7Human Rights FORUM

THE Right to Health of everyone isguaranteed both in internationalconventions and domestic laws.

The 1987 Philippine Constitution underArticle 13, Section 11 states, There shall

Dissecting the Hospital Detention Law

HEALTHCARE UNDERLOCK AND KEYn By CANDY DIEZ

Tbe priority for the needs of the under-privileged, sick,elderly, disabled, women, and children. The State shallendeavor to provide free medical care to paupers.

The United NationsInternational Covenant onEconomic, Social and CulturalRights (UN ICESCR) alsostresses the right to health ofeveryone. Article 12.2-D

emphasizes: The creation ofconditions which would assure toall medical service and medicalattention in the event of sickness.

However in spite of thesestate guarantees and

conventions, quality andaffordable healthcare remainselusive for Filipinos.

The unfortunate, impoverishedpeople

Suffering from prolongedlabor, Marites was admitted inBukidnon Provincial Hospital inMaramag on the 12th of July,2007. She was then pregnantwith her 7th child.

With her husband afflictedwith malaria, Marites was leftwith 6 children to feed, aPhp4,750.00 unpaid hospital billand a new-born baby detainedwith her at the provincialhospitals abandoned out-patient department. Withoutsufficient finances to settlehospital obligations, Maritesand her baby still remainedadmitted almost a month aftershe was hospitalized.Photos: MEDICAL ACTION GROUP (MAG)

8 Human Rights FORUM

Marites was just among the18 patients who lay languishingin carton mats in a wardresembling a detention ward inthe Bukidnon ProvincialHospital in August of 2007.Bukidnon patients wereconstantly afraid of acquiringother diseases during their stayin the filthy hospital ward.Patients detained for almostthree months have reportedlytried to escape the hospitalpremises for lack of adequatefood and nourishment providedby the hospital.

The Hospital Detention LawTo address the recurring

cases of patients who get heldin hospitals because they wereunable to pay their bills, alegislative measure was enactedin April 27, 2007, declaring theact of detaining patients inhospitals illegal.

Under Republic Act No.9439, popularly known as theHospital Detention Law,patients without the financialcapacity to settle their hospitalobligations but have fully orpartially recovered are allowedto leave the hospital or medicalclinic upon the accomplishmentof a promissory note.

The promissory notecovering the patients hospitalexpenses should be guaranteedby a mortgage or a co-makerwho will be similarly heldliable for the unpaid hospitaldues.

A patient also has the right

to demand for his/her medicalcertificate as well as otherpapers necessary for his/herrelease from the said medicalfacility. In case of deceasedpatients, the correspondingcertificates and other documentsshall be similarly released to thepatients relatives.

Failure to adhere to theHospital Detention Law wouldentail fines amounting to notless than twenty thousand pesos(P20,000.00), but not more thanfifty thousand pesos

(P50,000.00). The violating partymay also be imprisoned for notless than one month, but notmore than six months. Both fineand imprisonment may also beapplied depending on thediscretion of the proper court.

The Hospital DetentionLaw, however, does not applyto patients who opted forprivate rooms. It prioritizesindigent patients.

Profits vs public serviceWhile the Hospital............................................................

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

Gaol or refuge? Under RA 9439, hospitals cannot detain patients who are unable to pay for medical services.

The states lackof political andmoral will toaddress theissue ofhealthcareremains evidentin the 2007National Budget.

9Human Rights FORUM

Detention Law gained praise forits pro-poor principles, itspassage did not please hospitalowners as well as doctors andnurses. The Private HospitalsAssociation of the Philippines(PHAP) began publicly airingtheir opposition to the law.

PHAP argued that withoutthe payments from hospital fees,hospital funds will not sufficefor medicine and equipmentexpenses as well as the salariesof hospital employees. Thegroup added that the hospitalslack of fund sources will lead toclosures of hospitals and willfurther drive health profes-sionals to work abroad, wherebetter compensation and benefitpackages await them.

Rustico Jimenez, spokes-person of PHAP, argued thatmany hospitals are burdenedwith unpaid bills. According tohim, among the patients whosecured promissory notes, onlyone out of 10 of them honoredthe promissory agreements.Meanwhile, in their desperation,other patients resort to pro-viding fictitious names andaddresses to avoid their unpaidobligations.

