Why it's hard for the Philippines to raise compensation for doctors

And check out other pertinent issues the Philippine healthcare industry faces.

It would seem like the apples are not the ones making the doctors go away especially in the case of the Philippines, which has seen an uptrend in doctor migration in the past 10 years. This was amongst the issues tackled in the Manila leg of the 2017 Healthcare Asia Forum held in Makati on February 15.

Elvira Dayrit, director for Health Human Resource Development Bureau (HHRDB) of the Department of Health (DOH), led the discussion of the said issue, noting that the government has set up a plan to mitigate the dearth of doctors the country is currently facing.

Citing the Data from the Commission on Filipino Overseas, Dayrit noted that the cumulative migration of doctors has been steadily increasing since 2005 when a total of 297 doctors migrated. By 2015, CFO recorded 3,082 doctors who took the flight abroad. Dayrit pointed out that this has led to the country being the second top exporter of doctors next to India. “Our strength is that we really have good quality doctors, who can speak English and with good rapport,” she said.

However, looking at how this affects the Philippines, the outlook is not quite healthy. Referring to the 2007 data by the National Statistics Office, Dayrit revealed that seven of 10 deaths were not attended by medical authorities. The trend was prevalent in all other provinces outside the National Capital Region. And although she stressed that this was already reduced to four in ten deaths, the trend remains alarming.

The migration of the doctors may very well be due to the low compensation they are getting, Dayrit argued. According to the data from HHRDB, resident private doctors earn as low as PHP 18,134 monthly. A medical assistant in the United States earns, taking home up to PHP 3m per annum, compared to around PHP 210,000 per annum of a private physician. Dayrit raised, “Can we blame them from running away?” She stated that the blame could not be thrown at the Department of Foreign Affairs (DFA) for not limiting immigration of health workers. “The DFA does not want to limit immigration of health workforce, because it brings in money to the country. In general, we do not want to limit migration and mobility,” she argued. Given that the government could not control the migration of doctors, Dayrit said that there should be controls embedded in the code of practice instead.

One solution she suggested is the utilisation of nurses, which the Philippines currently have a supply glut of. “We have an oversupply, but only half pass the nursing license exams. The government is now thinking of using nurses in doing other tasks.” At the panel discussion. St. Luke’s Medical Center senior vice-president and head of hospital operations & chief nursing officer Annabelle Borromeo seconded this, noting that what needs to happen is care coordination rather than active medical treatment. “I think nurses are well positioned in entering that role. We have 250,000 licensed nurses who are unemployed and underemployed. If we use them we can help in the burgeoning cost of non-communicable diseases.” However, Dayrit was quick to reason that this would need a legislative push. “The local government doesn't have the item to absorb them. They don't have the capacity to hire additional nurses.”

Dayrit also mentioned that the Philippines is in need 25,000 health workers to fill the ideal situation of a barangay having at least one 1 health worker. This meets one of the steps the bureau is doing in realising the dream of Philippine doctors cementing themselves in the healthcare industry of the Philippines. “There should be an adequate number of Human Resources for Health (HRH) at all levels with competence to deliver Universal Health Care that is key preventive, promotive, curative, and rehabilitative health interventions,” Dayrit noted.

Another solution Dayrit proposed was studying the number of doctors in the country and the needs of the local government units. “First, we have to look at the supply side and the redistribution of these doctors. My own bias is for the rural areas. We really need to get government raise compensation. It will encourage people.”

Healthcare financing troubles

Meanwhile, Philippine Heart Center executive director Gerardo Manzo noted that there are other pressing issues confronting the healthcare sector especially the government and public hospitals. “You hear a lot of quality issues in the care delivered in government hospitals mainly because we do not have enough funds to take care of so many patients,” he said.

