Provisional Transcript

Audio Recording of meeting of Department of Health Undersecretary Janette Garin

with Members of the House of Representatives and their staff to discuss the DOH
Medical Assistance Program
Andaya Hall, Batasang Pambansa
May 20, 2014

Usec. Garin: Good afternoon everybody, Im Dr. Janette Garin representing the
Department of Health. I was actually with the House of Representatives for the past
nine years. So first and foremost in behalf of the Department of Health, allow me to
apologize for all the chaos and confusions that the Medical Assistance Program has
created. Admittedly, there were a lot of lapses in our end, guidelines were being
amended I believe for 3 times. So pasensya po sa nangyari, precise for me to say that
last week before the Secretary left for Geneva, this whole program was transferred to
my office. I willingly and gladly accepted because I look at my position as something
that was given to me with confidence and something that placed be there because of
the teachings of my previous mentors in the House of Representatives like boss Tito
Raul Del Mar, so andidito po ako ngayon, we admit medyo marami ang mga reklamo,
medyo marami ang confusions, so I hope, I hope you will allow us to apologize for
that, but also allow us to have a little breathing space.
For the past two days we actually reviewed all the, everything that we had
that has happened, including the guidelines, including the process, and precise for
me to say that admittedly most of the lapses were on the part of the Department
that we admit and the guidelines that was given to you was in contrary to the initial
guidelines that I presented to the Speaker and the officers of the House. Hence it
became more tedious. So we actually have a new set of guidelines, so well be giving
it in awhile. Just to mention few things. The previous administrative order that the
secretary signed will now be amended by the new AO that he signed before he left
for Geneva so just to clearly point out, well the, the GAA states that the eligible
patients are the indigent patients so nagkakaroon po ng maraming confusion because
yung iba kasi they, theres alot of definition to indigent patients so for this purpose
we defined the patients as MAP indigent patients. Okay, so the qualifications will be a
recommendation from the MAP officials, and who are the MAP officials? Kayo yan,
these are the Congressmen or your designated personnel.
So yun po ang nangyayari and the eligible patient are all patients admitted or seeking
consult in a government health care facility. Now on the implementing mechanism,
we also learned that because it was going together with PAU or the Public Assistance
Unit of the Department of Health, nagkaroon ng maraming requirements so on the
provision of Medical Assistance there were requirements as to the original complete
prescription for medicines and medical supplies, the original laboratory request, the
original physicians order request form and the statement of account all of this, so for
your previous guidelines under Section 4, B that whole paragraph has been deleted
so we, the new guidelines that you have now, its totally deleted kasi andudun nga
yung sinasabi ninyo na pinapabalik-balik yung pasyente, totoo yun kasi hinahanap
yung mga original request and the patient has to look for the doctor to sign it and
that task alone is very tedious kasi yung doktor minsan nag-ra-rounds, minsan nasa
ibang so lahat ng requirements na yun mawawala yun, also the hospitals, we had a
meeting with them last week and he said of a single contact person they are
required to have at least two contact persons in-charge of this program, the directory
of which we will give to you in awhile.
On the previous guidelines, there were also a, a, a table that reflected the guidelines
in terms of DOH-retained Hospital facilities and the non-DOH-retained hospital,
hospitals and health care facilities. Okay, basically the problem was this, for the DOH-
retained health facilities, mali naman po talaga, lalo na pag sinasabi nila na uy, sorry
po wala po ditong pondo yung Congressman ninyo, hindi po talaga dapat sabihin
yun. Okay, so we already called the attention of all the chief of hospitals and in-fact a
memo has been released to them last Friday.
So we will have three procedures, unang-una po yung pinapakiusap ng lahat na
downloading ng funds, the finance department, the finance section of the
Department of Health has facilitated that, but we understand that, because of
bureaucracy, minsan natatagalan. So if your funds are already downloaded in the
DOH hospitals. So I repeat unang-una po downloading of funds to DOH Hospitals
including retained hospitals that includes the regional medical centers and specialty
hospitals if your office has funds there, you can transact directly with them yung
point person nandudun, second, if in case nagpadala kayo ng pasyente, pagkapadala
ninyo ng pasyente sinabi ay wala po ditong pondo yung opisina ninyo which usually
happens, this is something that we admit should not happen but unfortunately the
process of requesting the funds and downloading it takes a lot of time. So the
proposal that we have in this case kung saka-sakaling pagdating, wala diyaan, walang
pondo yung office or whatever, we have a directory that will be given to you and that
will be e-mailed to all your offices. In that directory, there are two persons in-charge
of all hospitals, so makikita ninyo dun sa directory, andidito yung mga pangalan ng
mga hospitals and then kung sino yung contact person na tatawagan ninyo. So for any
problem, you immediately call, text or e-mail the persons in-charge of that hospital
and automatically they will issue a guarantee letter direct to your office and direct to
the hospital.
Kung saka-sakaling hindi pa natanggap ng hospital, dala-dala na ng pasyente ninyo
yan kasi ibibigay ng office ninyo pero kung yung pasyente naman nasa hospital, dun
din niya kukunin. Its just like an alternative, kung in case wala pa yung pondo ninyo
dun sa specific na hospital. In that way, we will not let the patient wait, we will not let
your office wait and if the patient will be discharged on that day or the day after, the
guarantee letter will be honoured. We also understand na yung guarantee letter na
unang nirelease, medyo yung format, I mean its good, its okay. Unfortunately the
format creates a lot of questions kasi nga parang its, its an indigency program of the
DOH. Nawawalan ngayon ng, lets admit it the political points in, in the case of the
office requesting it kasi ang nakapirma dun is Asec. Lagajid and it was placed there na
hindi pwedeng i-honor pag Saturday and Sunday. Andudun din yung nakalagay na its
charged in the office of the Secretary. So all of these were deleted. We will be giving
you the new format of the guarantee letter. What is there is a bar code on top
because that is our control, and thats also given to the hospitals. So nakalagay lang
dun yung pangalan ng pasyente, kung saang hospital and the amount that you would
like us to place in the guarantee letter.
