Indigent Patient Help Program - Mine, Ours, Yours

Indigent Patient Help Program –Mine, Ours, Yours

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Annual Conference of Tripartite Training Institution in Manila

March 27, 2015


In all hospitals in the Philippines,

both government and private,

there will always be indigent patient incidents.


Likewise,

in the practice of our medical / surgical profession, we will encounter indigent patient incidents.


What are indigent patient incidents?

These are the incidents in which the patients

don’t have or don’t have enough money

to secure the medicines, supplies, and tests needed

for their medical management

if these cannot be given for free.


Setting of indigent patient incidents?

• hospital’s emergency department

• inpatient services department

• outpatient department

• private medical clinic of an affiliated physician

• more common in government hospitals


The “indigent patient incidents” are

primarily a result of the

presence of indigent patients

in the community

(Philippines, provinces, cities, municipalities, etc.)


Indigent patients are present in the community

• because of the inherent presence of citizens

• who are jobless

• not working to earn

• struck by unfortunate events in life that drain their financial resources and reserve, etc.


In short,

there will always be a segment of the citizenry in any community in the Philippines which consist of

indigent patients.



secondarily a result of

increasing costs of healthcare

compounded by absence of hospitals

which can continuously give out

totally free medical services.



tertiarily a result of a

national health insurance system (specifically, PhilHealth)

which cannot cover all

the medical expenses of every citizen

whenever the latter get sick.


There won’t be indigent patient incidents in the community

if all individuals and families are

economically productive and

have a system to adequately meet

the demands of current and future medical expenses.

This scenario, however, is extremely difficult, if not possible, to achieve.


Controlling the costs of healthcare

and

strengthening the national health insurance system

can only mitigate and reduce the

number of indigent patient incidents.


There will always be indigent patient incidents

in our midst,

in our hospitals, whether government or private,

and

in our private clinics.


The presence of indigent patient incidents is

a daily challenge

to hospitals (both government and private,

but more for the government ones)

which have limited resources and budget for free

services, medicines, and supplies to give out.


It is a bigger challenge for the government hospitals

because of the citizens’ expectation that these

hospitals should cater to all indigent patients in the

community using taxes paid to the government.


For both government and private hospitals, the

challenge is not limited to the quantity of free

services, medicines, and supplies they can give to

indigent patients in their midst.


More importantly, the challenge is on the indigencyassociated quality and ethical issues.

Specifically, these are,

• there should be NO delay in treatment because of indigency reason and

• NO patient is deprived of proper medical/surgical treatment because of indigency reason.


For private practitioners with indigent patients in their clinics,

the challenges mentioned for the hospitals are

essentially the same though in lesser degree and

urgency.


The private practitioners are not expected to have stocks of medicines and supplies in their clinics that can be given to indigent patients for free when the latter consulted them.

What are usually and given free are the free consultation services and advices when there are indigent patients in the private clinics.


The issue of delay in treatment because of indigency

reason is not that great as compared to that in a

hospital setting because usually patients seen in

private medical clinics are not in life-threatening

condition.


Likewise, the issue of deprivation of proper medical /

surgical treatment because of indigency reason is

not that great compared to that in a hospital setting

because there is usually time to refer the indigent

patients to appropriate institutions with indigent

patient help programs.


The phenomenon of the indigent patient incidents

is a reality and a challenge

that all of us, working in the hospitals, both

government and private,

and running a private clinic,

have to face and must know how to manage.


We must admit that all these years all hospital administrators,

the entire physician workforce from all the clinical medical

departments and all private practitioners have always been

trying their very best to manage the “indigent patient

incidents” by assisting the indigent patients in securing the

needed medicines, supplies, equipments and diagnostic tests

to be done from various sources.

They should be commended for their

compassion and resourcefulness.


A question I pose:

is there a structured, comprehensive, effective and efficient indigent patient help program that we can adopt to mitigate our coping, if not to use the word struggling, with the indigent patient incidents in our midst?