With these arguments, PHAPthreatened to conduct anationwide hospital holiday,with PHAP member hospitalsclosing down two to three timesa month (although theiremergency wards will be keptopen). The holiday will continueuntil 2008 or until the law isamended or reasonable Imple-menting Rules and Regulations(IRR) are formulated. Amongthe 300 member hospitals ofPHAP are St. Lukes MedicalCenter, Asian Hospital,University of Santo Tomas (UST)Hospital, Medical City, and theMakati Medical Center.

The Department of Health(DOH) responded to the appealsof PHAP to consider the privatehospitals interest in the issue.DOH, through UndersecretaryAlexander Padilla, invitedPHAP in the formulation of theIRR of the Hospital DetentionLaw.

PHAP relented and post-poned its planned strike. Butafter the initial crafting of the

IRR, the group renewed its callfor the hospital boycott, sayingthe IRR can not sufficientlyprotect the interest of theprivate hospitals.

During the hospital holidaydebates, DOH Secretary Fran-cisco Duque III contested thearguments of the possible de-crease in the private hospitalsprofits. Duque pointed out thatthese hospitals are actuallyreceiving sufficient funds fromPhilHealth. According to theHealth secretary, 70% ofPhilHealth reimbursements goto private hospitals, and ameager 30% was reimbursed togovernment hospitals.

Last priorityAccording to the latest

analysis (2003) of the NationalStatistical Coordination Board(NCSB), 24 out of 100 Filipinofamilies have not earned enoughto fulfill their basic food andnon-food needs. Unemploy-ment rates also remained highaccording to the NationalStatistics Office, with 2.8 millionFilipinos unemployed as of Julythis year.

With not enough earnings tospend for basic necessities,healthcare remained the least of

the Filipinos priorities.In 1999, the DOH reported

that cases of under medication(antibiotics) or over-medicationon cheap preparations wereprevalent. The World HealthOrganization meanwhile at-tested in their World DrugSituation in 2000 that less than30% of Filipinos have regularaccess to medicines. 40% havenever seen a doctor.

In 2006, a meager 2.9 percentis being spent on medical careby a Filipino family. Expen-ditures on healthcare reflectedthat 24.1 percent alone was spenton hospital room charges in2001. 21.7 percent was used forother medical charges such asdoctors fees.

With poverty plaguingFilipinos around the nation, totrust in the governments healthcare aid is the second mostlogical recourse. The statehowever, has again failed in thisaspect.

The states lack of politicaland moral will to address theissue of healthcare remainsevident in the 2007 NationalBudget. The states budget forhealth in 2007 was only 1.28 %of the National Budgetcompared to the 8% allocation

for national defense and 21% fordebt service.

In fact in the WHO WorldHealth Statistics 2007, thePhilippines received a low rank(153rd out of 192 countries) in thegovernments health spendingas a share of a countrys totalspending on health.

Thus it is no longersurprising that in a studyconducted by the World Bankin 2001, data showed thatFilipino patients prefer privatehospitals over governmenthealth facilities. According tothe Filipino Report Card of Pro-Poor services, patients utilizethe private hospitals and clinicsthe most in the Philippines andacross the regions (46%-59%).Government hospitals rankedsecond with 30%-45% nation-wide and in NCR and Luzon.

In spite of their financiallimitations, Filipino familiescontinue to demand for qualityand satisfactory healthcareservices. This demand is farfrom being met by thegovernment, what with ameasly health budget allocationeach year. The need for betterhealthcare is therefore beinganswered by the privatehospitals.

Photo: MEDICAL ACTION GROUP (MAG)

10 Human Rights FORUM

In the guise of healthcarereform

While sincerely attemptingto resolve the accessibility andaffordability issues ofhealthcare, the passage of theHospital Detention Law has justmerely transferred the statesobligations to the private sector.

Instead of creating anenvironment in which health-care is accessible and affordableby allocating sufficient healthbudget to address the healthcareneeds of the public, thegovernment has preferred toprioritize expenditures fornational defense and debtservicing.

Patients are then forced tomake out-of-pocket payments,driving them to the mercy ofprivate hospitals that arecharging fees beyond thepatients financial means.

Private hospitals, mean-while, are far from beingunscathed. In their desire to earnmore profits, they have mana-ged to neglect the individualsthey have sworn to protect andcare for. Thus healthcare in theprivate sector is oftentimesbased on the financial capacityof the patient.

While the blatant profite-ering of private hospitals at theexpense of the poor Filipinopatients is by itself condemnable,their arguments, however arenot. The threat of hospitalclosures as well as the possibleincrease in the migration ofhealth professionals cannotsimply be disregarded.