Now, the people in-charge, kaya yan dalawa for the mean time, but in the next two
weeks they will be three. Why? Because they will be on 24/7 duty so that you can call
the number that we will be giving will be endorsed appropriately because they will be
on eight hours duty so holidays, weekend, gabi man, madaling-araw man, merong
sumasagot sa text or tawag ninyo. We will give the names to you and the contact
numbers at the appropriate time. Now, the third one is the Local Government Unit
hospitals. We already have issued a directive to all our regional directors to to come
up with a MOA that we have drafted its its a new memorandum of agreement for
them to make representations for the governor to sign to cover all the hospitals, and
in the case of LGU Hospitals we understand na sa iba walang problema pero yung iba
naman may problema. And on the part of DOH naman, we are bound by COA not to
release funds if we have no obligation. So their mechanism will again be like a
reimbursement process where all guarantee letters released by your office to them
will be reimbursed within 10 working days by the department. So yan po yung tatlong
sistema. Just to make a recap, there will be three mechanisms, the first will be your
funds will be directly downloaded to the specialty hospitals and all DOH-retained
hospitals and when that happens, you can communicate directly to them, but just in
case, pag punta nung pasyente ninyo, pagtawag ninyo, hindi kayo agad-agad na-
entertain, we will be giving you a directory for the personnel in-charge 24/7, just give
them the name of the patient, the amount and then a guarantee letter will be
immediately forwarded to your office. The hospital will also be copied and the
personnel in-charge, the cashier office will also be texted, yung number, the amount,
and the name of the patient. Para po agad-agad na ma-entertain. That mechanism
also follows for the LGU` Hospitals.
Now the other requirements, that yung table sa previous guidelines ninyo, that was
actually page four in the old requirements. What you have now is the new one.
Tinanggal na namin lahat yun. We admit its also very tedious especially if the patient
has to go to the social worker and come up with all these documentary requirements.
Now on the determination of the eligibility of the patient for assistance from the
MAP, we have also deleted that because the eligibility of the patient is actually your
decision. Then also to erase all doubts we included it in the guidelines kasi yung
LGU Hospitals are concerned na baka hindi sila mabayaran or whatever.
Nakalagay na doon that within 10 working days the department is obliged to pay
them. Thats why in the letter that we sent out to the governors and the regional
directors and the chief of hospitals, we requested for their corresponding bank and
bank accounts para direkta nang bank-to-bank na magbabayad lahat, lahat-lahat,
bank-to-bank na yung pagbayad ng central office sa lahat ng mga hospitals. Now,
there are also a lot of, the reason why there were a lot of requirements in the
previous guidelines, was that in the GAA that was approved, andudun na naka-
stipulate yung medicines given, laboratories done, yung mga itemized list. So all of
that will now be complied by a specific team that will be handling. So every patient,
tuloy-tuloy yung pagbigay ninyo ng assistance, but my office, there will be five, or
four or five personnel whose work will be to comply with all the requirements under
the GAA. Yung mga gamot na binibigay. So all of these requirements para hindi na
yun itulak sa pasyente. Kasi kaya rin nagrereklamo yung ibang pasyente dahil napi-
pingpong sila. Ang daming opisina na pinupuntahan, which is actually not good kasi
parang pinapahirapan pa sila. So that has been deleted.
And instead it will be a responsibility of my office to comply with all of these
requirements. Now on the, on the draft memorandum of agreement with the LGU`s,
while initially we wanted to just have it signed by the chief of hospital, hindi nga raw
pi-puwede kasi they are under the direct supervision of the local government chief
executive. So the others have decided not to put funds in the LGU` hospitals but for
those who will be putting funds, our our assurance is that, hindi naman siya
magagamit ng governor kasi first, we are bound by COA rules not to download kung
wala kaming payables. So kung may guarantee letter galing sa inyo, yan po ang
babayaran ng Department of Health. Now, there were also concerns that were raised
to us. We realized na nagkaroon ng dalawang forms. And yung una kasi, I was
confused when I was receiving calls because that the entire program was handled by
another office.
Now I understood ito palang dalawang forms because its a PAU or a Public Assistance
Unit Office, yung isang form na pinapadala sa inyo parang yung mga walk-in patient
na gustong magpatulong. The PAU office writes a recommendation and sends it to
your office. So medyo hindi maganda kasi parang ang feeling tuloy ng pasyente
nagpunta siya sa DOH, ngayon itutulak namin sa office ninyo. Pag hindi agad na-
entertain ng office ninyo, marami pang salita. So the decision of the Department is to
do away with all walk-in patients because in the first place it was made clear to us
that these funds are not DOH funds but are actually funds of Congressmen who are
there to assist their constituents. So the referral letter if ever you receive one coming
from DOH, dont mind that but we already gave instruction. I mean I personally gave
instructions last week to do away with all of those. Kasi hindi pi-puwedeng yung mgs
kapag may lumalapit dun ire-refer namin sa inyo. You know best and you know better
sino ang nanganagilangan ng tulong sa distrito ninyo. Isa pa, hindi rin talaga namin
alam kung constituent ninyo because they can always say theyre from this district,
theyre from this area tapos hindi naman. Now there was also the issue of the
compilation or the collation of patients for the day before referring to the MAP.
Parang binubuo muna sila lahat before ipadala.
Syempre tumatagal din talaga. Kaya everytime na pasyente (kung) if they go to your
office, just refer them to us immediately and within 30 minutes at the most that will
be yan na yung pinaka, pinakamatagal. The guarantee letter will be e-mailed direct
to your office. Whether it will be your office here or your district office, just give us
the e-mail address but aside from that and guarantee letter is also with the
respective hospitals so yung issue na kino-collate muna lahat before gawan ng
guarantee letter mawawala na yun kasi meron nang taong in-charge for that specific
hospital. So if I`m the patient, I`ll go lets say to the office of Congresswoman
Catamco, pagdating ko dun sasabihin ko dun Cong., nangangailangan ako ng tulong.
her office will text the person in-charge then the guarantee letter goes to her office
you print it and then you can always say Ito po tulong ni Congressman, tulong po ng
opisina, dalhin ninyo lang ito sa opisina, sa hospital, sa cashier office. that will be
entertained and in the guarantee letter, theres no mention of any any person in the
Department of Health, just was a mention there of a, of the indigency fund as being
used to assist them. Now meron ding mga tanong yung billing amount daw, hindi
nagko-coincide sa requested amount sa guarantee letter.