Manzo noted that this could be alleviated with the government’s sincere commitment to universal healthcare. As of now, he noted that 85 of the Filipinos are covered by the national health insurance program PhilHealth. This translates to more than eight in 10 Filipinos. “It looks like the very simple solution is that everyone should be covered with PhilHealth. What PhilHealth has been doing is not enough, but it is better than what we were getting before,” he emphasised.
Philippine Hospital Association President Jesus Jardin concurred, noting how patients are still shouldering the expenses. “The most important consideration is what value we can give our patients. The measurement we should use is giving quality care at a lower cost. The out-of-pocket expense is about 40%, are we really giving our patients value?” he raised.

Cardinal Santos Medical Center Chief Financial Officer Elizabeth Dantes pointed out that there are practical ways on how to not burden the patients with skyrocketing bills while at the same time keeping the operations cost intact. “When we say financing, it goes hand in hand with cost. We have a lot of innovations that bring down the cost of our hospital operations. What we did is to consolidate the needs of all the hospitals in terms of pharma, equipment and by that time we have negotiated the best pricing. Having the best pricing for drugs, supplies, and equipment would bring your cost considerably,” Dantes explained.

More so, there is a considerable benefit of employing the pay-per-use scheme in terms of the equipment used in hospital operations. Dantes shared that Cardinal Santos has partnered with suppliers which can provide them with medical equipment under the pay-per-use scheme. She said that this could be expensive at first glance but looking at it closely, the investment that might have been poured into buying bulky equipment could be diverted to infrastructure development. “In Singapore, a multinational company rents out cath lab machines which were sampled in India. The turnaround time for the usage for that pay-per-use cath lab machine gives them an ROI in one year,” she related, saying that a small hospital would not be able to afford to buy such machine at the get go given its PHP 50m price tag. “If you are a small, pay-per-use is the way to go, and if there’s a company that is willing to finance you, this is one way of financing your operations.”

Meanwhile, Dantes said hospitals should come up with their own strategies to lessen their costs while at the same time, maintaining a high-quality of service. This would be timely should the government ink the law raising the compensation of nurses in the country. “Manpower costs will be around 25 to 26% of all around operations. With the new law putting the minimum wage of nurses to PHP 25,000. We’ve done our own computation and it will wipe out half of our net income after tax if it goes to implementation because it not just the nurse that you are increasing,” she expounded.

Leveraging on HIS data

For his part, Cardinal Santos Medical Center Vice-President & Chief Information Officer Allan Bacallan presented how healthcare units can leverage on hospital information system (HIS) data in bettering services. “Over the years of my work at Cardinal Santos Medical Center, I have been constantly evolving the IT organization into THE go-to department for users’ needs for information guidance that supports decision-making for issues like expansion of services and markets, process flow optimization, innovations, and improvements in patient satisfaction indices,” he raised.

Bacallan noted how creating a real-time dashboard for operations-tracking can help players understand the dynamics of their operations. He told for instance that a dashboard could tell the waiting time of the patients and turnaround time in ERs. “In our hospital, we are targeting 3 hours. We want to use the dashboard to monitor that.” More so, the HIS data is increasingly being used in studying patient demographic, clinical outcomes, revenues and costs, the behaviour of employees and health providers, and even back-office systems like supply chain system.” You can even gather information to know the loyalty level of your patients,” he added.

For St. Luke's Medical Center Head of Hospital Operations & Chief Nursing Officer Annabelle Borromeo, this is a testament to the power of innovation. “Innovation is significant positive change. It’s a result. It’s an outcome. It’s something you work towards achieving on a project. If you are successful at solving important problems, peers you respect will call your work innovative and you an innovator,” she said.

She historised the different methods of processing innovation starting from the post-World War II up to the early 1990s. However, she cited that one good way of building an innovation portfolio is to use the three horizons mode first published in The Alchemy of Growth by Merhdad Baghai, Stephen Coley, and David White in 1999. “Where technology is right now, for us, is an enabler rather than a driver,” she said, noting some reasons on why companies are not innovating. “Managers don’t feel like they can. Innovation costs, as some are not resource-rich.”