HULSE OF REPRE!

Republic of the Philippines nS
HOUSE OF REPRESENTATIVES RECEIVED
Quezon City
Dare: _03 AUG 2015
. “09
SEVENTEENTH CONGRES: we
First Regular Session e ae
2 REGISTRATION UNIT
HOUSE BILL No. 2445 BILLS AND INDEX SERVICE

Introduced by Reps. CARLOS ISAGANI T. ZARATE, ANTONIO L. TINIO,
EMMI A. DE JESUS, FRANCE L. CASTRO, ARLENE D. BROSAS,
ARIEL B. CASILAO, and SARAH JANE I. ELAGO

AN ACT
PROHIBITING THE PRIVATIZATION AND CORPORATIZATION OF PUBLIC
HOSPITALS, PUBLIC HEALTH FACILITIES AND PUBLIC HEALTH SERVICES

EXPLANATORY NOTE

This Bill seeks to protect the right to health of the Filipino people, the poor especially, by
maintaining and upholding the public character of government hospitals, and, by prohibiting any
form of privatization of public hospitals, public health facilities and public health services.

“Article II, Section 15 of the 1987 Constitution mandates that “the State shall protect and promote
the right to health of the people and instill health consciousness among them.” Further, Article
XIII Section 11 also mandates that the “State shall adopt an integral and comprehensive approach
to health development and shall endeavor to make essential goods, health and other social services
available to all the people at affordable cost.”

‘The Right to Health is also enshrined in the World Health Organization constitution and in various
United Nations’ instrumentalities.

Yet, according to Asian Development Bank Country Partnership Strategy: Philippines 2011-2016,
six (6) out of ten (10) Filipinos die without medical attention, and nearly half of health care costs
are paid out of pocket.

According to the Department of Health (DOH) in 2010, the poorest of the population are the
main users of government health facilities. But public hospitals and health facilities have
suffered neglect due to the inadequacy of health budgets in terms of support for upgrading
to expand capacity and improve quality of services.

‘To address this, the DOH implemented so-called health reforms, which include, among others,
the provision of fiscal autonomy to government hospitals by allowing collection of socialized user
fees for services and converting these hospitals into government corporations. Upgrading of
hospitals and health facilities were targeted through different mechanisms including the very
disadvantageous public-private partnership (PPP) and income retention. These were consistently

1


espoused in Health Sector Reform Agenda (1999), Formula One for Health (2005), and Aquino
Health Agenda (2010).

Officials of the Department of Health claimed that such reforms do not constitute privatization.
But the World Health Organization defines privatization in healthcare as “a process in which non-
governmental actors become increasingly involved in the financing and /or provision of healthcare
services.”*' Based on this definition, privatization include the following: divestiture or outright
sale of public sector assets in which the state divests itself of public assets to private owners;
franchising or contracting out to private, for profit, or, not-for-profit providers; self-management,
wherein providers are given autonomy to generate and spend resources; market liberalisation or
deregulation to actively promote growth of the private health sector through various incentive
mechanisms, and; withdrawal from state provision, wherein the private sector grows rapidly as a
result of the failure on the part of the government to meet the healthcare demands of the people”.

Instead of alleviating the burden of poor patients, the health reforms implemented by the DOH
even contributed to further inaccessibility of health services, as previously free services and
supplies in public hospitals and facilities were subjected to “user fees”. Most poor patients who
are not qualified under the National Household Targeting System as sponsored PhilHealth
members could not even afford the present standard fees in government hospitals. However, the
increasing cost of health services and non-availability of supplies, procedures and equipment in
public hospitals greatly increase the out-of pocket payments of the people -- even those patients
covered by PhilFfealth -- resulting to their further impoverishment.

For example, when radiology services in Jose R. Reyes Memorial Medical Center were subjected
to public-private-partnership with Himex Corp, previously free x-ray procedure was charged P150-
300. In San Lazaro Hospital where many dengue patients go for treatment, patients have to pay
P150 for every blood test and P1,200 per blood pack (2011) because these are not given free. Even
barangay health stations and district hospitals charge patients or ask for “fixed” donations for
vaccinations, and supplies like cotton, gauze, and syringes. These fees are already difficult to bear
for families who carn a minimum daily wage of P456 (in NCR), but more so for those who have
no regular source of income, and, yet are not considered “poorest of the poor” by the National
Household Targeting System and, thus, are not covered by PhilHealth sponsored programs.

Meanwhile, corporatized hospitals, or government-owned and controlled corporation (GOCC)
hospitals, get the funds for maintenance and other operating expenses, capital outlay and personal
services from their income. Service patients in these GOCC hospitals are required to pay for
everything except for doctors’ fees. As a result, in 2011 for example, thousands of patients in the
Philippine Heart Center were waitlisted for operations until they were able to raise the cost of
patients’ share ranging from tens of thousands to hundreds of thousand pesos. Also, in the same
year, it was reported that patients who were not able to pay their bills at the Philippine Children’s
‘Medical Center were made to surrender their valuables as collateral -- “pawnshop style” — before
they were allowed to go home.

In fact, Hospital directors of GOCC hospitals have, for several years during budget deliberations,
been practically pleading for increased government allotment to better serve the patients especially
the indigents. Despite these reports, the persistent attempts to privatize public hospitals
nationwide have always been the government's primary response.

1 (J Muschell, Technical Briefing Note on Privatization in Health, 1995, WHO/TFHE/TBN/95.1, as cited by
Peedell,http://www.healthprofessionals4nhs.co.uk/wp-content/uploads/2012/01/Peedell-privatisation-is-
inevitable-bmj.d2996.full_.pdf)

2 BS Savas, “A taxonomy of privatization strategies,” Policy Studies Journal, 1989, as cited by Peedell


On the other hand, health workers, patients, and health advocates opposing the privatization of
the National Center for Mental Health, Fabella Hospital, and other hospitals also raise concerns
on the displacement of indigent patients comprising the large majority of those who avail of the
services given by these public hospitals, .