We already gave instructions for the hospitals, kung kunwari ang pinabigay ninyong
tulong is four thousand or lets say five thousand. Yung billing niya kasi nabawasan pa
pala ng Philhealth or whatever naging lets say three thousand five hundred na lang
para hindi na tumagal, pakuha ninyo na lang ng take home meds niya. Kasi meron
namang mga gamot din na inuuwi sa bahay so pakuha na lang dun. Idadagdag na lang
nila sa bill yun. The hospital wouldn`t mind as long as the amount stipulated in the
guarantee letter will be the amount will be the amount that the hospital will honor.
If the bill is like five thousand and the guarantee letter is four thousand five hundred
then they have to pay for the 500 kasi medyo mahirap silang i-ano... Okay, the other
issue was that yung nagbabago let`s say meron kayong pondo na ni-request and we
fully understand na sa dami ng nakakaharap ninyo syempre minsan, minsan kasi
napansin namin meron kayong constituents nag-aaral sa ibang probinsya o ibang
region, naaksidente dun nagkasakit whatever happens. Wala kayong pondo dun. So
instead of waiting for the downloaded funds, the personnel in-charge dun ulit sa
directory na ibibigay at i-e-mail namin sainyo within the day, yun ulit ang tatawagan.
Kasi nakalagay naman doon even yung hospital na hindi sa distrito ninyo. So we will
still honor that as long as yung pondo ninyo may naiwan pa na hindi siya fully
downloaded dun sa isang hospital. So yun yung pi-puwede but if i`ts like fully
downloaded at nautilized na, makikiusap naman kami na mahirap on our part kasi
the funds that are remaining are actually funds for use of the other Congressmen.
Yung on the memorandum of agreement that will be signed by the local
government chief executive, there was also this concern na ni-re-refer pa sila sa
social worker. Well, admittedly it really takes time especially na yung municipal social
welfare officer isa lang siya, pag nag-bi-break siya or nag-li-leave wala na.
Since its DOH and the hospital has the capability to determine and in the new new
guidelines, the definition of indigent patients and eligible patients is those seeking
consult and admitted in the government health care facilitiy. Then our legal
department also agreed that we dont need a social worker para hindi na sila
pupunta at di na sila mahihirapan. The mere fact that they sought consult in a
government health facility, thats enough. Now what would be the requirement for
the guarantee letter to be honoured, di ba meron yung mga dati original prescription,
original clinical abstract, original medical certificate, social workers, mga blah
blah blah. Pinatanggal na namin lahat yun. Kasi sad to say, tama din na magalit kayo
because we realized that many if not all of the hospitals meron palang corresponding
charges for this, so hindi namin alam yun, our apologies for that. Every document
pala na ni-re-require yung clinical abstract, medical certificate. Meron palang bayad.
So yung pasyente syempre, mas lalong nagagalit. At yun pala yung battle net, so ini-
explain ng hospital na, hindi, ini-entertain namin yan, kulang lang yung
requirements. Ngayon nung tinanong namin yung mga pasyente, eh kasi yung
requirements pala, may bayad din. So ang pangit tingnan. So all of that requirements
had been deleted because this is a requirement of the PAU office. Part kasi yun ng
parang ISO certification. So these were all deleted. The only requirement that the
guarantee letter will be requiring is an attach hospital billing. Okay, because from that
hospital billing, magkakaroon na kami ngayon ng papel na puwede naming i-trace
para dun sa lahat ng mga requirements for COA and GAA purposes so thats all the
ay just last last concern pala.
Ang daming tumatawag tungkol sa procurement of medicines. While we would like to
support that, our dilemma is that our hands are tied because in the funds that were
approved, naka-specify kasi siya na hospital assistance. May we just request na kung
pu-pwede for the next year, specified dun na puwede yung procurement of
medicines for medical missions because as of now, DBM does not allow us. Actually,
ang tiningnan din namin, hindi rin kasi solely ma-blame yung DBM kasi ang naging
problema, parang yung, may mga COA reports not related to PDAF but related to
procurement of medicines, in some hospitals and in some LGU`s. And because of
these, parang naging damay-damay ang lahat. So while they are doing things to
resolve that, hindi muna in-allow. So yun naman yung medyo dilemma namin but
then if you have medical missions these are like out patient, you can group them
together like oh you can have a diabetes clinic or you can have a hypertensive clinic
and then the laboratories and the medicines that they will be using can be charged to
the hospital. So pu-pwede po yung ganun. Yes, sir.
Question from the audience: Good afternoon po! Asec!
Usec. Garin: Hi bossing!
Question from the audience:My question is regarding health facilities that doesnt
have any medicines or medical supplies considering that Ive heard in the recent
news that some private almost all private hospitals in Metro Manila will not honor
cleans completion considering that Philhealth itself owes these hospitals these
private hospitals is having a hard time of facilitating for the papers in cleaning the
hospital for the Philhealth benefit of the patient. Kasi po that is one side kasi sa amin
sa probinsya, talaga pong minsan ang ospital ang for example in Biliran there is only
one hospital which is the provincial hospital. There is no private hospital, there is no
national government hospital. The nearest national government hospital is two hours
away. Now, most of the patients are really poor. Some of them needs immediate
attention, immediate operation surgical operation like that and has a lot of
prescriptions needed for the operations to be conducted immediately. Unfortunately,
lets agree that all mostly of the government hospitals especially in the rural areas
doesnt have the medicines.
Usec. Garin: The medicines these are for LGU`s Hospitals not from, hindi yung
DOH hospital.
