PUBLIC HEALTH LENS

By Romulo F. Nieva Jr., RN, MHSS

THE news headlines labeling Southern Philippines Medical Center (SPMC) as “Davao City hospital” are obviously misleading and have underlying malice. Such morbid typecasting is a blatant insult to the good governance and competent workforce of the hospital that have transformed SPMC into an advanced and well- equipped public health care institution (HCI) in the country. Just to fact check, SPMC is not a Davao city hospital. It’s a Department of Health (DOH)- retained regional hospital located in Davao city. So, this hospital is not the same as Ospital ng Maynila nor Ospital ng Makati, which are both city government- managed HCIs.

People who have raised doubts about the amount of PhilHealth funds received by SPMC are misinformed. PhilHealth Circular 34 s-2013, policy on the provision of special privileges to those affected by a fortuitous event, noted that interim reimbursement mechanism (IRM) was set up as a quick response to the calamity through substantial financial support, and in order to provide continuous health care services from the affected HCIs brought about by the disasters. Specifically, the IRM amount is based on the facility’s average reimbursement per day (ARPD). And the number of days covered shall be 90 days from the date of event onset. For instance, Hospital A was affected by an event that happened on January 12, 2020. Its ARPD for 2019 was P100,000. Hence, PhilHealth would provide funding for Hospital A an amount of P9 million (P100,000 x 90 days) for the covered period in 2020.

Based on the above policy context, they are asking the wrong questions. PhilHealth officials have clarified that the cash advances were based on the hospital bed capacity and the historical PhilHealth reimbursement data of the HCIs. The questions should have been, “Is the policy equitable to address the health needs of Covid-19 patients, their families, and those who were directly and indirectly affected? What would be the policy (financial) remedy for hospitals affected by Covid-19 when they had to stop accepting non-Covid patients or had been designated as sole Covid hospital? What are other proxy indicators to be considered, apart from bed capacity, to equitably distribute funding support? The SPMC officially became the biggest public hospital when Republic Act No 11326 of 2018 was enacted into law, authorizing the expansion of its bed capacity from 1,200 to 1,500. Additionally, SPMC was recognized to be the top PhilHealth income earner for 2014 to 2018, with accumulated PhilHealth claims of more than 5 billion. And in 2018-2019 alone, it got past the billion mark because of its efficient financing management in place. Thus, the hospital performed in good faith and followed the PhilHealth guidelines. And I fully support the call to systematically assess the policy because its current form has several flaws, disproportionately marginalizing other regions and provinces that have been equally affected by the pandemic. It must be thoroughly reviewed in terms of primary policy objectives, equity, policy mechanisms, transparency, and measurable outcomes. Other key variables to consider, on top of the bed capacity, would be population, poverty index, a the number of PhilHealth members (and non-members) particularly the vulnerable sector, and the financial impact on the HCI.  

I have enormous respect for people who have been consistently holding the Government into account. We are one with all Filipinos in calling for a transparent PhilHealth institution particularly in this time of health crisis. But when the health discussion becomes extremely politicized and stained with inappropriate context, the sense of public health advocacy gets lost. It reminds me of the novelist Chimamanda Ngozi Adichie’s TED Talk on the danger of a single story. She clearly articulated, “Many stories matter. Stories have been used to malign, but stories can also be used to empower. Stories can break the dignity of people, but stories can also repair that broken dignity.” It’s unacceptable to unfairly denigrate the good institution because we failed to hear its side of the story, and more importantly its people.

Almost every health professional in Mindanao has a memorable SPMC story as a health science student having been assigned to different units or departments. I spent my senior year in 2010 as a nursing student assigned to the Psychiatry area. That’s the time when I discovered that the SPMC was not just a typical DOH regional hospital because of the wide scope of its health care service extending to all regions in Mindanao, and even some areas of the Visayas. And what makes SPMC unique is how it has changed the common perception about public hospitals outside of Metro Manila, generally tagged as poorly equipped and weakly-governed institutions. Despite the limited resources compared with big hospitals in the National Capital Region (NCR), it has managed to improve its health services offering health care to all Mindanaoans.

If NCR has Philippine General Hospital, Philippine Heart Center, National Center for Mental Health, Philippine Children’s Medical Center, Philippine Orthopedic Center, Lung Center of the Philippines, National Kidney and Transplant Institute, and other specialty hospitals, the entire Mindanao has SPMC. The hospital has undeniably improved because of good hospital governance and management coupled with a competent and passionate workforce. Its sustainable financing mechanism has allowed the institution to invest in health care equipment, human resources, and information technology. Based on its website, it currently houses a three-storey Main building, a seven-storey Medical Arts building, a five-story Central ICU, a four-storey Trauma Complex, a four-storey Institute for Women’s Health and Newborn , a five-storey Children Institute, a five-storey Kidney Transplant Institute, a four-storey Orthopedic and Rehab Institute, a four-storey OPD building, a three-storey Mindanao Heart Center, a three-storey Cancer Institute with another two-storey extension, a two-storey Isolation Facility, and a two-storey Institute for Psychiatry and Behavioral Medicine. It is also a training and research hospital with very strong links to several academic institutions across Mindanao and beyond.

The hospital has been known for its magnificent pediatric cancer care. Its House of Hope, which has a half-way house for children with cancer and their families— as many of them are not from the Davao region, caters to the people in Mindanao and the Visayas. Accordingly, the House of Hope has dozens of beds in the Main and Annex Buildings to accommodate patients and their carers.  Unlike other local government- managed or DOH hospitals that have been experiencing various political pressure and influence over hospital decisions and operations, the hospital’s name was changed in 2008 to Southern Philippines Medical Center as a reflection of its ongoing development and growing capacity to provide health care to the people especially those who are in the vulnerable sector. Clearly, the growth of SPMC to what it is now is a product of years of assessing what the population of the whole Mindanao needs. This is a beautiful testimony of a long history of a healthy relationship between SPMC and Mindanao. This mutual relationship is mirrored in the hospital’s identity as a “hospital for Mindanao'', and not just a regional hospital.  And such beautiful imagery has been nurtured by decades of unparalleled service to the entire island. This is an ultimate care that gives a heartbeat of hope to the land of promise.    

Kudos to the incredible job, SPMC!

About the Columnist

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Romulo Nieva Jr. is a public health professional and currently a doctoral research scholar at the University of Otago in New Zealand.