In the Philippines, while the cost of medical care is low, funding medical expenses is difficult. This is perhaps one of the reasons why people are turning to charitable institutions to seek financial/medical assistance. No matter how rich they are, their bank savings will be drained if a patient had been staying in the hospital for too long or he has expensive maintenance medicines.
According to Rubin Z. Magno, Manager of the Charity Assistance Department (CAD), as of 1st Quarter this year, there are already 38,199 total number of cases received through the Individual Charity Assistance Program, to which the agency spent about P1.34 billion.
Topping the list of the most requested cases is confinement/hospitalization with 13,769 requests at P571.48 million; next is chemotherapy with 8,313 requests at P386.15 million; and medicines with 8,415 requests at P157.64 million.
In 2017, there are 143,200 overall total number of cases, to which the agency spent about P4.75 billion, and every year, the requests keep on increasing.
That’s why instead of introducing a new game this year, PCSO is focusing on innovating its strategies and enhancing its existing games to increase its sales revenues.
“As we all know, PCSO generate funds come from Lotto and other digit games, which is precisely the reason why we are going after illegal gambling because only gambling lords benefit from it. They don’t remit taxes to the government! While our Lotto, STL, and other games benefit everyone, especially the poor and the sick,” said PCSO General Manager Alexander Balutan.
Rising number of cancer cases
One of the alarming nature of requests at PCSO is chemotherapy, which ranked second after hospitalization/confinement.
In a four-year comparative report submitted by the PCSO-CAD, there were 25,566 requests for chemotherapy in 2014, 34,884 in 2015, 46,423 in 2016, and 49,635 in 2017.
According to Dr. Anthony Leachon, President of Manila Doctors Hospital Medical Staff Association and Past President of Philippine College of Physicians, cancer is the third leading causes of morbidity and mortality in the country after heart and vascular system diseases.
Among men, the six most common causes of cancer diagnosed in 2010 (Globocan) were lung, liver, colon/rectum, prostate, stomach, and leukemia. For female, number one is breast cancer.
“It’s bothersome because majority of patients are young and poor, and they have limited resources. Sad thing about it, they are the ones that smoke and drink a lot, have unhealthy diets, with no access to health facilities. When they are sick, they don’t have money to fund medications and monitor its recurrence as well,” said Leachon who is also an Independent Director of PhilHealth,
The seemingly increasing number of cases of cancer worldwide, including in the Philippines may be due to an increased detection brought about by the development of newer, more effective diagnostic tests and increase rate of consultations or screening, said Dr. Joan Marie Balbuena-Arcillas, Medical Oncologist at Manila Doctors Hospital and Asian Hospital and trained at Philippine General Hospital.
“Most patients diagnosed with cancer have masses or nodules that gradually or suddenly enlarge prompting consult and diagnosis. Other cases can be incidental during routine tests. The gold standard for diagnosing cancer is doing a biopsy of the mass or nodule,” said Arcillas.
Malignancies develop from normal cells in the body that mutate or transform into abnormal versions of themselves. Normal cells reproduce themselves in an orderly fashion and have specific life spans.
When exposed to certain factors such as cancer-causing chemicals, viruses, smoking or radiation, these normal cells may become susceptible to undergo changes called gene mutations. These mutations may eventually cause these cells to keep on reproducing, live much longer, and spread and reproduce in other parts of the body.
“A few individuals, however, are already born with certain gene mutations, and thus, they have an inherited predisposition to develop specific cancers, such as breast and colon cancer,” Arcillas added.
Cure for cancer
Sadly, there’s no absolute cure for cancer. Even after complete treatment and/or remission, there’s a probability for recurrence based on certain risk factors, such as a higher disease stage upon diagnosis and tumor subtype.
“This is why, like diabetes and hypertension, patients need to undergo regular monitoring and surveillance,” said Arcillas.
Cancer treatment depends on the cancer type and stage, and the specific treatment modalities that are to be done for each specific case.
“Surgery, radiation and systemic therapies (chemotherapy, hormonal therapy, immunotherapy) are the mainstays of cancer management for most types and cases. Other disciplines and services may also come into play to have a holistic cancer management, such as pain management, nutritional support, counselling, and rehabilitation,” said Arcillas.
The cost of surgery depends on the hospital and the specialty of the one performing the procedure. Government hospitals usually are cheaper and most have provisions for charity cases.
“Same goes for chemotherapy, but with the additional consideration of the specific drugs to be used. Certain drugs are prohibitively expensive especially the newer ones that have just been approved for use,” said Arcillas.
For now, there is no proven scientific evidence yet that alternative therapy in the form of herbal medicine, specific diet, or drink really work.
“Some may even be detrimental to overall health and resorting to these alternative treatments may cause delay in seeking management that can actually work. People who are diagnosed with cancer have the best chance of surviving by choosing evidence-based therapy,” said Arcillas.
Providing health care for all
Unfortunately, instead of going immediately to the hospital or doctor for treatment, majority of the poor and the young think first where to get out-of-pocket payments as these are not covered by their insurances.
“In contrast with the rich, they have HMO, PhilHealth, and savings. So kapag may cancer sila, hindi na nila ipinagpapaliban. If they have to go a doctor for colonoscopy to rule out colon cancer, or if they have a lump on their breast. They won’t think twice,” said Leachon.
“Consultations are usually out of pocket payments, which is 57 percent, mataas yan! Wala n’yan ang PhilHealth, and almost all, 100 percent you can avail of your benefits when you’re admitted (or confined),” he added.
Now that the House of Representatives has approved on third and final reading, the Universal Health Coverage (UHC) Bill or HB 5784 will “ensure that every Filipino citizen is entitled to healthy living, working and schooling conditions and access to a comprehensive set of health services without financial hardship.”
One of the salient features of the bill is “pooling of all funds intended for individual-based health services together (PCSO, Philippine Amusement and Gaming Corporation, etc.) and designating PhilHealth as the national purchaser” so patients won’t have to wait for hours or go to different charitable institutions to seek financial assistance.
For now, Leachon saw the need for the Department of Health to do a massive public healthcare information campaign and utilize the Social Media to promote preventive care or spot early signs and symptoms of any disease.
“There are several reasons why we fail in our healthcare system: ignorance or lack of knowledge, combination of poor and uneducated patients, non-compliance and implementation to law with corresponding penalties/punishments (e.g. nationwide smoking ban), no caloric counter, and the environment of the Philippines is not conducive to health – no parks, no biking lanes, no smoking areas. Schools/workplace do not encourage healthy diets. It’s shaping the environment,” said Leachon.
PCSO ASAP Desks
PCSO is mandated by its Charter, or Republic Act (RA) No. 1169 to “provide and raise funds for health programs, medical assistance and services, and charities of national character.”
Few people know that instead of going to PCSO Head Office in Mandaluyong City or its extension office at the Lung Center of the Philippines, patients can also go to 58 PCSO At-Source-Ang-Processing (ASAP) Desks in partner hospitals and facilities nationwide.
ASAP Desk aims to expedite the provision of services by partner hospitals and facilitate the manner the requests are processed in PCSO, which caters exclusively to the respective hospital’s patients so they won’t have to appear personally at the PCSO Offices.
It is also a point of access to Individual Medical Assistance Program (or IMAP), a flagship program of PCSO under the CAD designed to attend to the financial needs of all individuals with health-related problems through the provision of financial assistance.
Apart from ASAP Desks, PCSO also has 63 branches across the country. Patients will only need to submit a medical abstract, statement of account, letter from the hospital, and personal letter from the applicant.
Published originally at The Manila Times, Health Industry section, April 7, 2018 with minor edits