His must be one of the hardest jobs around. How do you provide help for seriously ill patients with seemingly unlimited medical needs from government’s limited funds?
It’s a question that Dr. Larry Cedro, charity sector assistance manager of the PCSO, has to grapple with daily.
“We do provide assistance to almost all … but we always tell the public that the role of the PCSO is to augment (their funds). So we check the condition of the patient, especially if the patient is the breadwinner. The question is how to provide an equitable distribution of funds,” Cedro said. It’s almost like deciding who lives and dies.
To help resolve that, the PCSO’s Individual Medical Assistance Program (Imap) uses the patient classification system being adopted by all hospitals and prescribed by the Department of Health.
“There’s an appropriate amount to be given,” said Cedro, adding that they take into account whether the patient is confined in a public or private hospital.
Classification
“For instance, if you are admitted in the charity ward of a government hospital and you are classified as F, then you are entitled to receive 100 percent (of your medical expense). If you’re admitted to the pay section of a government hospital, you are entitled to receive 90 percent. In a private charity ward, you can receive a maximum of 70 percent, and in a private hospital, your (subsidy is not) going to exceed 60 percent,” Cedro said.
When it comes to dialysis, the PCSO has developed its own package to complement PhilHealth’s 90-day dialysis package.
For the 90 treatments covered by PhilHealth, the PCSO covers 14. The PCSO also provides 14 syringes of Erythropoietin since PhilHealth is limited to procedures, Cedro said.
For chemotherapy, there is an enrollment system where the PCSO can cover 50 percent of the total treatment cycle.
“If there are six cycles of chemo, we cover three. But there are other assistance programs like Roche’s Access program that covers 50 percent of the remaining treatment. So, if a patient needs 18 cycles, Roche will cover half, the PCSO will shoulder five and the patient will shoulder the remaining four treatments,” the PCSO official said.
Data culled from the PCSO shows that there are 50 provinces in the country with operational Imap. Of these, Sorsogon, Zamboanga del Sur, Misamis Occidental and Zamboanga del Norte have increased their Imap allocation for those needing medical assistance.
Requirements
To avail themselves of PCSO help, patients must present the following requirements: valid IDs, the accomplished IMAP application form, the original copy of the statement of account, endorsement from medical social services, relevant laboratory results, progress notes from a physician, medical abstract and a histopath, or biopsy results for chemotherapy patients.
Patients are expected to submit the complete requirements during the first application and interview.
A patient can reapply for another subsidy after 30 days. This, for “Jerry,” would have an impact, since a cancer patient needs treatment every 21 days.
Other sources of assistance
“If you rely solely on the PCSO, you will die,” he said. Patients should seek out other sources of assistance to make sure they don’t miss their scheduled medication, he added.
According to the PCSO general manager Alexander Balutan, the agency has spent a total of P3.93 billion for hospital confinement for 145,531 beneficiaries out of 319,091 applicants in 2016.
Financial help for hospitalization remains the leading type of assistance sought by patients over the years, he added.
Assistance for chemotherapy comes next, with the PCSO spending P1.95 billion for 46,423 patients. Dialysis is third, with the agency spending a total of P81.7 million for 5,679 patients.
In line with President Duterte’s “free medicine” program, the charity agency is currently enhancing delivery of health services especially in cases that need immediate medical attention, Balutan said.
The current administration has been relying on Small Town Lottery, which is expected to generate around P27 billion to P30 billion this year, to increase the PCSO funds.
In 2016, the agency spent a total of P7.99 billion for medical assistance—an increase of 14.3 percent from 2015—which benefited more than 300,000 Filipinos, the PCSO said in a statement. —JODEE A. AGONCILLO