Question from the audience:Yes Kasi po ang ginagawa namin dun, during there
was PDAF and Im a doctor kasi. So ang ginagawa ko mino-MOA ko sa government
and then we abide by all of the COA rules. Ano bang requirement ng COA? Dahil pag
pinasok mo sa LGU yan, the LGU must be responsible for the funds under all COA
rules so mangyayari po dyan kailangan ng social profiling. Kailangan ko ng medical
certificate or hospital abstract. Hahanapan po sila ng, ng resibo ng mga gamot kaya
nangyayari po mas effective nun because nasa LGU ang pondo. Nagpa-facilitate ang
district office. Kung walang gamot sa loob ng ospital sa emergency room, kami mismo
ang bumibili sa botika sa labas, may resibo, nakapangalan sa pasyente para pag ni-
liquidate namin sa COA, malinis. Walang dahilan na kung saan napunta yung pondo
pero kung tatanggalin po natin ngayon yung mga requirements na I dont know if the,
the COA will acceptable sa kanila na walang mga supporting justifications. Just
hospital bill lang kasi alam ninyo po kung hospital bill lang ang sagot ng DOH pa, eh
talagang kawawa ang mahihirap dahil ang hospital walang gamit, walang gamot,
walang anaesthetics, halos wala.
Usec. Garin: Okay, for the COA, sa sa ganitong sistema lets go back to the ano
please... Okay for this kasi, for the guarantee letter, it will be acceptable to COA
because the patients bill will allow us to look into what we call the WEB PAIS. So
what DOH has setup is an internet linkage among all our hospitals, that we encode
the patients name,we get their records. So ibig sabihin, actually hindi na yun iko-
comply kasi meron na lang kaming mga tao na taga-comply nun. So we transfer the
burden of the patients to our staff. Now, yung sa LGU`s we will we will make
immediately presentations with the DBM kasi yung downloading of funds, hindi
namin alam kung papayagan in the previous meetings kasi, hindi pi-pwede kung wala
kang billing basis.
Now, what we can actually do is that, I dont know if it will be of much help. What we
can do is possibly include it in the MOA that the governor who will sign kasi yung
governor naman yung may pondo, the governor who will sign will also manifest that
while they are signing kasi its actually income for them eh kasi kaysa ang nangyayari
ngayon yung pasyenteng walang pambayad, hindi mo naman mapilit, with the
Congressional fund now, yung pasyenteng walang pambayad, aside from Philhealth
kahit papaano nadadagdagan ang pondo ninyo. So ang mangyayari dun, its also a
welcome income for them. Then maybe in the MOA, we will stipulate that its their
mandate to provide the basic meds and the commonly used medicines in their
hospital. So thats one that they can do, but after this meeting allow me to have
some time to make representations with DBM and COA on, on how we are going to
facilitate the, yeah, pwedeng dun na lang sa first slide. Next slide please. No, no, no,
slide, previous slide, okay so this is the new term that will be included. Yung eligible
beneficiary, so we do away with the social worker, with the assessment whatsoever,
they are seeking consultation, sinama namin yung rehab per request of other
congressmen, examination or other... regardless of room category, okay kasi meron
namang mga pasyente na hindi raw tinatanggap kasi nasa semi-private room or
private room. Unfortunately, there are illnesses that mandates (sic) their isolation or
minsan puno yung hospital. Hindi naman nila kasalanan na sa private room sila. So
isasama na lang siya. Ito lang yung problema namin yung professional fees.
Maybe you can help us with, ito talaga its, its really COA We, we made several
representations, binabalik naman ng COA sa amin which is somehow true kasi, as, as
indigent patients hindi, lalo na kapag Philhealth, meron na kasing professional fee.
Supposed to be yung doctor hindi na sumisingil. Kaya siya hindi nadya-justify kasi like
in the case actually in a meeting with Philhealth, I put forward a proposal sabi ko sa
Philhealth, baka naman pi-puwede kasi what happens is if Im the doctor, pasyente
kunwari pasyente si cong., Cong. Henry Pryde Teves. May Philhealth siya or HMO,
what Philhealth and MHO does, is that they pay the hospital for the medical bills, the
PF goes direct to my bank account. Ganun po yun. So sa government hospitals,
ganun din. The Philhealth goes direct to the bank account of the doctor.
So minsan, hindi alam ng pasyente na meron na siyang binayad. So what we are
recommending is they give the money or the PF direct to the patient, the patient
then pays that to the doctor. Then magtatawaran na sila para may semblance ng
bayad. We have a pending proposal about dun sa Philhealth, and medyo nag-okay
naman sila initially, kasi ang nangyayari ngayon, people do not know na yung doktor
nababayaran na pala ng Philhealth. Kaya pag sumisingil sila, akala naman ng pasyente
talagang walang naibayad.Nagdodoble actually. Kasi like hinahanap mo, so philhealth
like will pay you eight thousand so thats something we would like to solve. Will this
still get refunds from payment? Actually, yung sa ngayon. Ahh, kasi yung walang
Philhealth. Ngayon pala, yung just to inform you, theres a point of care. Okay. What
is the point of care program? The point of care says. May pasyente ka.Nasa
government hospital. Makikita naman ng hospital na walang pamabayad yun, walang
Philhealth. The point of care allows, actually it mandates the hospital to
automatically enrol the patient.
Nagkaroon lang ng kaunting glitch kasi nung nagbabayad na yung hospital sa
Philhealth na-disallow ng COA. Okay. Yung COA naman nung dinis-allow nila, kasi
nasa batas nga talaga na yung income ng hospital, hindi puwedeng pambayad ng
Philhealth premimum. So for an exemption we already had three meetings with
DBM, during the latest meeting we submitted a format again to Sec. Butch. And then
we are awaiting, I mean verbally and in principle secretary Abad already agreed kasi
sabi ko Boss ang kailangan lang naman talaga dito papel na pirmado ng DBM
instructing COA that they are now allowing hospitals they are amending that rule
that hospitals can pay for the premium. So medyo maso-solve na yun, so kung yung
pasyente walang pambayad, pagpasok niya at hindi siya enrolled dun sa matrix,
pwede siyang i-enrol ng hospital, yes. So yan yung point of care. So yung admission
niya na yan, mababayran na siya ng Philhealth.
Question from the Audience: Magandang hapon po. Tanong ko lang U-sec, are all
hospitals, nationwide ay may point of care?
Usec.Garin: Supposedly, all DOH hospitals, yes. Yung LGU naman, kapag sinama rin
sila yun lang yung naging ano yungpayment ng income kasama na rin sila. So lahat
po yun.
Question from the Audience: second po ay, yung, kasi, yung halimbawa po, makaka-
avail na ang mga indigent patients ng point of care, is it available 24/7? Ang ang
pag-issue po ng point of care para sa mga pasyente po?
