When bureaucracy rules health care
It seems that Filipinos have no choice but to actively learn the ins and outs of each government program as we go through the season of budget deliberations. The lack of trust and transparency has not afforded us the luxury of leaving it to our public servants to make the best decision for us. Instead, we must be vigilant and see beyond the flowery names of these touted programs to prevent siphoning off our taxpayer money.
The program of the week is the Department of Health’s (DOH) Medical Assistance to the Indigent and Financially Incapacitated Program, or Maifip. From the originally proposed P24-billion budget by the Senate, the bicameral conference committee is mulling to increase it to a whopping P51 billion, citing the risk of depriving millions of indigent Filipinos of health-care assistance.
While the name of the program sounds hardly arguable, Filipinos know how this is truly implemented on the ground: guarantee letters by politicians. Some critics have dubbed it the “health pork barrel,” where politicians lay claim to its usage, supposedly so they can more actively direct assistance to their constituents. In truth, however, it is merely a way for politicians to take credit—and control—over such aid without having to do anything. Essentially, they are middlemen with no added value.
The Maifip is the symbol of everything that is wrong in our health-care system. First, it represents the presence of too much red tape and bureaucracy. The volume of documentary requirements necessitates family members to spend an inordinate amount of effort to secure such certifications from various government agencies. In some cases, this requires bootlicking to curry favor from various persons-in-charge, from barangay to national levels. Such bureaucracy forces us to be beholden to public officials, usually in the form of votes or party support. It also comes at the expense of our dignity, as the poor are expected to tolerate long, thankless lines, and judgmental and dismissive attitudes from government offices.
Such red tape gives rise to the existence of guarantee letters, supposedly to assure health-care providers and facilities that patients are vouched for by their public officials. However, many in health care bemoan that these letters do not actually provide peace of mind because reimbursements are long delayed and unreliable. In a way, guarantee letters basically guarantee nothing for the provider.
The Maifip, as the spotlighted program in the national discourse, represents a more systemic problem in our health care. I wish it were simply an outlier, an isolated case of corruption, but its existence is the visible symptom of a more serious disease. Case in point: the DOH has suggested that lawmakers redirect the proposed additional funding straight to local government units instead, so they can boost LGU hospitals in aid of implementing zero balance billing. Others have suggested redirecting the funds to the Philippine Health Insurance Corp. to increase its coverage. No sooner had these suggestions been made than Filipinos expressed wariness about LGUs and PhilHealth pocketing or diverting the money. If corruption is perceived to be everywhere, to whom can we entrust our money?
Redirecting funds to the zero balance billing initiative is rightly met with skepticism because its rollout has been painfully slow. Already, the few hospitals identified in this program have patients spilling out in hallways and streets as the facilities struggle to keep up due to limited manpower and resources, while private hospitals would rather pretend PhilHealth did not exist at all, as our bills would attest. Adding funds to PhilHealth, when it has a poor track record of providing adequate coverage for patients and has been operating in such bad faith with health-care providers’ reimbursements, makes us skeptical that we will even feel any increase in its budget.
The problem that Maifip highlights is that our government uses a bureaucratic mindset when it comes to our health. Got a problem? Create a separate nice-sounding program for it. Let’s pat ourselves on the back for adding funding to a program, regardless of how inefficiently it is implemented. Let’s pretend that politicians are better at directing aid to needed beneficiaries rather than health-care and social work professionals themselves. All the while, they themselves do not even make use of the health hellscape they created, as they fly abroad for even the most basic of medical treatments.
If we really wish to ensure that the most vulnerable of sectors get the health care they deserve, we must create a system for all that is good and honest to begin with. If we remove the red tape, move away from the reimbursement and guarantee-letter model, and focus on how we can provide the best health care possible for any person walking in, then people will not need patronage politics or personal connections just to survive.
—————-
aatuazon@up.edu.ph
