8/21/2019 Good Pay for Better Health Care: Leyte Model
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June 21, 2015
Good pay for better health care: Leyte shows it can be done
The provincial hospitals of Leyte before typhoon Yolanda struck
the area in November 2013 had started drawin
attention for their scheme to hike the pay of their physicians
and staff despite the impediments. The pay of an
obstetrician-gynecologist, for example, stood to rise for August
2013 by P166,000 at the lowest, or by more
than P215,000 at the highest -- representing her combined share
from pooled monies generated through a loc
incentive scheme.
On the average, the Leyte physicians took home for August of
2013 an additional payranging from P106,000 to more than P161,000.
That’s on top of their average statutory payfor the same month,
including bonuses and allowances, of about P40,000.
The result was improved health care for the province. The number
of full-time physicians
attending to patients at the Leyte Provincial Hospital had
doubled to 19 by 2012, with moredoctors applying for a job. Service
has tended to improve as doctors vie for patients andwork to keep
them pleased -- the miracle of tying pay to performance.
How did the capitol consistently raise that much money? A team
organized by the Action forEconomic Reforms flew to Tacloban to
look into the practice -- to know what Leyte did, how did it, and
more. Highlights and how-to hints follow.
Provinces (and cities) may raise incentive funds from at least
two potential sources: ablepatients and PhilHealth. Able patients
are those who can afford to pay for hospital services.They are your
non-indigents. PhilHealth is shorthand for Philippine Health
InsuranceCorporation, which carries the mandate of providing health
insurance coverage to allFilipinos. With a budget of over P35
billion last year, it’s a rich source of wealth for health
if you know how to tap it.
To lay the scheme using these fund sources, the will and the way
must be in place. Musterinthe will is your department. This how-to
hopes to help in finding the way. It draws heavilyfrom the
experience of Leyte in implementing its hospital incentive
scheme.
So, you would need to:
• Charge (or, if warranted, adjust rates of) a fee for
service.
• Pool cash donations.
• Pool PhilHealth payments for professional fees.
For each of these, you have to put in place an agreed
distribution formula that bears in mindthe virtues of participation
and makes everybody happy.
FEE FOR SERVICEThis is a beaten path among provinces as a way of
recovering cost, whose success variesacross jurisdictions. As local
holder of the power of the purse, the Sanggunian enacts anordinance
imposing fees (or adjusting current charges) for certain hospital
services rendered
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prescribing how much and to whom the fees apply, and providing
how much of the proceedsgoes to what and to whom.
You would like to ring-fence the hospital account for your
incentives. Otherwise, the incomegoes straight by default to the
general fund and gets spent following the usual budgetaryprocess.
You would need therefore to lay the collections together, “fence”
them off, and keeany other from spending them on anything else.
How? By creating through the same ordinance, as the law allows,
a special account in thegeneral fund.
But bear in mind the hurdles. By law, you are not allowed to
hike the pay of any of yourofficial or employee higher than the
maximum salary rate fixed for her position. Another lawputs a limit
to what local governments can spend for personal services in the
form of salaries, premiums, bonuses, benefits, and the
like.
CASH DONATIONSFortunately, the legal impediments do not cover
cash donations. By definition, privatedonations to local
governments can only be used for the purpose for which these were
madeThe Leyte experience has impressively demonstrated that cash
donations from non-indigent
patients form a viable source of hospital income to fund the
incentive scheme. In 2013, thesamounted to a total of P3.7
million.
Again, you would need the Sanggunian to enact an ordinance
authorizing the collection of cash donations from non-indigent
patients, providing for the creation of a special account (aLeyte
did) or a trust fund (as the Commission on Audit requires) for
these donations, andprescribing the manner of distribution of the
proceeds, among other things.
PHILHEALTH PAYMENTSPhilHealth is another source of funds to tap
for the hospital incentive scheme. What youwould like to look into
is its reimbursement facility. The PhilHealth law says: “All
payments
for professional services rendered by salaried public providers
shall be allowed to be retainedby the health facility in which
services are rendered and be pooled and distributed amonghealth
personnel.”
This is ring-fencing the payments courtesy of the law. To use
them for the hospital incentivescheme, the province would only need
to attend to some key tasks, such as the following:
• Ensure that the hospital and its physicians are
PhilHealth-accredited. It takes some steps tget accredited. Knowing
these in detail would require you to pay your PhilHealth local
healthinsurance office a visit.
• Create through an executive order an ad hoc hospital committee
mandated to proposeguidelines for the pooling and distribution of
PhilHealth professional fees.
• Enact an ordinance prescribing the approved guidelines and
creating a trust fund for thispurpose. This task seeks to apply
sustainability to the pooling and distribution scheme.
Leyte’s is a story of success that’s worth the telling. Your own
is surely worth the wait.
Mario M. Galang is a senior fellow of Action for Economic
Reforms and a development andgovernance specialist.
www.aer.ph
http://www.aer.ph/