Usec.Garin: Yes, because the hospital enrols them. So the hospital gets their data,
may form na sila. Tapos hindi nga makakabayad yan babayaran ng Philhealth.
Question from the Audience: So it becomes automatically enrolled? Once they, they
are confined. Once they are confined in the hospital. How about Usec, yun pong ano,
yung mga emergency cases po, na, yung, yung kailangan po ng pasyenteng mahirap
ng kailangan they have to avail yung private doctors, is the point of care takes care
(sic) of that? Halimbawa po naaksidente po at nagkaroon po ng problema sa brain, so
the hospital especially the LGUs hospitals ay wala pong available sa kanila na
neurologist, kailangan pong kumuha ng private doctor? So how can we address the
problem of the patient?
Usec.Garin: Yes, yes, yes Actually as long as the patient is indigent and even if it is a
pay patient, tapos walang specialist na available, Philhealth covers them as long as
the doctor is Philhealth accredited.
Question from the Audience: So they are fully-covered po?
Usec.Garin: Yes, yes. Kaya lang yung Philhealth kasi meron silang like, for this case, ito
yung PF. For this case, ito yung PF. Sometimes kasi, the other doctors would charge
parang... plus, plus, plus.
Question from the Audience: Yun nga po eh, kasi halimbawa manininingil po ng,
yung neurologist, maninigil po siya kung minsan po ng 120, 000.00. Yan po ang ano.
Syempre hindi naman po mamimili yung pangyayari, ay hindi makakapamili kung sino
yung tao kung mahirap ba siya o mayaman, ang masama, ang mahirap po sa isang
mahirap na tao ay maaksidente hindi lamang po sa, sa motorsiklo, whatever accident
may happen to an individual, ay masasagot po ba yun? Kung minsan 120, 000, kung
minsan 200, 000. Halimbawa po kung minsan kasi mayroon din pong inaatake nasa
isang okasyon biglang inatake at dinala po sa heart center, or sa ibang specialty
hospital, masasagot po ba yun ng point of care?
Usec.Garin: For the Philhealth enrolment, yes. And the fee corresponding to that
Philhealth allows. Unfortunately and admittedly, nakakahiya mang sabihin, meron
talagang ibang doctors na they take advantage, so nagcha-charge sila ng malaki. May
taripa naman supposedly yun pero yung iba nga hindi sumusunod. Because, unlike
the lawyers, they have IBP. For the doctors, wala kasing integrated PMA. It was
actually the law that I believe congresswoman Binay, myself, and, bothers with they
are pushing before kasi there is no body, dapat din kasi, tama naman na sumingil kasi
hanapbuhay nila yun, pero yung tolerable, ang nangyayari kasi parang kanya-kanya
na, wala nang sinusunod. That is why na we have a pending proposal with Philhealth
maybe you can help us with that, na yung payment ng professional fee na
reimbursement goes direct to the patient para yung pasyente dala-dala na yung pera
ibabayad niya dun sila magne-negotiate. Kasi nangyayari sa ngayon talaga, it goes
direct to the doctor.
Question from the Audience: Saka po Usec, kung hindi po masasagot lahat ng
Philhealth, that is why concern po kami na maunawaan po ng COA at ng DBM na sana
po yung aming ahh, ahh allotted funds for the medical assistance ay mabigyan po ng
pagkakataon na makapag-rekomenda po kami ng professional fee din po pandagdag
dun sa hindi po ma-accommodate ng Philhealth.
Usec.Garin: Yeah, ahm we will also wait the presentations pero siguro sa, ito kasi
yung ngayon nakasama ito doon kasi previously mayroon yatang na-disallow yung
COA yun sa, sa PDAF pa before so thats why pero yung isa naman dun ahm, maybe
we should also inform the patients that there is this law lalo na kung government
hospital eh hindi pwedeng ma-hold yung patient. So kung nabayaran na yan
supposed to be yung hospital pwede na silang i-release.
Question from the Audience: Usec. Halimbawa po ah isang mahirap na pasyente na
lumapit sa amin na, na by emergency cases eh nalagay po sa private hospital how can
we be of help to them?
Usec.Garin: Through the medical assistance program that ahm, you, you recommend
as long as they are in the government facility ahm, ah private hospital.
Question from the Audience: Private po private po nadala po kasi yun po ang
pinakamalapit.
Usec.Garin: The, the solution talaga dun is you transfer.
Question from the Audience: In the, in the real sense po eh, Usec. nangyayari po kasi
yan.
Usec.Garin: Yeah, yeah, we understand marami pong nangyayaring ganyan. Pero
marami din pong immediately eh nililipat. Acutally there is a proposal to expand yung
medical assistance program to include the private hospitals. Kaya lang yung eto nga
yung ngayon madalian kasi siya during the budget hearing, Atleast like ahmn, we now
have 3 sets for request for the next budget.
Question from the Audience: Yun po kasing ah, alam ko yung funds na allotted for
every district ay it has to be identified by a, a district congressman or or party-list
ahm, ahh.
Usec.Garin: Actually po, not necessarily that is why we wanted to correct that kasi
marami na yung nagrereklamo noh, correct us if I am wrong, andaming nagreklamo
na bakit daw pinapa-identify ng hospital tapos pag gusto nang ilipat, ang hirap. Ang
totoo po, hindi naman po necessary na mag-identify kayo agad, unless you want your
money downloaded there immediately. Our initial recommendation was actually,
well send the guarantee letters then bayaran agad para walang, walang tagal, walang
maraming requirements kasi the hospital structure has a lot of requirements for
indigency program natutunga kasi diyan sila eh. So to solve that, yun yung prinopose
namin. But then there were others naman were very comfortable with outright
downloading so sabi namin okay naman yun. For those na wala kayong downloaded
na pondo, actually its easier, better and more flexible kasi by the time na nagpalit ka
ng isip, kunyare party-list congressman ka, dito ka naglagay ng pondo, then mayroon
din dun kasamahan ninyo, kaibigan ninyo tumatakbo din, you want to concentrate on
this area, so very flexible, all you have to do is look at our directory tell the person in
charge you want a guarantee letter immediately to this hospital, this patient, ipadala
agad. So hindi na yung na-download na dun, babawiin mo ulit, ire-realign mo.