If there is none, let’s brainstorm and share experiences with the goal of coming out with such a program.


I will start the ball rolling by presenting my experiences, thoughts, perceptions, opinions, and recommendations on an indigent patient help program in my private clinic and for Ospital ng Maynila Medical Center Department of Surgery.

After me, we will listen to the indigent patient help programs from Manila Doctors Hospital and Manila Med.

Indigent Patient Help Program –Mine

In my private clinic,

every now and then,

I encounter indigent patient incidents.

I always try my very best to help to make sure these indigent patients get the medical management they need.


Below are the measures that I had done and will

continue to do as indicated for indigent patients

consulting in my clinic.


• Practice value-based health care services

which is providing services in such a way that the

cost of the health care management is kept to the

lowest minimum possible or most reasonable

expense possible

while continuing to maintain and improve quality

and safe outcomes.


Value-based health care services emphasizes the importance of

• accurate clinical diagnosis to avoid unnecessary expenses

• no unnecessary paraclinical diagnostic procedures

• no unnecessary treatment procedures

• no unnecessary drugs and miscellaneous expenses

• but still maintaining quality and safe outcomes


Value-based health care services emphasize

the use of management options with minimum

possible or most reasonable expenses

yet maintaining and safe outcomes.


• Help them with recommendation of measures on

how to minimize the costs of medical management

(which diagnostic centers to go to; which hospitals to be admitted; room accommodations; which doctors to go to in case of referrals; etc.)


• Encourage them to use the benefits from PhilHealth.

• Treat and operate on them with the least or affordable professional fees. If indicated, give pro bono services.


• Give them medical and surgical supplies, if I have.

• Assist them in getting into government hospitals, if needed.

• Assist them in getting external sources of help like Philippine Charity Sweepstakes Office (PCSO) and other institutions.

Indigent Patient Help Program –Ours (OMMC Department of Surgery)


I started an Indigent Patient Help Program in 2001 when I became Chairman of the Department of Surgery of Ospital ng Maynila Medical Center.


Managing patients without the needed medicines and supplies can be very frustrating and depressing for the physicians, especially during emergencies.

This was the main driver for creating the Indigent Patient Help Program of the OMMC Department of Surgery.


The other driver for the Program was the need to provide quality and safe patient services even for indigent patients.


The objectives of the Indigent Patient Help Program of OMMC Surgery have been:

1) NO delay in treatment because of indigencyreason and

2) NO patient is deprived of proper surgical treatment because of indigency reason.


The program consists basically of the

Indigent Patient Help Boxes

which contain stand-by surgical supplies and medicines to be used for indigent patients when the inventory of the hospital is depleted.


Each resident has an Indigent Patient Help Box whose inventory has been maintained through donations from external benefactors, consultants, and alumni.


The program also consists of a

stand-by emergency fund

to be used for emergency purchase of supplies that are not available in the Boxes.


Another aspect of Indigent Patient Help Program is to get external donors for needed surgical equipments like cautery and suction machines that cannot be supplied by the hospital.


• Providing cost-effective management, not only to avoid premature depletion of funds for “indigent patient incidents” of the hospital but also to control the medical expenses of the patients.


• Giving advices on how to minimize the costs of medical management

• (which diagnostic centers and other hospitals to go to in case diagnostic and treatment procedures are not available in the hospital; which doctors to go to in case of external referrals; etc.)


• Encouraging them to use the benefits from PhilHealth.

• Assisting them in getting external sources of financial help like PCSO and other institutions.


• Conducting free in-house surgical missions (such as Operasyon Bosyo and Kanser sa Suso) using funds from external donors.

Indigent Patient Help Program –Yours (MDH; MCM)


Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Annual Conference of Tripartite Training Institution in Manila

March 27, 2015

Indigent Patient Help Program - Mine, Ours, Yours

Health & Medicine

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