Localizing health care programs

BANTAY GOBYERNO

Ike Señeres

A former Congressman told me about the tendency of some local politicians not to build local public hospitals, because they would rather have the indigents who are their voters to come to them for help, so that they could refer them to some national agencies for financial assistance. When I heard that, I remember stories about colonisers who did not want to educate their subjects, out of fear that if they become educated, they would rise up against their rule. It reminded me also about stories that some local politicians would not want to relocate the informal settlers who live within their jurisdiction, because they might lose their votes.

Just like the subjects of colonizers who remain uneducated, the indigents who are constituents of these evil politicians remain untreated. I say that these corrupt politicians are evil, because they do not care if their constituents would live or die, as long as they are able to win and election and steal the money of the people.

Although I believe in the wisdom of that former Congressman, it appears that some local politicians have succeeded in building their local public hospitals, never mind if their motive is to gain the support of the indigents who patronize these hospitals. In other words, these local politicians would get the votes anyway, whether they would build hospitals or not. Going deeper into the problem however, it appears that some local politicians are able to build the structures needed to function as hospitals, perhaps making money in the kickbacks earned as a result of the construction, but never ever supplying these hospitals with the equipment needed, and never ever providing these with medicines and other medical supplies either. That is the reason why indigents who have the misfortune of being admitted to these hospitals have to buy their own medicines, assuming that they have the money for that also.

Although it might have sounded like a good idea to devolve the administration of the public hospitals from the national government to the local government, the bright boys who planned the devolution apparently did not realize that some of the local politicians had other ideas about how to spend their local funds, and healthcare does not seem to be one of their top priorities. I do not really understand how local graft and corruption works, but it seems to me that some local politicians have become experts in balancing acts, in this case balancing the need to steal as much money from the local coffers as much as possible, and doing enough, perhaps just enough to win enough votes for the next coming elections. Sad to say, local politics have become a business enterprise in some local jurisdictions without even a bit of corporate social responsibility to go with it.

Given the fact that locally elected public officials may not necessarily be good managers, it may be a good idea to convert public hospitals into locally owned and controlled corporations so that these could be run by professional managers. On that note, it would also be timely to say that good doctors may not necessarily be good managers also, and doctors who do not have solid management backgrounds should not even be chosen for selection either.

Perhaps this insight could also be applicable to our public schools, wherein even the best of the teachers may not necessarily be good managers either. As I understand it, many hospitals abroad are privately managed even if they are publicly owned. As privately managed corporations, they are evaluated and rated in the same way as private hospitals, and they are very competitive because of that.

It seems to me that the fate of poorly run public hospitals are comparable to the fate of poorly run cooperatives, two separate businesses that are both failing because their managers are not really professional and are generally hired because of political reasons and not because of technical capabilities. In the case of cooperatives however, members only suffer from the loss of money, and nobody dies.

It’s another matter in the case of hospitals, because there is a life and death proposition in many of their functions. There is hardly any data available anywhere, but given the right surveys, the data could come out that many people die in public hospitals because of the lack or doctors, equipment and supplies. And unlike in other countries, nobody ever gets sued, and more often than not, the guilty ones would always _{get away with it.}

As it is now, there is already a system for grading the performance of hospitals, but more often than not, the local government executives are not taken to task for the failures of the hospital managers to pass the standards. Perhaps due to the lack of awareness, the constituents of these executives are not aware that their local executives are directly responsible for the hospital managers who are under them, and should even be liable as well in case of lawsuits.

It is a big wonder that despite the poor quality of services in local public hospitals, inept politicians are always elected one term after another, as if their performance has nothing to do with the life and death of their constituents.

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