Members of the Sangguniang Panlalawigan’s Committee on Health last week urged the Eastern Bicol Medical Center (EBMC) to explore ways to address problems faced by patients in paying for doctors’ professional fees and expensive medical implants.
In the meeting held last Feb. 15, 2024 at the SP session hall, Provincial Board Member and committee chair Dr. Santos Zafe joined PBM Dean Roberto Vergara, PBM Rafael Zuniega and PBM Robert Fernandez in discussing the issue with Provincial Health Officer II Dr. Hazel Palmes, EBMC Chief of Hospital Dr. Vietrez Abella and Administrative Officer Paolo Araojo.
Despite the coverage provided by the Department of Health’s Medical Assistance for Indigent Patients (MAIP) Program, which includes various medical procedures and supplies, there have been documented cases of patients struggling with unpaid bills at the provincial hospital, a resolution sponsored by PBMs Zafe and Vergara noted.
The MAIP provides support for drugs, medicines, medical and orthopedic devices, dental services or other medically-related needs prescribed by the physician of a health facility for in-patients and out-patients, in excess of the packages/case rates covered by PhilHealth subject to the availability of funds.
Aside from drugs and medicines, the fund covered laboratory, imaging, radiological and other diagnostic procedures; blood and other related blood procedures; all clinically indicated medical, surgical, high-risk cases of obstetrics-gynecologal, opthalmological, dental, implants, medical devices and supplies and other relevant procedures; prescribed post-hospitalization, rehabilitation services, aftercare program, appropriate mental and psychosocial support; and all hospital bills including professional fees, provided the expenses for the fees shall not exceed 50% of the approved amount of medical assistance.
The measure passed during the Feb. 12 regular session underscored the need to find possible solutions to ensure that patients receive the necessary care without having to bear undue financial burden, including payment assistance programs, review of billing practices, or funding sources.
Likewise, PBM Edwin Tanael sought the presence of the EBMC management to shed light on why patients are still required to pay professional fees despite receiving medical assistance from the government.
Answering PBM Zafe’s query regarding the long-standing problem, Dr. Abella clarified that EBMC cannot provide the implants as there is no available supplier here, with the expensive device imported from Manila by the surgeons doing the operation.
“The EBMC is not part of the implant transaction as it is between the doctor and the patient,” she stressed, pointing out that the cost of the implant can only be paid under MAIP if it is supplied by EBMC and included in the hospital bill.
The only way to do that would be to execute a memorandum of agreement with the supplier of the surgeon’s choice, it was emphasized, as the brand or type of implant is the personal preference of the doctors or specialists.
PBM Vergara asked why the hospital management could not impose its will on doctors to use a medical device from a supplier designated by EBMC.
“Mahirap ‘yan,” PBM Zafe responsed, saying that as professionals, doctors have the right to refuse and cannot be forced to use a device that they think is not fit for the patient.
Some implants get rusty once installed as they are not 100 percent titanium and it would be risky if other types of implants are used.
AO Araojo suggested that multiple MOAs can be inked with separate suppliers, as the Malasakit Center funds will only pass through the hands of the provincial government and EBMC.
That would be the first option, Zafe agreed, with the second the hospital chief’s recommendation that the province set up an “implant fund” for the sourcing of the devices.
PHO Palmes said the amended guidelines of the Malasakit Centers Act provide hospitalization and medical assistance not only to indigents but also financially incapacitated patients, especially implants, as long as the chief of hospital can guarantee payment under MAIP without resorting to out-of-pocket expense.
The provincial hospital can also have its patients treated in private hospitals on the island, with bills paid out of the MAIP, but a MOA has to be executed with the private hospital concerned.
Abella disclosed that she has initiated the MOA with Immaculate Heart of Mary Hospital (IHMH), with a separate agreement with the Catanduanes Doctors Hospital, Inc. (CDHI) to follow soon.
The MAIP guidelines state that in case of non-availability of clinically-indicated drugs and medicines, services and procedures, and lack of available beds in the government health facility as certified by the chief of hospital or his/her designated official, the concerned health facility may enter into a Memorandum of Agreement with DOH-licensed and PhilHealth-accredited government or private health facility to provide the needs of the patient charged to MAIP Program funds.