Hotels and Death Houses: The Social Class Divide in Hospitals

Thesis Statement: Hospitals are reflections of the social class divide because the quality of service
received depends on the ability to pay.

Imagine being transported to an enormous building. At the entrance, the reception will greet
you with its crystal chandelier and ambient lighting, reminiscent of a five-star hotel lobby. Walking
past the reception and into the brightly-lit hallway would feel like stepping into a portal. How can
that fancy reception lobby be in the same building as these bright and white-washed hallways? It was
peaceful and quiet. People clad in white would come in and out of the rooms lining the hallways. A
door slightly ajar from someone recently stepping out of the room gave you a view of the inside. There
were white walls like in the hallways, and a person with tubes around their body, lying on a white
bed, surrounded by companions sitting on plush seats. They were somewhat entertained by the flat-
screen television mounted on the wall. The door closed completely before you can see more of the
inside. Continuing to walk down the hallway, you came across a large trolley of food pushed by
someone wearing scrubs. He delivers the food to every room. You caught a glimpse of what was in
the plate when he entered a room. The food looked infinitely better than the microwave-ready food
that you have been eating for the past weeks.

You tore your attention away from the food trolley and found yourself in another place. It was
another building and was completely different from the first one you have been to. The building is
enormous too, but it felt like it is looming over you. You took a hesitant step inside. There were no
chandeliers and fancy receptions. All there was is a bleak hallway; the lack of lights set it apart from
the building you were at earlier. A few steps in and you arrived somewhere properly illuminated by
light. Inside the massive room were two rows of white beds with rusty frames. Every bed was
occupied, and their companions were cramped in the small gaps between beds, sitting on plastic
chairs and fanning the patients with cardboard fans. You saw a mother manually pumping air into
her child’s mouth while she slept. You wondered how long she has been doing that. There was a flurry
of movement and you saw people clad in white crowd around a bed. There was an air of panic in the
room and everyone was silent. The atmosphere was suffocating, and you willed your legs outside the
building. Outside, you saw both buildings side by side. You looked up. Big bold letters spelled out
‘hospital’ on both buildings. How can two vastly different buildings be both hospitals?

Scarborough and Fralick (2019) defines hospitals as “institutions built, staffed, and equipped
for the diagnosis of disease; for the treatment, both medical and surgical, of the sick and the injured;
and for their housing during this process.” It came from the Middle English ospitale, meaning a
charitable institution that provides residence for the poor, pilgrims, and travelers (hospital, n.d.).
There are two general kinds of hospitals: the public and private hospitals. Private hospitals are
owned and ran by, as evident from the name, a wealthy private individual or a group of individuals.
These hospitals are high-class, with advanced facilities, machineries, and rooms that can pass as hotel
rooms. On the other hand, public hospitals are owned and funded by the state. Public hospitals are
lacking compared to private hospitals. The facilities are less advanced than their private
counterparts. The influx of patients is almost always more than what the hospital can accommodate,
resulting to the crowded wards and to patients staying in the hallways (Lucas, 2017). As of 2018,
there are 1,071 licensed private hospitals and 721 public hospitals (Department of Health, 2018 as
cited in The Manila Times, 2018).

Private hospitals, as profit-based institutions, earn millions of pesos annually. In a report by

Lavado et al. (2011), the total revenues of private hospitals in 2006 was 46 billion pesos, with an
average of 74 million pesos per hospital. This profit enables these private hospitals to continue
improving their facilities, such as machineries and additional buildings. In a report by the World
Health Organization (WHO) (2011), the private sector employs 70% of all the health care
professionals in the country. This accounts for the quality of the services in private hospitals, as
majority of health care professionals are in private hospitals. Meanwhile, public hospitals are non-
profit based and are solely dependent on government budget. The management of public hospitals
are divided between the Department of Health and local government units. The Department of Health
is responsible for about only 70 national hospitals, while local government units are responsible for
provincial, district, and municipal hospitals (World Health Organization, 2011). This means that the
budget of the Department of Health is only for the 70 national hospitals while the provincial, district,
and municipal hospitals have to compete in the budget allocation of the local government units. In
2019, 132 billion pesos is allocated for 82 provinces, averaging to 1.6 billion pesos for every province,
and multiple sectors, including the health sector, share that budget (Department of Budget and
Finance, 2018). On the other hand, the Department of Health was allotted 16.796 billion pesos for
Health Facilities Enhancement Program (HFEP), averaging to 239 million pesos per national hospital
(Philippine Information Agency, 2019). The discrepancies in the budget result to the difference
between the quality of services between national hospitals and provincial, district, and municipal
hospitals. National hospitals tend to have better facilities than provincial, district, and municipal
hospitals, however private hospitals still tend to be more favored because of their perceived better
quality overall (World Health Organization, 2011).
 Because of the differences in the quality of services rendered, prices between private and
public hospitals are significantly different. In a report by Lavado et al. (2011), expenses of people
confined in private hospitals are twice than of people confined in public hospitals. Only 30% of the
population avails the services of private hospitals, specifically the individuals belonging to the higher
social class who can afford these services (World Health Organization, 2011). On the other hand,
since public hospitals are state-funded, where the services are free or partially covered by the
government, it caters to the lower social classes. While free services may seem like a good thing at
surface level, the quality of services in public hospitals are less adequate compared to their paid
counterparts (World Health Organization, 2011). From this, it can be seen that hospitals are
reflections of the division of the social classes.

