I’m sorry for not updating this blog often these days. A lot of things have been needing my attention and I’m almost up to my neck with “work” that now I come to understand how that Koala bear must be feeling, hanging on to my stethoscope for a lllooooooooonnngggg time. But she’s great with the kids so too bad she had to stay for a while longer.
For the meantime, check out this week’s medical blog carnival at my health blog, Prudence, M.D.
Or rather, the article that some people might hate me for writing…
UPDATE: This post, “The Problem of R.A. 9439″, is included in this week’s edition of Medical Grand Rounds, hosted by Dr. Emer, of Parallel Universes. Go visit his blog and see the posts of the other participants of the Grand Rounds about health staff concerns, reviews, interviews, news, and tales of patient encounters.
“We are all kept alive by the work of man’s mind - the individual minds that still retain the autonomy necessary to think and to judge. In medicine…the mind must be left free.”
— Leonard Peikoff, “Medicine: The Death of a Profession,” Voice of Reason, 306.
Republic Act 9439 or the Anti-Hospital Detention Law was signed by President Gloria Macapagal-Arroyo last April 27. Under this law, it would be:
…unlawful for any hospital or medical clinic to detain or to otherwise cause, directly or indirectly the detention of patients who have fully recovered or partially recovered or have been adequately attended to or who may have died, for reasons of nonpayment in part or in full of hospital bills or medical expenses. (http://www.gov.ph/news/?i=17643).
Patients who wanted to leave the hospital but aren’t capable of settling bills will now have the right to demand to be allowed to leave the hospital with corresponding medical certificate and pertinent discharge papers upon execution of a promissory note covering the unpaid obligation.
The law was said to be not applicable to those who stayed in private rooms.
While it may seem that this law could help those who’re in need of medical care yet lack the finances, in turn, it actually directly transfers the burden of the unpaid expenses upon those who privately-own hospitals and indirectly to the hospital employees and other patrons of the hospital who diligently pay their bills. It is doubtful that the government will subsidize any of these unpaid expenses because it cannot even take care of its own government hospitals.
Read more of this entry in my health blog.
The government, with its reputation for coming up with temporary and piece-meal solutions to social and economic problems, is now contemplating barring Filipino doctors from migrating and working overseas. Health secretary Francisco Duque seems to be keen on imposing such ban on deployment:
Here’s the article published in the Philippine Daily Inquirer this August 3:
DoH: Gov’t can stop doctors from leaving; it is the law
MANILA, Philippines — Filipino doctors would be barred from migrating and working abroad to avert a possible shortage of medical practitioners, if Health Secretary Francisco Duque III had his way.“You don’t expect Indians and Cambodians to treat Filipinos,” Duque Thursday told reporters on the sidelines of his meeting with provincial governors and his counterpart in the Autonomous Region in Muslim Mindanao on the “FOURmula One for Health” strategy of the Department of Health (DoH).
“While we’re out there treating other people, the irony is we don’t have anyone to treat our own people. Of course, the authorities will not allow it. Political leaders will not allow that. I will not allow it. If I have to respond to it today, I will close the door,” he said.
According to Duque, the Migrant Workers and Overseas Filipinos Act of 1995 (Republic Act No. 8043) allows the government to implement this extreme measure, especially “when the profession is deemed mission-critical.”
“The government has the authority, the power, to close the exit doors,” he said.
The ban on deployment is in Section 5 of the law, which states that the labor secretary, “in pursuit of the national interest or when public welfare so requires may, at any time, terminate or impose a ban on the deployment of migrant workers.”
On the brink
Duque said that while he did not have exact data, he believed that the Philippines was on the brink of a shortage of medical doctors.
He estimated that the country had lost from 5,000 to 6,000 doctors since 2001.
A big number of doctors have also studied or are studying to become nurses for them to be able to work overseas.
Duque said he was scheduled to meet on Friday with the University of the Philippines’ National Institute of Health, which had conducted a study on the migration of doctors.
“I will ask if there is any threshold to be established that will signal government authorities to shut the door,” he said.
Asked if preventing Filipino doctors from leaving the country would not violate their rights, Duque said: “I will give you this question — When do individual human rights end and national interest begins?”
Solutions
Duque said that in the late 1990s, the government invoked the deployment ban in the Migrant Workers Act to stop the exodus of Filipino pilots.
“They were all leaving and threatening the integrity of the airline industry. What the labor department and the other relevant agencies did was to invoke [the Migrant Workers Act]. We have to protect the national interest,” he said.
Duque said the health department’s response to the steady migration of doctors included the continuing implementation of its “Doctors to the Barrios” and “Pinoy MD” programs.
He also mentioned a medium-term solution complemented by the foundation of Jose Miguel Arroyo, President Gloria Macapagal-Arroyo’s husband, which awards scholarships to poor but deserving medical students at UP and the Pamantasan ng Lungsod ng Maynila.
To put away the trivial errors first, let me correct the article by saying that yes, there is a law stating that the government has the capacity to prevent deployment of migrant workers, as stated in section 5 of the Migrant Workers Act of 1995 RA 8042 and not RA 8043 (which is actually about policies regarding inter-country adoption of Filipino children):
Sec. 5. TERMINATION OR BAN ON DEPLOYMENT - Notwithstanding the provisions of Section 4 hereof, the government, in pursuit of the national interest or when public welfare so requires, may, at any time, terminate or impose a ban on the deployment of migrant workers.
While that I expect the government to put out some more aggressive solutions about the deteriorating health care, I didn’t expect that the government would actually contemplate this kind of action. And the question posed by the Health Secretary is a bit disturbing:
When do individual human rights end and national interest begins?
I believe individual human rights should always be first priority, except perhaps when a criminal act is concerned. But concerning the personal lives of those who only wish to survive, what right does the government have to interfere? What right does it have to impose that here your human rights end and that your life need to be sacrificed for the sake of “national interest”? And the question that I commonly ask, who defines the public?
Even if the government does decide to impose the ban, I don’t think it’s going to solve the problem of deteriorating healthcare. Public health funds and implementation, the current medical system, the medical community, and a cooperative community of patients are the important factors in a working healthcare system. To make the healthcare system work, all of the factors should be taken cared of. The imposition of a ban is just like stoppering a sinking ship full of holes with a cork. It only prevents the water from getting in through one hole, while it does nothing to take care of the rest.
And perhaps the government is forgetting that it cannot control the minds of people. It may be able to hinder the physical migration of workers (the doctors, in this case) but it cannot stop the doctors from leaving the medical profession, which I think would be the next thing happening if this imposition of ban on deployment of migrant workers ensues. So this leaves us where? A health care system still not working and a community of medical healthcare practitioners whose rights to live and practice their profession the way they deem it right trampled upon.
And if this happens, doctors may just decide to stop being doctors and go on strike.
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