Mas matagal yun. So for those who were not able to submit a list of breakdown.Wala
pong problema. You just call/text Atty. (?) here Moly is the one heading the group. So
thats Moly. Kasama rin dun yung AO ko si Ethel, and then yung si Annalyn. Ito si Moly
he will be heading the staff, ito si Moly pakita mo yung Si Moly will be the one
supervising the personnel na 24/7 on 8 hours rotation to cater to your calls So yung
dun sa directory ulitin ko lang dalawa lang muna yung pangalan dun may dadagdag
na pangatlo, telephone numbers and name of hospitals. So kung yung pasyenete
nandito sa hospital A, ito yung pangalan ng pasyente Hospital A, amount, text ninyo
lang yung inyong designated na office or ano padala kaagad namin yung guarantee
letter by e-mail kung walang e-mail we will fax it but at the same time we give a copy
to the cashiers office and the directors office in the hospital. Para pagkapunta yung
pasyente kung yung lumapit nandidito or district office, punta sila, ibibigay.
Question from the Audience: For clarification lang po, sana po eh lend me your ears,
silence please. Hindi po tayo magkakaintindihan if everyone, all of us are talking. My
clarificatory question lamang po ako Usec. Yun po bang ating available personnel in
your office po eh can accommodate all congressmens ah concerns, regarding, with
regards (sic) to the sending of a guarantee letters kasi po katulad ko lamang po sa
aming distrito po ay napakarami po na nabibigyan ng, na binibigyan namin dati ng
guarantee letter eh kung minsan po animnapu kung minsan po eh isang daang
pasyente eh kung kami pong lahat eh almost 300 congressmen po kami can they all
accommodate all of us po for that particular day. Pangalawa po. Ay..yun po munag
sgaot.
Usec.Garin: Actually yes, ahm pasensya lang po nagkaron po kasi ng konting
misunderstanding when this program came in and initially we thought it will be
assigned to my office, we trained people, kaya lang nung nagkaroon ng konting,
nagkaroon ng meeting si Sec. and with some leaders of the House, nagkaroon ng
konting miscommunication so hindi po, parang na-cut, na-cut because they thought
that, that hindi na kailangan yung gagawa ng guarantee letter, gagawa ng guidelines, I
mean gagawa nung yung mga medicines given, laboratories requested, because it will
be requested by the patient sa hospital. Yung lumabas na ngayon na may bayad pala
yung lahat ng data na yun, ahm actually ni-retrieve namin yung lahat na trinain, we
started calling them, we had a meeting last week, dinagdagan ng tao, so
makakayanan po nila. And ahm, if there will be a battle neck at some point of time,
nagdadagdag po kami nang nagdadagdag ng tao. But for now, people who were
facilitating before thats a total of 6 or 7 people ahm, now they are 14 and 21. So yun
po situation po. For sure they can accommodate everybody.
Question from the Audience: Secondly po, yung ah patients po na na-confine po or
iko-confine pa lang sa LGUs hospitals in my province po ay papano po sila mabibigyan
ng gamot ng hospital kung wala pa po kasi sabi po ninyo yun munang hospital bill ang
ibibigay, isesend po sa inyo. Tama po ba ako. Yun lang pong hospital bill ang isesend
po sa inyo at kayo po ang magda-download ng pera sa provincial government kasi ito
pong LGUs noh ay under po ng provincial executives ay papano po tatanggapin ng
isang LGU hospital katulad po ng samin provincial hospital sasabihin na lang po na.
Papano po ba ang communication namin? Ahm, kami po ay magbibigay ng
endorsement sa director ng LGU hospital? Or halimbawa po provincial hospitals or
district hospitals within my district magbibigay po ba ako ng endorsement sa director
para po lahat ng kanyang kailangang gawing examinations, laboratories, ultrasound,
CT scan, those are facilities available in hospitals tska po yung medicines yun po ba ay
i-endorse ko po sa district, ay sa director ng hospitals for that matter.
Usec.Garin: Yeah, we actually sent already a memo to all regional directors and we
will be making representations isa-isa po sa lahat ng hospital na any gurantee letter
na dala-dala ng pasyente galing sa opisina ng congressman, tanggapin nila because
we will also be sending a direct similar copied sila para at least alam nila na mayroon.
Now yung ipadadala namin sa congressional office ninyo na ibibigay ninyo ngayon sa
pasyente na ito po tulong ni congressman, ganyan, dadalhin ng pasyente yun di ba,
ibibigay niya sa hospital, pagdala niya sa hospital, lahat po iyon let us say at the end
of two weeks iko-compile ng hospital and then they just send it to the regional office.
The regional office will now validate it with us and then we say yes, kasi magpapadala
na kami ng amount and do that fund transfer within ten working days. That is the
maximum, ten working days.
Question from the Audience: Maraming salamat po. Klarong-klaro na po. Maraming
salamat po.
Usec.Garin: So hindi po tatagal yung utang.
Question from the Audience: Magandang hapon po ulit Usec, Janet. Alam ninyo po
sa DSWD version. Yung oresent version ngayon, I was able to talk to the Secretary
Dinky and ah, ganun din ang assistance fund eh kasi from the same fund that what
the DOH will provide. Ang napagkasunduan po namin ah regarding dun sa situations
like us na malayo kami sa regional office, malayo po kami sa mga regional hospitals,
or national agencies, eh ida-download po nila, meron na po silang ginawang MOA
from the central office ang pipirma yung regional director ng DSWD at ah ida-
download po yung pondo let us say 12 million. Sabi ni Secretary Cong, kahit kalahati
lang muna, kasi masyadong malaki ang pondo so yung kalahati po i-da-download daw
sa local government na gusto mo na mag-i-implement ng programa ng DSWD at ah,
yung provincial government na yun which will be signed by the governor and the
regional director of the department yun pong pondo na yun eh responsible na po ang
LGU. So yung LGU sila na ang all the auditing policies of the government they should
abide by it. And after ma-consume yung 6 million, responsibility ng local government
na i-liquidate sa DSWD bago ma-release ang second batch ng pondo. So mas mas
magiging effective ito kaysa yung kada release for example walang ibang dapat itong
daanan kundi sa local government ah facility dahil malayo nga yung national eh kung
dalawa-dalawa liquidation tatakbo ka pa ng region malayo pa maghihintay ka pa ng
ten days, doubt it if the national government can immediately facilitate the
assessment, the liquidation of all districts in the country, dahil po isa lang ang opisina
niyan eh.
