A Medical Center | Photo by LEDC on Unsplash
Part IX of a “Cancer/Medical Moonshot” Series
“We already have state-of-the-art medical facilities in the Philippines. Philippines Asian Hospital, St. Luke’s Hospital, and the various hospitals of the major medical schools, to name a few. I’m sure Cebu and Davao or even Baguio City have their own as well”, thus commented a retired American of Filipino descent, Eligio Abellera, M.D., of the Great State of Georgia.
Dr. Abellera, whom this columnist calls “a role model for Filipino-American Super Agers”, responded with a superlative observation for this series’ Part VIII, which argued why “Duke University Can Be the Ideal Partner for a New Philippine Medical Center”. Its first paragraph says: “Duke University appears to be an ideal partner for the Philippine Medical Center (MedCenter), which will be a state-of-the-art replica of the first one built in Manila in 1901. It was then a project of U.S. President William McKinley and William Howard Taft, the first civil governor-general of the new American colony.”
Indeed, Dr. Abellera speaks the truth about the presence of modern hospitals in some of the major cities of the Philippines. But those operated by provincial governments and even by privately owned hospitals in rural towns and smaller, far-flung cities do not have the right modern medical equipment and facilities. And almost all medical facilities in the Philippines require advance deposits for medical care, especially hospitalization that requires surgery. This requirement of a down payment for medical services or hospitalization often makes marginalized people forgo any life-saving healthcare procedure at all. Or the so-called “preventive outpatient visits” even to mere clinics.
On the other hand, the proposed new Philippine MedCenter will operate in the style of Duke University Hospital, which donors, especially foundations, fund. It is also supported by the State of North Carolina and other local government entities. Most of its patients also have modest employer-sponsored insurance coverage, and those who are retired have Medicare coverage. And of course, the Duke University Hospital operates with full “accountability, transparency, integrity and credibility” (ATIC, as this writer coined the acronym in 2000).
Here is an actual medical case. A fellow Sorsoganon had to undergo a heart procedure at St. Luke’s Hospital in Metro Manila. Sorsogon City has a provincial hospital and four private hospitals. But they do not offer heart surgery or any similar procedure. To cut a long story short, the Sorsoganon had two bypasses early this month, and the hospital bill was reportedly more than PHP 5-million (about US$87,000). He probably would have to sell many of his assets to pay the hospital bill. There is really no good medical insurance in the Philippines. The proposed new Philippine MedCenter will usher in a workable cooperative-style medical coverage, as will be explained in this series.
“…[T]o have subsidized ways of so-called “preventive care and medicine” plus the early detection of, and medical intervention for, heart disease, cancer, and other major causes of death among the sick.“
The question now? If many Filipinos cannot afford even dentures, how can they pay for heart procedures? According to Philippine government data, as of 2023, approximately 17.54 million people (15.5% of the population) in the country were living below the national poverty line, down from 19.99 million in 2021. Despite the alleged decline, high food prices have tempered progress, with roughly 9.79 million people still unable to meet basic food needs.
A fellow columnist, Crispin Fernandez, M.D., wrote an op-ed piece, “Entrepreneurship – Lessons Before or After Onset of Poverty?” on December 7, 2023. Dr. Fernandez said: “Even so-called universal healthcare (in the Philippines) that doesn’t cover outpatient services smacks of being penny-wise and pound-foolish.” The lack of recognition of the basic dictum that an ounce of prevention is better than a pound of cure is appalling. While dialysis is fully funded, preventive outpatient visits for early detection and management of early-onset kidney failure are not funded. Dialysis obviously costs a lot more than early interventions.”
There is an easy way for the Philippine government to assure people, especially the poorest of the poor (to use an oft-quoted adage), to have subsidized ways of so-called “preventive care and medicine” plus the early detection of, and medical intervention for, heart disease, cancer, and other major causes of death among the sick. To achieve this ideal coverage, the government can use the entire “Value-Added Tax” (VAT), which normally exceeds US$10 billion (and counting) per fiscal year.
The Bureau of Internal Revenue (BIR) in the Philippines collected approximately PHP 643.85 billion (US$11.10 billion in the current exchange rate of PHP 58/US$1) in VAT in 2024. It marked a 35.48% increase from the previous year, according to VATupdate. This figure accounted for more than 22% of total BIR tax collections in 2024, making it a major source of government revenue, notes VATupdate. Most of the VAT and other taxes (aside from income tax and real-estate taxes) are used by politicians to fund prestige projects (that run into trillions of pesos every year). Many public works projects serve only political ends and, more often than not, end up as “ghost (or uncompleted) projects”.
