Honorio M Cruz, MD, FACS
Oct. 1, 2012
It’s indeed an honor to have one of the Filipino Surgeons receive this award. It is a long overdue honor, which the nominator himself admitted that maybe, nobody took the initiative. The Philippines have one of the first chapters of the American College of Surgeons in Asia, made prominent by the efforts of Dr. Ona himself. He was our guest of honor last night at the SPSA meeting’s 40th Anniversary, together with former president of the Philippine College of Surgeons and the Philippine Medical association, Dr. Rey Melchor Santos. The topic was The Spirit of Volunteerism, the Filipino-American Surgeon.
Dr. Ona gave an encouraging talk on the state of the Philippine Health Care. Beaming with pride, he ticked off his two year accomplishments so far and the hope of further progress. The glaring inadequacy of the health care budget which is only 6% of the GDP, well below that of developed countries, even lower than its neighboring countries like Thailand and Malaysia. With an outlay of $7/Filipino (2009 stats?), how could we improve health care? He was able to increase the budget from Php 18 billion to Php 44 Billion and Php 56.8 Billion for 2013 and more importantly, a reform that the establishment politician have vehemently resisted, the governors controlling the health care budget in their locality, where according to him, 40% of which disappear, probably in the pockets of the politicians. Accountability, with detailing of how the budget will be disbursed before being released rather than like a pork barrel at their disposal. Admirable goals, how it translate to the local areas is something we hopefully see is enforced. He was surprised, being a surgeon, that 40%? of the hospitals don’t even have an operating room. This is being remedied and a lot of construction in these hospitals is anticipated, together with furnishing basic necessities which standard hospital should have. Lofty goals indeed.
He was glowing with pride that they have met their goals of identifying the areas and the families of the most underserved populace, like the “informals” (a PC name for the squatters) and enrolling them to Phil Health. They have divided the Filipinos into quintiles, from the dirt poor to the richest, he claimed to have enrolled the first quintile and is hoping to do the same to the next quintile soon. A really lofty goal since 40 million is about the size of the American uninsured. Maybe we should look at this model, in the face of the financial straits we now have. I have written before on expanding and financing the Medicaid instead of overhauling the whole Health Care System to obtain coverage for the poor and uninsured. Another subject was the HR bill and the difficulties encountered with the Religious bloc. The reverse wish list of the different segments of the economic spectrum, with the poor wishing less but having more children and the rich having less than they wish for. It seems that making people rich maybe our way out of the population explosion.
Finally he touched on the Medical Missions and the touchy subject of the new PRC Regulations which was passed “when he was away”, commenting that the PRC panels were unaware that this is in the purview of the Department of Health. This was seconded by Dr. Santos as well in his earlier speech. Dr. Ona then broached a touchy subject which came in the forefront when he talked about Phil Health. If Phil Health will already be covering the poorest of the poor, is there a need for medical missions from abroad? A more pleasant topic to discuss than what is presently causing uneasiness in the medical community. I’m not sure about the figures on the number of Philippine physicians, but for percentages, 40 % of Filipino doctors are classified as specialists and only 10% are surgeons. Coupled with the maldistribution, with about 50% of them in Metro Manila, there is a big need for surgeons in the outreaches which could not be met with its present manpower. Doctor Santos also voiced the same concern in relation to the formation of an ASEAN Surgical Association, trying to impose stringent requirements on who could do surgery in the accredited hospitals. His goal is to bring those non-certified surgeons to the association and train them to be certified. Outright banning them will certainly lead from an already acute situation to dire straits. Medical Missions could certainly help in the endeavor. Dr Ona promised to streamline the process of credentialing and approval of the missioners and the elimination of the dreaded VAT tax for medicine and medical equipment being used for the mission or donated to the mission hospitals.
Dr. Santos voiced for the first time directly, we welcome your missions and offer of help but don’t be a competitor. The subject has been expressed obliquely and in whispers like, the missions are being done not on the most underserved segment of the population, with lack of oversight on the economic status of the patients. The subject will be more acute if Phil Health covered patients are done, where does the money go from the government, money that will purportedly be paid when done by the local doctor. Now we are talking about real money. While the overseas missioners I’m sure would not be interested, I guess the local doctors which we enlist to help us, like the Ophthalmologists and the Anesthesiologists during our missions could certainly be eligible to bill. Will they be classified as competitors?
The main meeting detailed the Society’s 40 year history since its foundation, its outstanding record in continuing medical education, being one of the few who has been able to maintain a category I credit all this years and the last one for a 6 year approval, a rarity. The medical missions have been a major part of its activities to help our fellow Filipinos in medical needs. Its record of safety, a major complaint for other missions, has been outstanding with only 3 deaths out of 8,000 major operations which show the diligence and strict standard in choosing the cases that could be done safely. New models in the performance of missions in the form of adoption of hospitals in the Philippines with donation of equipments and training of health care personnel and doctors, a more lasting “mission in partnership” than what is presently happening.
Lofty goals, and expectations, let us hope that Secretary Ona and our wish for a healthier outlook for the Philippines materialize as envisioned.