How do hospitals reflect the social class divide? Healthcare and treatment for sickness and
injuries do not differ even if the patient is rich or poor. Health care is equal and standard, as stated in
the 25th article of the Declaration of Human Rights:

“Everyone has the right to a standard of living adequate for the health and well-being of
himself and of his family, including food, clothing, housing and medical care and necessary social
services, and the right to security in the event of unemployment, sickness, disability, widowhood, old
age or other lack of livelihood in circumstances beyond his control.” (p.52)

However, the existence of private and public hospitals contradicts this article by displaying
inequality and consequently, encourages the division between the social classes. This division is
evident even in the environment and conditions in public and private hospitals. Wards in hospitals,
that are cramped and inadequate, are much like the houses of the poor in slums. Wards symbolizes
the masses. Private rooms, much like the exclusive subdivisions or the high-rise condominiums that
are accessible only through a large sum of money, represents the rich.

People from the lower social classes believe that hospitals are institutions that drain their
bank accounts or life savings. Every second spent in a hospital corresponds to an additional amount
in the hospital bill. Every drop of IV, every word spoken by the doctor, every time the nurse checks
on the vital statistics, and every square meter of the room has a corresponding price. Because of this,
even if hospitals are supposed to treat the injuries and sickness of the people, only the rich are able
to avail of these services. The poor, on the other hand, refuse to go to the hospital, even in the matter
of life and death, because death is free, and hospitals are not. The poor tend to fear treatment, instead
of seeking it, because treatment is equivalent to some amount that they most likely do not have.
 There are ways to access health services from private institutions through reimbursement
using Philhealth. However, in a survey conducted by Philhealth, 29% of members are not well-
informed about the full extent of their benefits. Members of the lower social class are often victims of
inadequate information as they do not have access to media. In addition, the cost requirements for
transactions to reimburse money is often too large that it cannot cover smaller transactions. The
coverage also varies per member, which is disadvantageous for some members (World Health
Organization, 2011). Despite the Philhealth assistance, additional expenses are still high. To
compensate for this, patients tend to loan money to pay for their confinement (Lavado, et al., 2011).
In this scenario, the oppression of the lower social classes is evident, as they are stuck in the cycle of
loaning and working to pay for loans, which is nearly impossible to get out of.

In the 17th to the 19th century, hospitals were considered as death houses because
conditions are unsanitary and outcomes of procedures are usually unsuccessful (Cockerham, 2014).
As technology progressed, these conditions improved, and hospitals became what they are today.
However, what happened in the 17th to the 19th century seems to be repeating today. Public
hospitals have become death houses. Services remain inadequate in public hospitals. The rate of
improvement in the morbidity and mortality of children is slowing, and maternal mortality remains
high (World Health Organization, 2011). The inability to pay for treatment leaves the poor no choice
but to leave everything to the hands of death. In the end, only the rich, who are capable of paying, are
able to receive and benefit from treatment.

From the data provided above, it is evident that the poor and the rich cannot receive the same
services. Health care is a universal right. Treatment, in theory, should be the same injury or illness.
However, the existence of public and private hospitals displays inequality between the services
received by the rich and the poor. It seems that only the rich have the right to health care. If that is
the case, health care is not standard, contradicting the Universal Declaration of Human Rights. Since
inequality is present, it is debatable whether this right can actually be considered universal.
Treatment for the rich and the poor differs vastly that it can be proposed to change the definition of
a hospital in the dictionaries.

References
Cockerham, W. (2014). Medical sociology. John Wiley & Sons, Ltd.
Department of Budget and Finance. (2018). Local Budget Memorandum No. 77-B. Manila.

hospital. (n.d.). Merriam-Webster's Dictionary. Retrieved from https://www.merriam-

webster.com/dictionary/hospital

Lavado, R. F., & et al. (2011). Profile of Private Hospitals. Makati: Philippine Institute for Development
Studies.

Lucas, D. L. (2017, September 4). With cash to spend, gaunt PGH no longer in death throes. Inquirer.

Scarborough, H., & Fralick, P. C. (2019, February 22). Hospital. Retrieved from Encyclopædia
Britannica: https://www.britannica.com/science/hospital

The Manila Times. (2018, April 26). At a glance: The Philippine health care system. Retrieved from The
Manila Times: https://www.manilatimes.net/at-a-glance-the-philippine-health-care-
system/395117/

United Nations. (2015). Universal Declaration of Human Rights. Brussels: Office of the United Nations
High Commissioner for Human Rights .

World Health Organization. (2011). The Philippines Health System Review. Geneva: WHO Press.