Don't blame the nurses for the "medical crisis"

Of late, some people are raising a doomsday scenario about what they call a “looming medical crisis” in the Philippines. Many hospitals in the provinces, they say, are closing because medical personnel—medical technicians, doctors, and nurses—are leaving in droves for high paying jobs abroad.

For those guys who have left I say “good for you because soon you will be sending dollars back home, thus enabling your families to pay for the kids’ tuition. You may even have your dream house one day, something that you could never imagine had you stayed within the country’s borders.” For those who are crying wolf about the supposed crisis, I say “you are barking up the wrong tree.”

The idea about a “medical crisis,” of many people going back to their Maker without seeing a doctor, is real. That crisis has long been there even before media’s stories about doctors and nurses leaving for a better life abroad became fashionable. At the root of this problem is poverty that is preventing sick people from availing of hospitals’ services. It’s also a crisis of governance, or the government’s failure to provide health care either through investments in this vital social infrastructure or a universal health insurance system. It’s definitely a crisis of career because for a long time, nurses have long been treated like slaves, logging in long working hours yet getting meager wages: P5000-6000 (US$90-110) dollars a month. That amount is only half the teachers’ or the cop’s salaries.

These problems are the ones driving the medical personnel abroad. Of course, there are pull factors as well. When the Americans, Europeans, and Japan started to realize there are not enough people to care for their aging population they knew they only have to call Manila to solve their problem. These countries put their money where their heart is by paying decent dollars to our nurses and caregivers. In the Philippines, these professionals are nothing but glamorous peons in white who are commanded to care only for those who can afford to pay the bills.

Solution? Leave the nurses, or the doctors who became nurses, alone. Let them go to where their services are appreciated a lot more. The fear that their departure will send most local hospitals falling like dominoes is hogwash. Those hospitals that collapsed did probably because of management failures or a combination of many other reasons and not because a nurse or two have resigned and left to pursue their dreams. And when the nurses indeed leave, local pay for nurses and doctors could possibly rise to a point where many would probably be enticed to stay. That’s what market forces can do. It’s possible that the cost of health care will probably rise but that’s what you get for giving the nurses their dignity.

If Filipinos can afford to enrich Globe Telecom and Smart Communications to the tune of P10-20 billions net after tax each year, surely they can afford to pay more for health care. Let’s face it: even “poor” people in urban poor communities—nay slums or squatters’ colonies—burn their money in cigarettes, liquor, and gambling (e.g. jueteng, masiao, sakla, cock fighting) all day while waiting for their spouse to bring home the bacon.

And while the nurses and doctors leave, let the government fix the health care system maybe by expanding health insurance coverage or investing in more health care facilities. Let the local government units, probably at the provincial level, set up provincial hospitals based on their own financial capability. That’s one of their mandates under the Local Government Code anyway. And let the private sector, the civil society do their shares. Policy makers may also consider deregulating the health insurance industry to allow greater competition. Why not allow foreign health insurance companies to come in and offer their services?

These measures will take time to yield results. The government has been doing some of them for years now. The government has been spending money for its “doctors to the barrio” program. These efforts are definitely wanting but they should continue.

Militant organizations in the health sector have been pressing the government to raise health expenditures. It’s a sound recommendation except that farmers are also asking for more money for the farm sector; the soldiers agitating for better, costlier weapons and gadgets to fight off rebels; and the students and teachers demanding more funds for schools. Every body else is demanding more largesse from the government while consistently trying to avoid paying the right amount of taxes.

Solving the medical crisis therefore is a struggle that will be won over several generations. It’s a struggle that could only be won in tandem with other crucial reforms, specifically fiscal reforms. This struggle, of course, will be a lot easier if the country could attain high (i.e. 6-7 percent growth in gross domestic product), consistent, and job-creating economic growth for a decade or two. That’s what China is doing and it’s achieving great strides in poverty alleviation and health care.

It’s a long shot but while we are doing these reforms, let the nurses go. Their departure will not destroy the local health care system as we know it. It might even help solve the problem. How? Rising demand for medical professionals here and abroad will raise pay scales, thus encouraging many of the best and the brightest to go into the profession. For every hundred that will go into the medical profession in response to their dreams of landing a dollar-earning job abroad, only a few would actually be able to leave due to “friction of distance” including the difficulties to get a visa, cultural considerations, and even love. In the end, the country will gain. Call it brain gain.