Dr. Ernesto O. Domingo, a renowned medical practitioner and a 2013 Ramon Magsaysay awardee, was one of the speakers during the 44th Annual Convention of the Philippine College of Physicians (PCP) last May 3, 2014 at the SMX Convention Center, Pasay City.
The convention’s theme is “Inequities in Health: The Widening Gap Between the Rich and the Poor”. His talk focused not only in defining who the rich and the poor are, but also delved into the existing inequities in health care.
“The Philippine Health Care system is ‘a leper on the steps of the temple’…it is not my intention to criticize or put the blame on anyone but rather to present the problem, the cancer, so that the passers-by shall suggest their own remedy.,” Dr. Domingo emphasized.
He identified specific examples of inequities that…[pq]…the poor suffer because of dysfunctional financing, health services, human resource, governance, regulation and information.[/pq]
The example he cited in financing had to do with the concept of ‘catastrophic illness’. In a family, when a member becomes ill, it affects the whole family beyond the illness. If you are lower middle class, after one illness, you become poor and if you are poor, you become destitute.
He also pointed out a clear indication of inequity by showing how large the share of out of pocket health expenditures compared to the share of government health expenditures and health insurance expenditures. For health services provision, majority of the Filipinos, especially the poor, make use of public health facilities.
However, a majority of secondary and tertiary hospitals in the country belong to the private sector, thereby creating an inequity in the access of quality health care.
In the area of health human resource, he cited the Department of Health pegging the total number of government doctors at 2,838, but this pales in comparison to the whopping 6,151 doctors serving in only 5 medical centers in the National Capital Region.
Dr. Domingo also talked about inequity in health governance which had to do with putting in place functioning health systems at the local level from the province, down to the municipality and the city. According to him, we do not know at what level of function our local health systems are at this point, and this fact contributes to the inequity.
In terms of regulation, he presented a specific case wherein government regulators (BFAD), who were trying to make an effort to make sure that unbranded generics are of good quality, were charged in court by a drug company. While the case was being decided on by the Supreme Court for 7 years, “it held hostage public health and clinical medicine, meddled into something scientific, technical” and may have affected how patients were treated.[pq]There is a lack of quality and real time information or data on health at the national and local levels…[/pq]
…which affects the way the health system addresses potential health issues and problems, such as outbreaks,” he said.
He summarized the attributes of ‘good universal health care’ as follows: accessibility, efficiency, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public.
Dr. Domingo calls on doctors to change the way they teach medicine, veering away from informative education and focusing on “transformative education,” which will help empower doctors to provide their patients with appropriate knowledge so that they can navigate through the health care system and get the help that they need, when they need it.
Liezl Formilleza – Dunuan, Medical Observer