While You Were Sleeping

The Korean telenovela series Ghost Doctor portrayed a genius surgeon in a coma whose spirit was able to possess another surgeon’s body. The genius surgeon thought of patients in persistent vegetative states as space-occupying bodies, since the beds could be used for other patients with better prognosis.

In the Philippines, the families of patients in private hospitals decide to bring their patients home to allow natural death when the resources are not sufficient to support the growing hospital bills. Further medical intervention would be considered extraordinary measures. Government hospitals are usually inundated with patients so there is an urgency to discharge patients as soon as they are more stable in order to provide more beds for incoming patients.

Last week our hospital celebrated the 5th anniversary of the Malasakit Center – a one-stop shop for government funding agencies in one geographic location so that patients can be discharged with out having to pay a single peso of their hospital bill. In Philhealth, this is known as the NO BALANCE BILLING. However there are big bills that reach millions of pesos, but the outcome of patients still end in death. It’s a difficult call for the doctors handling patients in the ICU to decide on prognosis, quality of life and health outcomes. Moreso, patients in persistent vegetative state, more commonly known as “comatose”.

Last Wednesday, we organized our hospital’s first bioethics conference. The lecturer discussed the four (4) basic principles of ethics: autonomy, non-maleficence, beneficence and justice. A case of persistent vegetative state was discussed and concepts such as respect for autonomy, paternalism, common good, distributive justice, motivation, quality of life, futility, advanced directives, and allowing natural death.

The parents did not want to bring the patient home. They didn’t have the resources to take care of him while they worked, whereas if the patient remained admitted, his care would be at no cost to the family. However, with the poor prognosis, he would be depriving another patient of the same resources that were afforded to him.

Join us tonight on #HealthXPH at 9PM MLA time to discuss this complex topic:

T1. In your opinion, should the government pay for the care of patients in persistent vegetative state?

T2. When and how should healthcare workers bring up discussions of allowing natural death?

T3. If you were the healthcare worker assigned to pull out the ET tube and withdraw life support, how would you feel?

Malasakit at 5!

 

The Malasakit Center of Vicente Sotto Memorial Medical Center is the first of its kind, an out-of-the-box one-stop shop center with all government agencies providing medical financial assistance to patients for financial risk protection.  The VSMMC Malasakit Center celebrated its 5th Anniversary with the author of the Malasakit Center Act, Senator Bong Go.

This event was an opportunity to showcase the many talents of the Medical Social Service staff.

5^th Anniversary Celebration

Malasakit Center:

Compassion through Linking Patients and the Government

Helping others is one way to help ourselves. Back in February 12, 2018, the first Malasakit Center was launched by the government in the Vicente Sotto Memorial Medical Center (VSMMC) in Cebu City. 

Bisyo ang magserbisyo. Unsa ang Malasakit Center? It is a one-stop shop that houses representatives from the Department of Social Welfare and Development (DSWD), Philippine Health Insurance Corporation (PhilHealth), Philippine Charity Sweepstakes Office (PCSO) and the Department of Health (DoH).

With a predominantly private sector-driven healthcare system, financing healthcare in the Philippines has been largely from out-of-pocket spending until the establishment of the Philippine Health Insurance Corporation (PHIC), better known as PhilHealth, in February 14, 1995. However, using a case rate scheme, PhilHealth may or may not fully fund the patient’s healthcare depending on the patient’s final diagnoses, leaving room for out-of-pocket spending.

For PhilHealth-accredited government hospitals like VSMMC, they are bound to deliver all medically essential services and supplies to the service case patients without collecting from them through PhilHealth’s No Balance Billing policy. This compels these hospitals to absorb the cost not covered by PhilHealth as Quantified Free Service (QFS). Unfortunately, limitations in government procurement prevent these hospitals from providing all services and supplies to patients, rendering some patients to procure them outside of the hospital.

For patients who are unable to afford their healthcare needs, they would seek financial assistance from various government agencies like the DSWD and the PCSO, each having respective and distinct programs for medical financial assistance and involving separate sets of paperwork.

The fragmented access to medical financial assistance availed outside of the hospital unnecessarily prolongs the hospital stay of the patient: medically indicated procedures and treatment are delayed until the prescribed drug or implant is made available through government medical financial assistance.

