Must PGH staff chip in for poor patients?

Our reflex response to the question is that doctors, nurses and staff of the Philippine General Hospital (or any public health facility) should not be expected to dig into their pockets to help patients buy medicine or pay for clinical tests.

The staff’s spending on indigent patients has raised questions over whether the PGH, the premier state medical center, is given adequate funds, and why its 2023 budget reportedly had been slashed instead of increased.

The Department of Budget and Management said it did not cut the hospital’s budget, but PGH workers and their sympathizers said that P2.5 billion in its 2022 budget had been chopped off in the 2023 outlay submitted to the Congress by Malacañang.

The DBM explained that it just did not put back in the 2023 National Expenditure Program (NEP) the amount that the Congress had added as a one-time capital outlay when it passed the 2022 General Appropriations Act (GAA), or the current budget.

Whether the missing amount was in the NEP or the GAA may be semantic, but whether the debate is over a definition of terms or skewed priorities, the stage is set for the politicians in Congress to fix any funding inadequacy or imbalance.

The All UP Workers Union-Manila/PGH said through its president Karen Faurillo that instead of being cut, the proposed PGH budget of P5.412 billion should be beefed up so the hospital can hire more nurses, give more aid to indigent patients and upgrade facilities and equipment.

Since COVID-19 hit the country in 2020, the PGH has suffered a reduction in its budget – down to P6.9 billion in 2021, to P6.3 billion this year and a proposed P5.9 billion for next year.

Dr. Jonas del Rosario, PGH spokesman, said that the hospital originally asked for P6.1 billion, which should cover “infrastructure development.” Along the way, however, the amount was slashed to P5.9 billion.

‘Absorptive capacity’ too slow?

Dr. Edsel Maurice Salvana, director of the Institute of Molecular Biology and Biotechnology at the National Institutes of Health at UP Manila, commenting on the budget, mentioned among other things the “absorptive capacity” of the system:

“The spokesman of PGH says the current budget is sufficient despite the hysterics of some people on social media about UP and PGH budgets being cut. This is why it is important to get primary source information rather than relying on chismis.

“Apparently there is still a lot of money left over from last year’s budget that carries over to the next year. Which brings us to the heart of the problem – absorptive capacity. The procurement and spending laws of the Philippines are so circuitous and arcane that it is difficult to spend government money without the risk of losing your retirement benefits and going to jail.

“As someone who signs a ton of papers every single day for our institute, I can attest to the stupidity of having up to five signatories just to buy bond paper. And it still doesn’t stop the shenanigans at the higher levels. I hope the government addresses these issues once and for all.”

*      *      *

If we may digress, that point about “absorptive capacity” brought up by Dr. Salvana – although in another budgetary context – deserves more than cursory mention.

A problem lurks in the bureaucratic maze related to funds that remain uncommitted or unspent by yearend. There is often a flurry of repairs or “reblocking” of major roads despite their clearly being still in good condition.

Some officials do not want to leave huge funds unused at the end of the year, otherwise, the pile could just be sent back to treasury and possibly be lopped off in the next budget unless justified all over again.

Their contractor friends know this and hang around, just a text or call away, for the Christmas windfall of contracts for easy and unnecessary repair or upgrading of roads and other public works.

To rush the paperwork, after tearing it up or jackhammering – and worsening the pre-Christmas traffic mess – the contractor suspends the work till he gets the promised deal signed, sealed and delivered.

Tap big politicos, not PGH staff

Netizens have joined the discussion, many of them lamenting that PGH personnel have had to dig into their pockets to help poor patients – while billions in discretionary and confidential funds are given to big politicos in key offices.

One thread started with Dr. Carlo Trinidad @hellokidneyMD being answered by Soc Md @Marav1Ma saying: “When I had my fellowship training in PGH all of my duty team from my residents, clerks and even our med tech at the dialysis unit had to shell out money from our own pockets just to help our patients not miss their much-needed dialysis session.” Some reactions:

*jim punsalan @jimpunsalan – “Was there for PGI to IM residency then cardio fellowship. No salaries for first two years then our dep’t chair put together all donors and split it up among those without items… Had to spend for meds of patients, inotropic agents (dopa) and whole blood. As a PGI, resident and less so as a fellow, it was 50 percent or more service and 50 percent training. I would think this has improved today, but with a budget cut, who knows?”

*Nostalgicochee @nostalgicochee – “I really believe PGH has done so much especially this pandemic. Dapat nga i-prioritize sila. Wala na nga DOH secretary babawasan pa ang budget for PGH. Di nman ata makatarungan.”

*Stephanie Miaco, MD @StephMiaco – “That’s almost a given in PGH... seen it up close. It’s pretty harsh on everyone’s pockets, eh no?”

*Buttercup @houseofdyosa – “Nalungkot naman ako nang mabasa ko to. Kakaiyak na nakakagalit.”

*Vikki Brillantes @QattyBes – “So many decades passed, and it is still the same story! We never learned as a people! Di tayo umaalma sa kawalan ng prioridad sa kalusugan ng ating mamamayan! Nakakalungkot! Paurong!”

*Bebot Sarte @BebotSarte – “How to end the corruption in our gov’t so we can provide better health care & education to the people?”

*      *      *

NB: Author is on Twitter as @FDPascual. Email: [email protected]. All Postscripts are also archived at ManilaMail.com