print

Print
this
June21,2015

Goodpayforbetterhealthcare:Leyteshowsitcanbedone
TheprovincialhospitalsofLeytebeforetyphoonYolandastrucktheareainNovember2013hadstarteddrawing
attentionfortheirschemetohikethepayoftheirphysiciansandstaffdespitetheimpediments.Thepayofan
obstetriciangynecologist,forexample,stoodtoriseforAugust2013byP166,000atthelowest,orbymore
thanP215,000atthehighestrepresentinghercombinedsharefrompooledmoniesgeneratedthroughalocal
incentivescheme.

Ontheaverage,theLeytephysicianstookhomeforAugustof2013anadditionalpay
rangingfromP106,000tomorethanP161,000.Thatsontopoftheiraveragestatutorypay
forthesamemonth,includingbonusesandallowances,ofaboutP40,000.
Theresultwasimprovedhealthcarefortheprovince.Thenumberoffulltimephysicians
attendingtopatientsattheLeyteProvincialHospitalhaddoubledto19by2012,withmore
doctorsapplyingforajob.Servicehastendedtoimproveasdoctorsvieforpatientsand
worktokeepthempleasedthemiracleoftyingpaytoperformance.
Howdidthecapitolconsistentlyraisethatmuchmoney?AteamorganizedbytheActionfor
EconomicReformsflewtoTaclobantolookintothepracticetoknowwhatLeytedid,howit
didit,andmore.Highlightsandhowtohintsfollow.
Provinces(andcities)mayraiseincentivefundsfromatleasttwopotentialsources:able
patientsandPhilHealth.Ablepatientsarethosewhocanaffordtopayforhospitalservices.
Theyareyournonindigents.PhilHealthisshorthandforPhilippineHealthInsurance
Corporation,whichcarriesthemandateofprovidinghealthinsurancecoveragetoall
Filipinos.WithabudgetofoverP35billionlastyear,itsarichsourceofwealthforhealthif
youknowhowtotapit.
Tolaytheschemeusingthesefundsources,thewillandthewaymustbeinplace.Mustering
thewillisyourdepartment.Thishowtohopestohelpinfindingtheway.Itdrawsheavily
fromtheexperienceofLeyteinimplementingitshospitalincentivescheme.
So,youwouldneedto:
Charge(or,ifwarranted,adjustratesof)afeeforservice.
Poolcashdonations.
PoolPhilHealthpaymentsforprofessionalfees.
Foreachofthese,youhavetoputinplaceanagreeddistributionformulathatbearsinmind
thevirtuesofparticipationandmakeseverybodyhappy.
FEEFORSERVICE
Thisisabeatenpathamongprovincesasawayofrecoveringcost,whosesuccessvaries
acrossjurisdictions.Aslocalholderofthepowerofthepurse,theSanggunianenactsan
ordinanceimposingfees(oradjustingcurrentcharges)forcertainhospitalservicesrendered,

prescribinghowmuchandtowhomthefeesapply,andprovidinghowmuchoftheproceeds
goestowhatandtowhom.
Youwouldliketoringfencethehospitalaccountforyourincentives.Otherwise,theincome
goesstraightbydefaulttothegeneralfundandgetsspentfollowingtheusualbudgetary
process.Youwouldneedthereforetolaythecollectionstogether,fencethemoff,andkeep
anyotherfromspendingthemonanythingelse.
How?Bycreatingthroughthesameordinance,asthelawallows,aspecialaccountinthe
generalfund.
Butbearinmindthehurdles.Bylaw,youarenotallowedtohikethepayofanyofyour
officialoremployeehigherthanthemaximumsalaryratefixedforherposition.Anotherlaw
putsalimittowhatlocalgovernmentscanspendforpersonalservicesintheformof
salaries,premiums,bonuses,benefits,andthelike.
CASHDONATIONS
Fortunately,thelegalimpedimentsdonotcovercashdonations.Bydefinition,private
donationstolocalgovernmentscanonlybeusedforthepurposeforwhichtheseweremade.
TheLeyteexperiencehasimpressivelydemonstratedthatcashdonationsfromnonindigent
patientsformaviablesourceofhospitalincometofundtheincentivescheme.In2013,these
amountedtoatotalofP3.7million.
Again,youwouldneedtheSangguniantoenactanordinanceauthorizingthecollectionof
cashdonationsfromnonindigentpatients,providingforthecreationofaspecialaccount(as
Leytedid)oratrustfund(astheCommissiononAuditrequires)forthesedonations,and
prescribingthemannerofdistributionoftheproceeds,amongotherthings.
PHILHEALTHPAYMENTS
PhilHealthisanothersourceoffundstotapforthehospitalincentivescheme.Whatyou
wouldliketolookintoisitsreimbursementfacility.ThePhilHealthlawsays:Allpayments
forprofessionalservicesrenderedbysalariedpublicprovidersshallbeallowedtoberetained
bythehealthfacilityinwhichservicesarerenderedandbepooledanddistributedamong
healthpersonnel.
Thisisringfencingthepaymentscourtesyofthelaw.Tousethemforthehospitalincentive
scheme,theprovincewouldonlyneedtoattendtosomekeytasks,suchasthefollowing:
EnsurethatthehospitalanditsphysiciansarePhilHealthaccredited.Ittakessomestepsto
getaccredited.KnowingtheseindetailwouldrequireyoutopayyourPhilHealthlocalhealth
insuranceofficeavisit.
Createthroughanexecutiveorderanadhochospitalcommitteemandatedtopropose
guidelinesforthepoolinganddistributionofPhilHealthprofessionalfees.
Enactanordinanceprescribingtheapprovedguidelinesandcreatingatrustfundforthis
purpose.Thistaskseekstoapplysustainabilitytothepoolinganddistributionscheme.
Leytesisastoryofsuccessthatsworththetelling.Yourownissurelyworththewait.
MarioM.GalangisaseniorfellowofActionforEconomicReformsandadevelopmentand
governancespecialist.
www.aer.ph