For most rural patients unaccustomed to the city, many of them have a hard time filing for these financial assistance requests so that processing for assistance is not consummated. What the hospital could potentially collect from government agencies are then eventually absorbed as quantified free service instead.

Recognizing the need for an inter-agency collaboration, VSMMC looked for an out-of-the-box, one-stop-shop solution for the patients’ convenience foremost and for the Medical Center, secondarily.

After almost two years of VSMMC Malasakit Center’s operation, the Malasakit Center Act  or Republic Act 11463 was signed into law on December 2019. Before its signing, DR. GERARDO M. AQUINO JR , the Medical Center Chief II of VSMMC, was a member of the technical working group to finalize the house bill institutionalizing Malasakit Center in DOH-run hospitals in the country.

To date, there are 154 operational Malasakit Centers throughout the country.

Being the first in the country, VSMMC Malasakit Center has become the benchmark of other hospitals wanting to open their own Malasakit Centers.  Directors and management personnel from other hospitals came to see for themselves its operation in the first two years of the center.  Our partner agencies include Philhealth, PCSO, DSWD, PAGCOR and the DOH.

Since its inception, the Malasakit Center of VSMMC has been continuously serving the Filipinos 24 hours a day, 7 days a week.

The Hospital Management ensured that staff complements sent by partner agencies are augmented by the hospital’s Medical Social Workers and Support Staff to render round the clock service. 

Following Joint Administrative Order  (JAO) No. 2020 – 0001, the Malasakit Center offers assistance to patients in the following Order of Preference: the Philhealth, the PCSO, DSWD, DOH-MAIPP then finally the quantified free service of VSMMC.

Qualification.  VSMMC Malasakit Center applies the No Balance Billing or No Co-payment policy for admitted non-private patients.  Patients have to be seen by the hospital’s physicians at the Out- Patient Department (OPD), Emergency Department (ED) and or admitted at the Service Wards of the hospital.

VSMMC Malasakit Center has served a total of 729,084 patients at the end of 2022.

From the perspective of a medical doctor, The Malasakit Center offers opportunities to augment services that are limited in our institution.

It is quite fortuitous that the Malasakit Center was already functional when the COVID-19 pandemic hit.  Everything happens for a reason.  That reason causes change.  Sometimes it hurts, sometimes it’s hard, but in the end it’s all for the best.  Our COVID-19 Incident Command System Planning Chief said that the Malasakit Center is really a blessing to our patients.  Quality medical services can now be reached and accessed by the least, the last and the lost, most especially during the pandemic!  It saved patients and their families from financial catastrophe.

A medical social worker assigned at the Malasakit Center shares that The Malasakit Center gives our indigent patients HOPE – that they can access the healthcare that they need even if they don’t have money on hand.  They are thankful for the chance to serve because patients are the reason why we are here.

The first ever Malasakit Center operations manager Mergin Acido expresses her awe that the Malasakit Center really liberates patients from financial, psychological and emotional burden.

Quoting our own SOTTO LIVE producer, incident commander, and medical center chief Dr Gerardo M. Aquino Jr, Bilang doctor na nasa government for almost 35 years na in service, ito yung panahon na talagang sinasabi nila na dito namin nararamdaman yung gobyerno natin.

As we celebrate the 5^th anniversary of the Malasakit Center, the Vicente Sotto Memorial Medical Center wishes to thank our partners:  the Office of the President, the office of Sen. Christopher Lawrence Go, the Office of the Special Assistant to the President, the Office of the Presidential Assistant for the Visayas, the Department of Health, the office of Dir. Girlie Veloso, and the rest of our partners from the PhilHealth, DSWD, PCSO, and PAGCOR. This would not have been possible without your unending support.

Quality service is its own publicity.  The VSMMC Malasakit Center delivers results on better health outcomes, responsive health systems, financial risk protection and respect for human dignity.  Even amidst the COVID-19 pandemic, Vicente Sotto Memorial Medical Center was recognized by the International Hospital Federation, earning an honorable mention  under the Seddiqi Holding Excellence Award for corporate social responsibility during the 2021 IHF Awards in Barcelona, Spain.

Gikan sa kailagman sa among kasing-kasing, daghan kaayong salamat! Kay dinhi sa Sotto, kalidad nga serbisyo among garbo!