Health care is a fundamental right

MAKATI’S public health system was one of my first priorities as mayor. The student activist in me rebelled against a system where only the rich could get the best health services while the poor were left to the mercies of what have been derided as Mona Lisa public hospitals, after the line in the Nat King Cole song: “They just lie there, and they die there.”

Quality health care is a fundamental right of every citizen. It is the obligation of every government to provide citizens, regardless of economic stature, access to the best health care.

Among the first programs I reviewed was the health care program started by my predecessor. At that time, the health program of Makati was already considered a model program. Indigents were provided free hospitalization at the Makati Medical Center, where one floor with 75 beds had been rented by the municipal government.

It was, in concept, a good program and I saw no reason to discontinue it. Bad programs should go. There should be no debate. But good programs should be continued, and if needed, reformed.

So we reviewed the program and saw several weaknesses. First, it defined an indigent as someone earning less than 31,000 a month. Now in 1986, 31,000 was way below the minimum wage. If applied strictly, very few would qualify under the program. Yet the entire floor was always full. And this led us to the second weakness: there was no control system. Since the program allowed elected officials, and not doctors, to recommend patients, almost all the patients were not indigents. To make matters worse, some of the patients were not even Makati residents.

The program obviously needed a major overhaul so we concentrated on two points: The adoption of more realistic conditions for admission, and measures to ensure that only residents of Makati would be admitted.

Initially, we raised the income ceiling from 31,000 to 35,000 a month, opening the program to more residents (We would raise the ceiling a few years later to 310,000). Aside from widening the base of beneficiaries, we also decided to include all municipal employees and their families. This was one way of compensating for their low pay.

We included national government employees as well – all Makati policemen, firemen, and public school teachers and their families.

The Makati Health Program (MHP) is popularly known as the Yellow Card among Makati residents, after the yellow-colored identification cards. The yellow card is a badge of citizenship, and the privilege of using the yellow card is revoked once a beneficiary moves out of Makati.

We decided at the onset that the beneficiaries should be made to pay service fees, depending on their income categories. These were token amounts, but it was my way of telling the beneficiaries that they should not always expect services to be given free all the time. Residents should learn to give in return, to share in the cost of quality health care service.

During the early years of the program, residents like Gliceria Habijan of West Rembo, who ran up a bill of 3198,463.43, paid only 31,000. Josefa Castro underwent neuro-surgery. The total cost: over 3558,000. She paid only 3200.

Today, the Yellow Card remains one of the biggest perks of being a Makatizen and proof that a government can deliver what its citizens need most.

Yellow cardholders now include senior citizens, persons with disability (PWDs), and employees of several Makati-based government agencies. They can avail themselves of the full range of services at the Ospital ng Makati (OsMak). They are also entitled to free consultations in the city’s 26 barangay health centers.

Last month, the Makati Health Development Council (MHDC) approved major policy changes in the program.

Cardholders are no longer classified into categories based on the family’s monthly income. Instead, a uniform rate of 3500 will be charged patients with bills exceeding 35,000. Treatment for patients whose bills are below 35,000 will be free of charge.

The board also decided to extend to senior citizens lifetime membership in the program, which means they need not renew their membership every three years.

The program has succeeded, in my view, in addressing the health needs of our citizens. Where others would worry about their hospital bills, residents of Makati know that they can rely on their government to help them in medical emergencies.

Take the recent case of Christine Pabunan, a 16-year-old resident of Barangay Pembo who suffered from severe pneumonia. She was treated for six months and her medical expenses totalled 3945,309.99. With her Yellow Card, she did not pay a single centavo.

Since the 1990s, the Yellow Card program has been considered a benchmark for health care programs. The city government has hosted delegations from various local governments as well as international organizations interested in duplicating the program.

In 2002, the program was selected as a recipient of the Dubai International Award for Best Practices in 2002 by the Dubai Municipality and United Nations-HABITAT (UN-HABITAT) for its “outstanding contribution towards improving the living environment.”

While we deeply appreciate the recognition, what gives us a sense of fulfillment is knowing that we have made a difference in the lives of Makati residents. The Yellow Card program shows that government can really work for its people.