In 2003, two hundredhospitals closed down and eighthundred were partly closed dueto the lack of health workers.The Philippines to date is thenumber one exporter of nursesaround the world. An estimated85% of Filipino nurses areworking abroad. The Profes-sional Regulation Commissionin 2004 reported that 8,931nurses leave the country eachyear. The large internationaldemand for nurses triggered thedoctors to become nurses as well.The medicine enrollees havedecreased by 33% in 2004.

If the government is trulysincere in its efforts to address

the cases of hospital detentionin the country, the passage of alaw prohibiting such cases willnever be enough.

Until the widespreadpoverty continues to ail theFilipinos, until the governmenttruly recognizes its right tohealth obligation to its people,until comprehensive andsystematic reforms in thevarious aspects of the healthcaresystem in the Philippines areimplemented, the passage of theHospital Detention Law willonly remain a symbolic gestureof the states attempt to fulfillits Right to Health obligationsto the Filipinos.

REFERENCES:

Presentation

GMA News TV. (2007 May 24) Privatehospitals defer strike over new law.May 24, 2007. http://www.gmanews.tv/story/43718/Private-hospitals-defer-strike-over-new-law (Accessed: October 17, 2007)

IBON Info. (2007 Oct. 3) RP amongworlds worst in health services. http://info.ibon.org/ index.php?option=com_content&task=view&id=204&Itemid=51(Accessed: October 22, 2007)

Medical Action Group, Inc. (2007 Aug.1). Bukidnon Provincial Hospitalpatients profile.

National Statistics Office. (2007 Oct.9) Change in spending patternamong Filipino families seen in2006. http://www.census.gov.ph/d a t a / p r e s s r e l e a s e / 2 0 0 7 /ie06tx.html (Accessed: October 19,2007)

National Statistics Office. (2007 Oct.7) Medical care expenditures in 2000reached P34.6 billion. http://w w w . c e n s u s . g o v . p h / d a t a /pressrelease/2002/ ie00mdtx.html(Accessed: October 19, 2007)

Peria, E. (2007 Mar. 14) Access tomedicines with the right to health inthe Philippine context. PowerpointPresentation.

Republic Act No. 9439, The HospitalDetention Law. http://www.senatorpiacayetano.com/ psc/a l l t h e b i l l s . p h p ? r e c o r d I D = 37(Accessed: October 15, 2007)

Salaverria, L. (2007 May 25) Hospitalholiday off, Sen. Pia Cayetanoexplains. Philippine Daily Inquirer.h t t p : / / n ew s i n fo . i n qu i r e r. n et /i n q u i r e r h e a d l i n e s / n a t i o n /view_article.php? article_id=67895(Accessed: October 17, 2007)

Salaverria, L. (2007 May 24) Privatehospitals protest new law, threatenstrike. Philippine Daily Inquirer.h t t p : / / n ew s i n fo . i n qu i r e r. n et /b r e a k i n g n e w s / n a t i o n / v i e warticle.php?article_id= 67658(Accessed: October 17, 2007)

Tandoc, E. (2007 June 5) Threat ofhospital holiday lingers. PhilippineDaily Inquirer. http://n e w s i n f o . i n q u i r e r . n e t /b r e a k i n g n e w s / n a t i o n /view_article.php? article_id=69679(Accessed: October 17, 2007)

United Nations. Human Rights TheCommittee on Economic, Social andCultural Rights Fact Sheet no. 16(rev.1), p. 40.

CANDY DIEZ works with theMedical Action Group (MAG).Photos: MEDICAL ACTION GROUP (MAG)

Congressional Planning andBudget Department. (2006 Nov.)An analysis of the presidentsbudget for fiscal year 2007. http:// i a 3 5 0 6 3 4 . u s . a r c h i v e . o r g / 0 /i t e m s / C o n g r e s s B u d g e tP l a n n i n g D e p t 2 0 0 7 N a t i o n a lBudgetofPhilippines/budget07.pdf(Accessed: October 22, 2007)

Dizon, N. (2007 Aug. 30) Hospitalholiday to proceed in SeptemberPHAP. Philippine Daily Inquirer. http:// n e w s i n f o . i n q u i r e r . n e t /breakingnews/nation/view_article.php?article_id= 85634 (Accessed:October 17, 2007)

Galvez Tan, J. Philippine nationalhealth situation in 2005. Powerpoint

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