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HEALTHCARE UNDER

LOCK AND KEY


conventions, quality and
affordable healthcare remains
elusive for Filipinos.

The unfortunate, impoverished

Dissecting the Hospital Detention Law people


Suffering from prolonged
labor, Marites was admitted in

T
n By CANDY DIEZ
Bukidnon Provincial Hospital in
THE Right to Health of everyone is Maramag on the 12 th of July,
2007. She was then pregnant
guaranteed both in international
with her 7th child.
conventions and domestic laws. With her husband afflicted
The 1987 Philippine Constitution under with malaria, Marites was left
Article 13, Section 11 states, “There shall with 6 children to feed, a
b e priority for the needs of the under-privileged, sick, Php4,750.00 unpaid hospital bill
and a new-born baby detained
elderly, disabled, women, and children. The State shall with her at the provincial
endeavor to provide free medical care to paupers.” hospital’s abandoned out-
The United Nations emphasizes: “The creation of patient department. Without
International Covenant on conditions which would assure to sufficient finances to settle
Economic, Social and Cultural all medical service and medical hospital obligations, Marites
Rights (UN ICESCR) also attention in the event of sickness”. and her baby still remained
stresses the right to health of However in spite of these admitted almost a month after
everyone. Article 12.2-D state guarantees and Photos: MEDICAL ACTION GROUP (MAG) she was hospitalized.

Human Rights FORUM 7


Detainees: Indigent patients and their families kept in detention at the Bukidnon Provincial Hospital of Maramag. Photos: MEDICAL ACTION GROUP (MAG)

Marites was just among the


18 patients who lay languishing
to demand for his/her medical
certificate as well as other
The state’s lack (P50,000.00). The violating party
may also be imprisoned for not
in carton mats in a ward papers necessary for his/her of political and less than one month, but not
resembling a detention ward in release from the said medical more than six months. Both fine
the Bukidnon Provincial facility. In case of deceased
moral will to and imprisonment may also be
Hospital in August of 2007. patients, the corresponding address the applied depending on the
Bukidnon patients were certificates and other documents discretion of the proper court.
constantly afraid of acquiring shall be similarly released to the issue of The Hospital Detention
other diseases during their stay patients’ relatives. healthcare Law, however, does not apply
in the filthy hospital ward. Failure to adhere to the to patients who opted for
Patients detained for almost Hospital Detention Law would remains evident private rooms. It prioritizes
three months have reportedly
tried to escape the hospital
entail fines amounting to not
less than twenty thousand pesos
in the 2007 indigent patients.

premises for lack of adequate (P20,000.00), but not more than National Budget. Profits vs public service
food and nourishment provided fifty thousand pesos ............................................................ While the Hospital
by the hospital.