And aside sa kanilang normal standard operations, ito pa yung dagdag na trabaho
galing sa mga pondo ng ito nga former, I doubt it kung mapapabilis po natin, we are
talking here of lives of the people, health ito eh. Hindi naman ito rehabilitation, hindi
po ito, ito po ay immediate ang kailangan. Tatakbo sa emergency room. Kailangan
kaagad ng gamot alam ninyo po yun, doktor po tayo.Hindi pi-pwedeng paghintayin ng
sampung araw ito. Kung hindi puputok yan. Kaya po sa akin po bigyan po natin ng
leeway naman, lalo na yung mga lugar na katulad sa amin na ang layo namin sa
regional ah, department na kung pwde po meron namang existing COA rules.
Napakahigpit ng COA ngayon alam natin lahat.Talagang napakahirap ngayon. Kawawa
ang mga LGU ngayon, dahil talagang sobrang higpit ng COA ngayon talagang pag-
iisipan mo, na tatanungin mo muna sila tama ba itong paggastos ko bago mo gawin
para siguradong safe ka. Sa akin po sana naman sa mga ganitong sitwasyon sana
magawan naman ng paraan para kaagad na maibigay ang

Usec.Garin: We will, we will relay and then come, come back to you, magpaalam po
kami on how to go about it. Initially kasi nung napag-usapan kasi ang downloading to
LGUs when were at the DBM office, ang nasabi kasi nun is hindi kasi diretso sa
hospitals, but the premise kasi doon, nagkakaroon ng problema, kaya nga magkaiba
yung premise, now that is a very valid reason, before kasi yung nagiging problema na
kapag downloaded ang pondo, tapos kasi nag-away si Gov at si Cong or si Mayor
ginamit yung ganun hindi nan are-retrieve, that is the problem that we have now in
the health facilities enhancement. Kasi
Question from the Audience: Samin po for sigurado, excuse me, wala pong
problema sa amin.
Usec.Garin: Yeah yeah
Question fromthe Audience: kapatid ko yung governor.
Usec.Garin: We will make the necessary representations. But for the mean time.
Question from the Audience: Thank you po.
Usec.Garin: Nasaan yung powerpoint? Next slide, next slide, balik, balik, balik. Okay,
i-ano ko lang, i-clarify ko lang Cong, i-clarify ko lang Cong, ito ay DOH-retained
facilities without downloaded funds. Hindi ibig sabihin nun kailangan may guarantee
letter talaga lahat. Minsan kasi, agad-agad yung nagpupunta sa inyong pasyente
Heart Center pala siya o nag-aaral siya dun sa UP Visayas so nasa Western Visayas
Medical Center siya. Yung pag-download takes time. Kasi may mga documentary, kaya
sina-suggest namin na kung wala kayong downloaded pondo dun. Minsan naman
mayroong a little miscommunication, na nag-request na pala kayo ng downloading of
funds for that hospital kagaya nga namin, we extend our apologies, last week ko lang
nalaman yung case ni Congresswoman Lucy Torres na nagreklamo ng si Cong. Lucy,
may representative ba sa office ni Cong. Lucy dito? Please extend our apologies. Kasi
nung una, actually last week ko lang nalaman yung ganitong problema nung nag-i-
ednorse na nga na sinabi niya sa hospital ng pasyente na sinabihan, wala po kayong
pondo dito. So medyo hindi nga maganda ang dating.
It should not have been said. Now kung wala kayong pondo, hindi pa dumating, yun
pala yung request nila, yung request niya came in late parang nandudun sa second
batch. Yung natanggap ng hospital first batch pa lang. So kung ganung problema, dito
kayo para mas mabilis. Habang hinihintay natin yung downloading padala na kaagad
kayo ng ano request for medical assistance. Agad-agad ibibigay namin yung guarantee
letter. Kasi pag may guarantee letter na dala ang pasyente ninyo, parang PCSO yan, di
ba pag dala nila wala nang tanong yung ospital kasi yung guarantee letter good as
cash yan. Kumbaga parang SM gift cheque. Okay. The guarantee letter we give it to
your office. We send it to your office. Next slide.Next slide. Yung guarantee letter.
Okay for those who were asking this is the guarantee letter that we will make. Now
kung kunyare buo pa, we will just put it hospital bill. Ilalagay lang namin yung
breakdown nung kanya kung may breakdwon. Kung walang breakdown, we just place
the hospital bill and the amount. You see PHC 140 yung may number at may mark.
Okay that is Philippine Heart Center may corresponding number. That is actually a
code. That code will allow us to retrieve the data of the patient. Kaya yung mga
nakalagay sa GAA na mga, ito yung mga requirements, yung COA, yung medicines
given. That will not be your work. That will be our work. Because that control number
will allow us to retrieve all patients information from our computer and the
computers of the hospital. So yun po yung ibig namin sabihin. So dito tinanggal na rin
namin yung pumipirma na si Asec. Gibby Lagahid, Asec. Gibby is kaya nandyadyan
siya before kasi siya yung heading PAO office and hes the EA of Secretary Ona. We
also admit na hindi nga maganda tingnan na mayroong ibibigay kayo tapos yung
makikita ng pasyente na Asec. Lagahid so nawawalan ngayon ng points na totoo
naman na kayo ang nag-facilitate ng pondo. So thats why the new guarantee letter
will just be like this. No signatory. No mention of the secretary of the, no mention of
any EA or any personality, yan lang. E-mail namin, just give it. What is important is
you give the form that we have, because the hospitals know that when they look at
the control number, pasok na kaagad yun. Because that number will be, will
corresponding to the amount that we placed there. And that number when it comes
to us, compute nang compute na kami. At the end of two weeks alam na namin kung
magkano yung ipapadala sa kanila through bank to bank. Yes po? Ay sir, sorry sir.
