paralysis until the end of their lives, go?
This is the lingering question in the mind of Jesusa once the privatization project pushes through. Of course, no sane private company will invest its money where it will not profit, Jesusa said.
“There are people who can pay, but more people cannot. How about the poor like us?” she asked. “I hope they will study more on how privatization will affect the poor.”
Many will die, Jesusa added. And the only way to stop this is to make healthcare more accessible for all and receiving more funding by the government.
“There are non-negotiable things that are really obligation of the state, just like healthcare,” Velchez told The Manila Times. “Health is our public good. You cannot depend on private institutions to manage it.”
As stated in the Universal Declaration of Human Rights, “everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
For families like the Maniegos, the privatization of private hospitals (and colleges) would only deprive them of some of those rights.