The Hospital Detention Law


To address the recurring
cases of patients who get held
in hospitals because they were
unable to pay their bills, a
legislative measure was enacted
in April 27, 2007, declaring the
act of detaining patients in
hospitals illegal.
Under Republic Act No.
9439, popularly known as the
Hospital Detention Law,
patients without the financial
capacity to settle their hospital
obligations but have fully or
partially recovered are allowed
to leave the hospital or medical
clinic upon the accomplishment
of a promissory note.
The promissory note
covering the patient’s hospital
expenses should be guaranteed
by a mortgage or a co-maker
who will be similarly held
liable for the unpaid hospital
dues.
A patient also has the right Gaol or refuge? Under RA 9439, hospitals cannot detain patients who are unable to pay for medical services.
8 Human Rights FORUM
Detention Law gained praise for
its pro-poor principles, its
passage did not please hospital
owners as well as doctors and
nurses. The Private Hospitals
Association of the Philippines
(PHAP) began publicly airing
their opposition to the law.
PHAP argued that without
the payments from hospital fees,
hospital funds will not suffice
for medicine and equipment
expenses as well as the salaries
of hospital employees. The
group added that the hospital’s
lack of fund sources will lead to
closures of hospitals and will
further drive health profes-
sionals to work abroad, where
better compensation and benefit
packages await them.
Rustico Jimenez, spokes-
person of PHAP, argued that
many hospitals are burdened
with unpaid bills. According to
him, among the patients who
secured promissory notes, only
one out of 10 of them honored Photo: MEDICAL ACTION GROUP (MAG)
the promissory agreements. the Filipinos’ priorities. for national defense and 21% for
IRR, the group renewed its call
Meanwhile, in their desperation, for the hospital boycott, saying In 1999, the DOH reported debt service.
other patients resort to pro- the IRR can not sufficiently that cases of under medication In fact in the WHO World
viding fictitious names and protect the interest of the (antibiotics) or over-medication Health Statistics 2007, the
addresses to avoid their unpaid private hospitals. on cheap preparations were Philippines received a low rank
obligations. During the hospital holiday prevalent. The World Health (153rd out of 192 countries) in the
With these arguments, PHAP debates, DOH Secretary Fran- Organization meanwhile at- government’s health spending
threatened to conduct a cisco Duque III contested the tested in their World Drug as a share of a country’s total
nationwide ‘hospital holiday,’ arguments of the possible de- Situation in 2000 that less than spending on health.
with PHAP member hospitals crease in the private hospitals’ 30% of Filipinos have regular Thus it is no longer
closing down two to three times profits. Duque pointed out that access to medicines. 40% have surprising that in a study
a month (although their these hospitals are actually never seen a doctor. conducted by the World Bank
emergency wards will be kept receiving sufficient funds from In 2006, a meager 2.9 percent in 2001, data showed that
open). The holiday will continue PhilHealth. According to the is being spent on medical care Filipino patients prefer private
until 2008 or until the law is Health secretary, 70% of by a Filipino family. Expen- hospitals over government
amended or reasonable Imple- PhilHealth reimbursements go ditures on healthcare reflected health facilities. According to
menting Rules and Regulations to private hospitals, and a that 24.1 percent alone was spent the Filipino Report Card of Pro-
(IRR) are formulated. Among meager 30% was reimbursed to on hospital room charges in Poor services, patients utilize
the 300 member hospitals of government hospitals. 2001. 21.7 percent was used for the private hospitals and clinics
PHAP are St. Luke’s Medical other medical charges such as the most in the Philippines and
Center, Asian Hospital, Last priority doctor’s fees. across the regions (46%-59%).
University of Santo Tomas (UST) According to the latest With poverty plaguing Government hospitals ranked
Hospital, Medical City, and the analysis (2003) of the National Filipinos around the nation, to second with 30%-45% nation-
Makati Medical Center. Statistical Coordination Board trust in the government’s health wide and in NCR and Luzon.
The Department of Health (NCSB), 24 out of 100 Filipino care aid is the second most In spite of their financial
(DOH) responded to the appeals families have not earned enough logical recourse. The state limitations, Filipino families
of PHAP to consider the private to fulfill their basic food and however, has again failed in this continue to demand for quality
hospital’s interest in the issue. non-food needs. Unemploy- aspect. and satisfactory healthcare
DOH, through Undersecretary ment rates also remained high The state’s lack of political services. This demand is far
Alexander Padilla, invited according to the National and moral will to address the from being met by the
PHAP in the formulation of the Statistics Office, with 2.8 million issue of healthcare remains government, what with a
IRR of the Hospital Detention Filipinos unemployed as of July evident in the 2007 National measly health budget allocation
Law. this year. Budget. The state’s budget for each year. The need for better
PHAP relented and post- With not enough earnings to health in 2007 was only 1.28 % healthcare is therefore being
poned its planned strike. But spend for basic necessities, of the National Budget answered by the private
after the initial crafting of the healthcare remained the least of compared to the 8% allocation hospitals.