Question from the audience:Good afternoon Usec.
Usec.Garin: Yeah, good afternoon sir.
Question from the audience:Good afternoon distinguished colleagues. My name is
Ted Garcia, I am the Congressman of the 2
nd
district of Bataan, and a former three-
term governor. I have no queston but it might help in our discussion if I explain how
we were doing it in Bataan. In Bataan, I know the history of devolution because I was
the governor there in 1992. And when I saw that the (inaudible) sabi ko this is bound
to fail because yung kaakibat na pondo, wala. And so when I had the opportunity to
(inaudible), sad to say akala ko okay na, kulang pa rin. And so what we did is about
ten years ago, we entered into a MOA with DOH, where lahat ng MOOE ng DOH will
be matched by the province on a one-to-one basis. Binibigyan din ho namin ng MOOE
pati ho yung lahat ng construction so I think it is succeeding becuase now it is
perfectly functioning. And talagang napakaimportante po ng public hospital kasi mas
mura sa public hospital and kagaya ho ngayon because of that MOA, lahat ho ng
pasyente sa Bataan General Hospital which is a tertiary hospital with a compliment of
300 bed eh nakakpaglibre na kami ng lahat ng gusto naming ilibre.
Usec.Garin: Although suggestions are noted sir and in fact we have heard about the
arrangement of your hospital. Unfortunately medyo mahirap siya i-implement
nationwide nga because of the law of devolution. But ahm, if there is a move to
renationalize your services, we will not have any objections..
Question from the audience:But as I was saying, mula nang ma-renationalize ho
akala ko wala nang problema because national government na ang in-charge eh
andaming pera ng national government, instead of local governments. Yun pala
meron pa ring problema and that problem as well when we, pinagtulungan po nam in
ng DOH atsaka ng province of Bataan on a one-to-one basis.Yung lahat ng MOOE nila
eh minatch namin ng MOOE on a one-to-one basis. Lahat ho ng infrastructure ng
construction one-to-one din and so we were able to construct three new, brand new
bulding, three, three-storey building connected to each other by a pedestrian bridge.
Then ang hospital po namin ISO registered na po. ISO recognized.
Usec.Garin: We will take note of those reccomendations po.
Question from the audience:Thank you very much po.
Question from the audience:Good afternoon, Usec, to my colleagues and to
everyone present here.
Usec.Garin: Hi Cong.
Question from the audience:This is not a question. It is an appeal because I share
the same sentiments with Congressman Espina here, and with the other
representatives. We also have a hospital run by LGU. So ahm, hindi masyadong
kumpleto ang aming supplies and medicines. Tapos minsan ang aming equipments
dahil sa dami talaga ng pasyente. Ang record namin 130 patients ang nako-confine.
Wala pa yung out patient kasi sa Pasay City, sabi nga ni Secretary Ona when he visited
our hospital its a melting plot. So ah, if I may suggest Usec. Sanay if, ahm, if
pwedeng gawin yung ginagawa yata ng DOH, please corret me if I am wrong,
ginagawa ng DOH sa inyong mga national government, national hospitals, na idina-
download na yung pondo, and then pwde ring ilagay na trust fund para hindi
magamit kung saang purpose ng local government units at ito po ay for
replenishment kasi nga po talagang ah, emergency needs ang mga kailangan ng
aming patients. So ganun nga ba ang ano, ang ginagawa na ng DOH sa inyong mga
hospitals?
Usec.Garin: Actually mam, Actually Cong, for DOH hospitals, the funds are
downloaded but they can not use it for procurement of medicines and equipments. It
is downloaded there it becomes a trust fund lalo na sa specialty hospitals because of
their status as a GOCC. Andudun yung pera, so every patient na pumupunta dun for
medical assistance parang china-charge tapos magli-liquidate sila at the end of the
month, na ito yung na-cosume ng one month. They come up with a ultilization report
submits it to COA and to us and I believe Congress and Senate will also be copied dun
sa utilization report nakalagay doon, downloaded funds ahm, patients given services
and then amount utilized, so ganun din po. Our dilemma here kasi, in the general
appropriations act, the funds were specified, andyadyan po sa budget na inapprove
ng kongreso at senado that it is purely for medical assistance. For patients seeking
consult in a government health facility.
Yung procurement of equipments at procurement of medicines, hindi siya nasama
dun. So when we had several discussions with DBM, and we asked those questions,
we were told na baka i-consider. But because there was also the health facilities
enhancement fund that is being given to LGUs, kasama na dun yung facilities anf
infra, hindi na naisama, ginawa siya na purely for medical assistance. Now ahm, what
DBM told us kasi ito na nga tapos na nadyadyan na yung libro. What they told us is
that what can be done di ba may pasyente meron naman dun yung binabayad. Its
income that they get. That income. They can now use to procure medicines or
equipments whatever they like. So yun yung sinabing proposal. Now, if we download
the funds even to LGU hospitals, granting that COA will allow us, I am sure it is still, it
will still, still it cannot be used for procurement of equipments and supplies. Pi-
pwede lang siya na parang ganun din, everytime may patient, bayad, bawas, bawas.
Question from the audience: Yes Usec, thats what I meant yun pong ahm pag
anndyan na yung patient we will not buy the equiments, supply, para lang yung
director ng hospital meron siyang free hand na makagawa ng paraan kung papaano
niya maa-answer yung needs nung aming pasyente. Kasi sa aming LGU, although may
mga gamot talaga dahil sa dami ng patients, nauubusan din agad. So pag GL ang
ibibigay po natin, hindi rin pwedeng ibili right away ng medicines na kakailanganin ng
pasyente yung GL. So baka po pipwedeng mapansin.
Usec.Garin: We will make the necessary representations and ask for the guidelines
for LGU downloading citing nga yung sa DSWD. But then allow us to reiterate nabasta
pag downloaded sa LGU, hindi na mababawi yun so yung pagda-download
siguradong walang problema. Alam natin kasi medyo liquid pa ngayon. Minsan kapag
ka end of the year, marami kasi kaming ano eh.

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Transcript prepared by office of Rep. Antonio Tinio
rep.antonio.tinio@gmail.com