Lining up for health care

Outside an office along Alabang-Zapote Road in Las Piñas, the lines of clients start forming as early as 4 a.m. Judging from their modes of transportation, they come from all walks of life: they arrive in tricycles, jeepneys, SUVs, even chauffeured Mercedes Benzes.

Many arrive before dawn to make sure they will be among the first to be attended to when Hi-Precision Diagnostics opens at 6 a.m.

The tertiary medical laboratory lists 20 branches in Metro Manila, Pampanga and Cebu on its website, including two HP Plus offices in Rockwell, Makati and Alabang, Muntinlupa.

I knew nothing about the laboratory so I asked two satisfied clients, both senior citizens who are no longer covered by HMOs because of their age, why they kept going back to Hi-Precision. One goes to Las Piñas, the other to the Alabang branch. They gave the same reason: the cost of medical tests is just a tenth of the rates in regular hospitals. And the results, they swear, are just as reliable.

In fact, the senior citizens told me, the results are so reliable their own doctors, who work in top hospitals, recommended that they have their lab tests done at Hi-Precision.

One of my doctors, who works in a top hospital, also recommended that I have my lab tests done at Healthway, where services are a bit pricier than Hi-Precision (though still much lower than in the big hospitals) but where the waiting lines are shorter.

For many Filipinos, shorter waiting lines at health centers are a luxury they cannot afford. On top of laboratory tests and doctors’ fees, medicine is needed for treatment. The total health care bill can eat up entire monthly salaries and elderly pensions.

Generic drugs, cheap and reliable, are now widely available, but the types of drugs on the generics list are still too few. Those not on the list are still unusually expensive compared to prices in other countries, and I’m not referring only to India.

During a visit to London, I was surprised to buy branded Claritin in a regular drug store at just a tenth of the price in Manila. Many Filipinos who visit the United States stock up on vitamins, food supplements and maintenance drugs, which are way cheaper compared to the same products in the Philippines.

Senior citizens at least enjoy a break from that hefty value-added tax on medicine. But drug prices remain steep, especially when added to the overall cost of health care services including laboratory tests. Even for those chauffeured around in luxury vehicles in their advanced age, paying only a tenth of the price charged in big hospitals is worth waiting in line.

Visit the emergency unit of the Philippine General Hospital and you will get the picture. The lines of patients waiting for emergency treatment spill out into the curb.

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Those long lines are on my mind as World Health Day is marked today. The theme of the observance is awareness of vector-borne diseases such as dengue and malaria.

Dengue, preventable when diagnosed correctly and treated early, kills scores of Filipinos every year. The cost of laboratory testing is surely a big factor in the high fatality rate.

In one mid-sized private hospital chain in Metro Manila, someone I know was confined in the emergency room for three days when she ran a high fever and suffered severe stomach pains. Doctors suspected dengue, but the results eventually showed she had urinary tract infection. She was sent home with antibiotics. Her total bill was P6,000, but this was about a decade ago.

A few years later, the cost of four days of confinement in the same hospital chain, for dengue testing, had gone up to P14,000.

Two brothers who were released from the hospital at the end of four days were rushed the next day to the San Lazaro Hospital in Sta. Cruz, Manila, where they were diagnosed with dengue, placed on IV and given regular shots until their fever and pains dissipated. Their combined bill amounted to just a little over P1,000.

The government hospital was, of course, overflowing with patients, unlike the mid-sized private one. San Lazaro is one of the hospitals where you can see new mothers sharing not just charity wards but also hospital beds.

Many of the country’s best doctors work in government hospitals. “Serve” is a better word since, apart from the modest pay, the doctors often bring their own equipment such as alcohol and gloves and give other forms of assistance to indigent patients.

The expertise at affordable costs is another reason for those long lines of waiting patients at government hospitals.

But those long lines are as much a deterrent as high costs in private hospitals for those with symptoms of dengue. Unless they start convulsing, the stomach pain becomes unbearable or they can no longer keep their food down, dengue patients are likely to wait for the fever to subside, until they find themselves with full-blown hemorrhagic fever and it’s too late.

This attitude is not confined to the very poor. A child I know from a middle-class family was rushed to a top hospital with late-stage dengue and was fortunately cured. The family’s bill: over P100,000.

There are millions of Filipinos who cannot earn that amount in a year. For them, health care, like quality education, is a luxury beyond their reach.