Human Rights FORUM 9


In the guise of healthcare Presentation
reform GMA News TV. (2007 May 24) Private
While sincerely attempting hospitals defer strike over new law.
to resolve the accessibility and May 24, 2007. http://
affordability issues of www.gmanews.tv/stor y/43718/
healthcare, the passage of the Private-hospitals-defer-strike-over-
new-law (Accessed: October 17, 2007)
Hospital Detention Law has just
merely transferred the state’s IBON Info. (2007 Oct. 3) RP among
obligations to the private sector. world’s worst in health services. http:/
Instead of creating an /info.ibon.org/ index.php?option=com
environment in which health- _content&task=view&id=204&Itemid=51
(Accessed: October 22, 2007)
care is accessible and affordable
by allocating sufficient health Medical Action Group, Inc. (2007 Aug.
budget to address the healthcare 1). Bukidnon Provincial Hospital
needs of the public, the patients’ profile.
government has preferred to
prioritize expenditures for National Statistics Office. (2007 Oct.
9) Change in spending pattern
national defense and debt among Filipino families seen in
servicing. 2006. http://www.census.gov.ph/
Patients are then forced to d a t a / p r e s s r e l e a s e / 2 0 07 /
make out-of-pocket payments, ie06tx.html (Accessed: October 19,
driving them to the mercy of 2007)
private hospitals that are
National Statistics Office. (2007 Oct.
charging fees beyond the 7) Medical care expenditures in 2000
patients’ financial means. reached P34.6 billion. http://
Private hospitals, mean- the cases of hospital detention REFERENCES: www.census.gov.ph/data/
while, are far from being pressrelease/2002/ ie00mdtx.html
in the country, the passage of a
unscathed. In their desire to earn (Accessed: October 19, 2007)
law prohibiting such cases will Congressional Planning and
more profits, they have mana- never be enough. Budget Department. (2006 Nov.) Peria, E. (2007 Mar. 14) Access to
ged to neglect the individuals Until the widespread An analysis of the president’s medicines with the right to health in
they have sworn to protect and budget for fiscal year 2007. http:/ the Philippine context. Powerpoint
poverty continues to ail the /ia350634.us.archive.org/0/
care for. Thus healthcare in the Filipinos, until the government Presentation.
items/CongressBudget
private sector is oftentimes truly recognizes its right to P l a n n i n g D e p t 2 0 07 N a t i o n a l Republic Act No. 9439, The Hospital
based on the financial capacity health obligation to its people, BudgetofPhilippines/budget07.pdf Detention Law. http://
of the patient. until comprehensive and (Accessed: October 22, 2007) www.senatorpiacayetano.com/ psc/
While the blatant profite- systematic reforms in the allthebills.php?recordID=37
Dizon, N. (2007 Aug. 30) Hospital (Accessed: October 15, 2007)
ering of private hospitals at the various aspects of the healthcare holiday to proceed in September—
expense of the poor Filipino system in the Philippines are PHAP. Philippine Daily Inquirer. http:/ Salaverria, L. (2007 May 25) ‘Hospital
patients is by itself condemnable, implemented, the passage of the /newsinfo.inquirer.net/ holiday’ off, Sen. Pia Cayetano
their arguments, however are Hospital Detention Law will breakingnews/nation/view_article. explains. Philippine Daily Inquirer.
not. The threat of hospital php?article_id= 85634 (Accessed:
only remain a symbolic gesture h t t p : / / n e w s i n f o . i n q u i r e r. n e t /
October 17, 2007) inquirerheadlines/nation/
closures as well as the possible of the state’s attempt to fulfill
increase in the migration of view_article.php? article_id=67895
its Right to Health obligations Galvez Tan, J. Philippine national (Accessed: October 17, 2007)
health professionals cannot to the Filipinos. health situation in 2005. Powerpoint
simply be disregarded. Salaverria, L. (2007 May 24) Private
In 2003, two hundred hospitals protest new law, threaten
hospitals closed down and eight ‘strike’. Philippine Daily Inquirer.
hundred were partly closed due h t t p : / / n e w s i n f o . i n q u i r e r. n e t /
breakingnews/nation/view
to the lack of health workers.
article.php?ar ticle_id= 67658
The Philippines to date is the (Accessed: October 17, 2007)
number one exporter of nurses
around the world. An estimated Tandoc, E. (2007 June 5) Threat of
85% of Filipino nurses are hospital ‘holiday’ lingers. Philippine
Daily Inquirer. http://
working abroad. The Profes-
newsinfo.inquirer.net/
sional Regulation Commission breakingnews/nation/
in 2004 reported that 8,931 view_article.php? article_id=69679
nurses leave the country each (Accessed: October 17, 2007)
year. The large international
United Nations. Human Rights – The
demand for nurses triggered the
Committee on Economic, Social and
doctors to become nurses as well. Cultural Rights Fact Sheet no. 16
The medicine enrollees have (rev.1), p. 40.
decreased by 33% in 2004. ..................................................................
If the government is truly CANDY DIEZ works with the
sincere in its efforts to address Photos: MEDICAL ACTION GROUP (MAG) Medical Action Group (MAG).

10 Human Rights FORUM