Undoubtedly, when public hospitals are opened to private investors, in whatever degree or form,
the orientation of health care shifts from service to income and profit. When public hospitals are
privatized, the general public, thus, suffers.

Public hospitals and public health facilities were built to serve the public. People’s taxes should be
returned to the people in terms of adequate and free social services including health services
especially for poor patients, Adequate and sustainable budget should be allotted to public hospitals
and public health facilities -- ro fully cover the expenses for maintenance and other operating
expenses, personal services and capital outlay -- so that they can fulfil their mandate of serving
the public especially the poor.

Health care must be made accessible, affordable, and appropriate to the needs of the people.
Public hospitals, as part of the public health care delivery system, must be fully developed and
strengthened by the government, not privatized.

‘This Bill s a major step to address the inaccessibility and inequity in health care made worse by
Privatization of public health services. As legislators, we are duty-bound to uphold the health and
well-being of the people. In order to have a comprehensive and integrated health care delivery
system as mandated by the Constitution of the Republic of the Philippines, the urgent approval
of this bill is earnestly recommended.

7
Abpraved, ‘
Bayan Muna Party-list
Rep. ANTONIO L. TINIO Rep. and cast.ao
Act Teachers Partylist Anz awis Partylist

Rep. E I. ELAGO

‘Kabataan Partylist

Rep. EMMI A. DE JESUS hte . BROSAS
Gabriela Women’s Party Gabriela Women’s Party


Republic of the Philippines
HOUSE OF REPRESENTATIVES

Quezon City

SEVENTEENTH CONGRESS
Fi

HOUSE BILL No._2475

Introduced by Reps. CARLOS ISAGANI T. ZARATE, ANTONIO L. TINIO,
EMMI A. DE JESUS, FRANCE L. CASTRO, ARLENE D. BROSAS,
ARIEL B. CASILAO, and SARAH JANE I. ELAGO.

AN ACT
PROHIBITING THE PRIVATIZATION AND CORPORATIZATION OF PUBLIC
HOSPITALS, PUBLIC HEALTH FACILITIES AND PUBLIC HEALTH SERVICES

Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:

SECTION 1. Title. This act shall be known as the “Anti-Privatization of Public Hospitals,
Health Facilities and Health Services Act of 2016.”

SECTION 2. Declaration of Policy. \tis the declared policy of the State that it shall protect
and promote the right to health of the people and instill health consciousness among them.
Further, the State shall endeavor to make essential goods, health and other services available to
all the people at affordable cost.

SECTION 3. Definition of terms. Vor purposes of this act, the following, terms shall mean:

a. Public hospitals ~ all Department of Health (DOH) -retained and national hospitals,
and provincial and regional hospitals under the local government.

b. Public health facilities — Health centers, lying-in, and barangay health stations under
the national ot local government.

©. Public health services — all diagnostic, laboratory, medical, surgical, and health-related
services provided by public hospitals and public health facilities to indigent, service or
poor patients.

d. Indigent/service/poor patients ~ those who have no source of income, or whose
family income are below the mandated minimum daily wage and/or below the minimum
monthly cost of living as set by appropriate government agencies.

SECTION 4, “Privatization” so defined. \s used in this Act, the term “privatization” shall
mean the process in which non-government actors become incrcasingly involved in the financing
and/or provision of health care services. ‘This includes, but not limited to, the following:

a. outright sale;
b. public-private partnership;


corporatization;
contracting out of equipment and services;
joint venture;

franchising;

management control and/or corporatization;
leasing; and

user-charges.

SECTION 5. Prohibition of Privatization of Public Hospitals, Public Health Facilities,
and Public Health Services — No public hospital, public health facility, and public health
services shall be privatized. Likewise, under no circumstances shall any person, whether natural
or juridical, initiate, cause, and approve the privatization of any public hospital, public health
facility ot public health services.

rire mean

SECTION 6. Bed allotment for indigent/service/poor patients in public hospitals. At
least 90% of the total bed capacity of all public hospitals shall be allotted for
indigent/service/poor patients.

SECTION 7. Liability and Accountability Any person, whether natural ot jutidical, who
initiate, cause ot approve the privatization of any public hospital, public health facility or public
health services is liable under this Act.

SECTION 8. Penalties Any person who violates any provisions of this Act shall be penalized
accordingly:
a. MFirst Offense”— A fine of not less than one hundred thousand pesos (P 100,000.00)
but not more than two hundred thousand pesos (P200,000) and suspension of one
year to two years from public office;

b. “Second Offense”. A fine of not less than two hundred thousand pesos (200,000)
but not more than five hundred thousand pesos (P500,000) and temporary
disqualification fom holding any public office of not less than three years but not
more than six years; and

c. “Third Offense”- A fine of not less than five hundred thousand Pesos (P500,000)but
not more than eight hundred thousand pesos (P800,000) and temoval from public
office and perpetual disqualification from holding any public position ot office,

SECTION 8. Separability Clause If any provisions of this Act is declared invalid or
unconstitutional, other provisions hereof which are not affected thereby shall continue to be in
full force and effect.

SECTION 10. Repealing Clause — All provisions of laws, orders, decrees, including rules and
regulations inconsistent herewith are hereby repealed or modified accordingly.

SECTION 1, Effectivity Clause- This Act shall ake effect (15) days following its publication
in the Official Gazette or at least two (2) national newspaper of national circulaticn,

Approve,