Public Hospital or Black Friday?

Standing in front of Philippines General Hospital

I had the opportunity to visit the Philippines General Hospital, which prides itself on being the best public hospital in the entire country. The outpatient department has all specialties, ranging from pediatrics to dermatology to neurology. On average, the Out Patient Department sees almost 2,000 patients every single day. Patients will wait in line starting at around 4 AM and try to get an appointment to see a doctor. According to local doctors, the hospital is almost always 150% to 200% over capacity (1,300 beds). The In Patient Department of the hospital is also extremely over packed. There is absolutely no sense of privacy as a single ward can have up to 30 patients. In certain areas of the hospital that are undergoing renovation, such as the Emergency Room, patients can be seen lying in chairs or around the waiting areas hooked up to IVs. The ER is fitted to have a maximum capacity of 25 patients. However, it usually manages to cram in around 100 patients. The pediatric unit is also a disheartening scene. With no concept of a NICU or nursery, newborn babies stay right next to chronic, and toxic patients in the pediatric wards that hold upwards of 30 people in one room. There is often no place for family members to rest or get sleep and many are seen sprawled across the floor or the patient’s bed. Around 60% of the population cannot afford to seek private health care and thus must rely on the public health care system. The hospital also has a private health care component which is drastically different. Here, the area is clean and open. The facilities are well maintained and there is more privacy. One night’s stay in the private side may cost around 3,000 to 5,000 pesos. The minimum wage per day for those living in Manila is 500 pesos and in those living in the periphery it is 300 to 400 pesos. PhilCare, the national health insurance program, covers all costs for those earning under 100 pesos a day, which is the worldwide level of poverty, but there are many left in the gap that are not covered for and must rely on public health care. In the public sector, those that see patients are generally medical school students and residents, who are using this as grounds for their training. In the private sector, attendings are generally the one that see patients. Furthermore, attendings are not salaried employees. While they received some benefits from being employed with the University and must give lectures, they can charge whatever they would like for their consultation fees. 

This dilemma brings to reality the endless debate as to whether healthcare is a right or a privilege. In the Philippines, it is a right but the quality of care given for free is at times questionable.