Gensanportal - Mindanao News Blog

The problem of medical economics is part of the problem of world economics and is inseparable and indivisible from it. Medicine, as we are practicing it today, is a luxury trade. We are selling bread for the price of jewels. The poor who comprise 80% of our population cannot pay and starve; the doctors cannot sell and suffer. The people have no health protection and the doctors, no economic security.

DAVAO CITY (MindaNews/11 August) -- I wish I said that.
But they were said more than 70 years ago by Dr. Henry Norman Bethune, a brilliant Canadian Thoracic Surgeon, painter, poet, inventor, originator of the first MASH (Mobile Army Surgical Hospital), and dedicated teacher to those who worked alongside this indefatigable person. He died on November 13, 1939 in North China, fighting for his ideals in Mao Tse Tung’s army against the invading imperial Japanese army.

But what he said then is still very true today. Perhaps even truer. Especially in the Philippines.

This is because, even in those times, institutions had already placed themselves between the doctor and his patient; and they were already laughing all the way to their banks.

There was a time when the only person who stood beside the doctor in his clinic, other than the nurse, was his pharmacist, who compounded the galenicals, medicines that the doctor tailor-fitted for his patient. And these medicines were the cheapest and most effective, being customized for the individual patient.

Then the drug industry came and erased all this with mass produced medications that they advertised as more accurate, more convenient, more hygienic, more scientific, and more effective. They were also more expensive, which really makes it a bit strange because mass manufactured goods are supposed to be cheaper than customized items.

But greed, reflected by the unethical marketing practices on the doctors by the drug companies placed these medicines out of the reach of the average patient.

So into this breach, sprang in the next demon: The Health Insurance. Or his even more evil brother the Health Maintenance Organization (HMO). The HMOs, being pre-need companies, are not under the control of the usual insurance laws that protect the insured from undue exploitation.

The concept of sharing risks and resources are as old as tribal Man himself. A tribe develops when a group of people band together to meet their needs collectively for the better survival of the most number of people. And sharing of resources is the best way to the satisfaction of an individual’s needs and survival of the many in a community.

And it is not surprising that Jesus’ second miracle was about sharing. When five thousand Jews followed Him up a mountain in the hope of seeing Him rain manna from heaven, He shamed them into sharing their hastily packed meager lunches by showing them a little boy who was willing to share his five loaves and two fishes with the multitude.

Indeed when everybody had eaten his fill, there were still 12 baskets of food left over. It was not the Miracle of Multiplication. It was the Miracle of Division. Sharing what little you have willingly with the rest.

But this is not the same as Health Insurance; because with the HMO, the Devil now stands between the Good and the Multitude. And instead of offering security and survival, the Demon is selling Fear. The Fear of the inevitable illness when one is in the prime productive period of his life. And when one’s productive life is over, the poor individual is culled or deselected from the rest; left without any hope of affording health care exactly at the time he needs it most: his old age.

This fear of illness and disability and the subsequent inability to work and be productive for his/her family, sends the individual into panic; because he knows that a certain number of industrial illnesses lead to slow incapacitation and chronicity. So he grabs at the juiciest (and most expensive) package the Demon dangles. But when he discovers that he does not get as sick as he feared, he feels cheated. So he decides to cheat back and malingers. This is aided and abetted by the health benefactor, the doctor, who discovers that he suddenly has lost his private practice to the HMO and is actually working as its casual employee. He gets paid by the piece (patient) and his fees are predetermined by the HMO.

The Demon gets back at both of them by deselecting the chronically ill patients (woe to those who do not malinger!) and slashing the doctors’ and the hospital fees.

The hospitals, when they find their fees slashed, get into the cheating fray by padding their bills. And they do it with gusto because the HMOs and especially the PhilHealth (Medicare) do not pay their bills on time. Sometimes, if not often, particularly when the government needs money to foot the bill for some high officials’ junkets abroad or his/her reelection expenses, PhilHealth postpones payment for a year or two. With no consideration for cost of money. This is a supreme example of cheating disguised as bureaucratic mumbo-jumbo. And this has been one of the main reasons for the collapse of quite a number of smaller hospitals in the countryside. Those that really serve the less fortunate.

And so a real vicious cycle, a downward spiral occurs. The Germans call it the Teufelskreis, the Devil’s Circle that goes straight down to hell.

There are no little boys with five loaves and two fishes out there anymore.

There are only Demons fighting each other for a better hold.

And even Obama, the Savior of the Universe, is still in limbo. Neither black nor white.

Not even gray.

[Dr. Jose “Ting” M. Tiongco, chief executive officer of the Medical Mission Group Hospitals and Health Services Cooperative-Philippines Federation, writes a column, Child of the Sun, for MindaNews. He is author of two books, “Child of the Sun Returning” (1996) and “Surgeons Do Not Cry” (2008). The second book is available at UP bookstore, National bookstore and MindaNews]


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written by versace, December 24, 2010

Thanks for taking the time to talk about this, I feel fervently about this and I take lv cell phone pleasure in learning about this topic. Please, as you gain information, please update this blog with more information. I have found it very useful

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