This is a continuing story on the disparities in the services received by PLHIVs in different hubs in the Philippines, even if they are required to pay the same amount by PhilHealth.
Living with HIV for eight years now, Paolo’s* CD4 count was going down. And so his attending physician told him to have his viral load counted. This test, Paolo said, “costs P6,000!”
For Paolo, the costs of the viral load testing is not the problem per se; instead, it is the inconsistency of the services offered by the treatment hubs. At least in his treatment hub (i.e. San Lazaro Hospital), part of the treatment, care and support (TCS) that he receives is getting his ARV supplies every three months, and paying two other visits for his CD4 test to ascertain if his ARVs are working for him. The viral load counting is not included in the services offered, thus the need for him to cough up approximately P6,000.
There are other treatment hubs in the Philippines that provide other TCS services to PLHIVs enrolled in their systems. For instance, RITM-ARG in Alabang requires PLHIVs enrolled in its system to get their viral load counted, as well as CBC, Creatinine, TB skin test or PPD, and X-ray at least once a year, during their “anniversary” (that is, when they were enrolled into the system). These tests are provided for free as part of PhilHealth’s Outpatient HIV/AIDS Treatment (OHAT) Package.
Paolo, like most PLHIVs who are taking ARV medications, is also a PhilHealth member. And his treatment hub requires him to completely pay, and then submit to them the necessary PhilHealth documents before they could serve him.
“Even if I’m an old PhilHealth member and I’m able to avail free CD4 count tests and my ARV medications, I was still asked to pay that amount [for the viral load test],” Paolo said.
In an interview with Outrage Magazine, newly appointed PhilHealth director Risa Hontiveros said that particularly for a government hospital, not providing the complete tests could constitute a violation.
Under PhilHealth’s Circular No. 19, s-2010 or the Outpatient HIV/AIDS Treatment Package, “covered items under the benefits are drugs and medicines, laboratory examinations, and professional fees of providers.” The circular adds that “all treatment hubs in accredited facilities are required to follow the guidelines set by the DOH.”
Meanwhile, under the revised OHAT Package, Circular No. 11-2015 released last June, PhilHealth once again stressed that “there shall be no separate accreditation for HIV/AIDS Treatment Hubs as OHAT Package providers, as long as they are PhilHealth accredited health care institutions.”
Similar to the first circular, the newer circular emphasized that “covered items under this benefit are drugs and medicines, laboratory examinations based on the specific treatment guideline, including CD4 level determination test, viral load (if warranted) and test for monitoring ARV drugs toxicity and professional fees of providers.”
The revised guidelines also stated that the OHAT package can already be accessed in all 22 DOH-designated HIV/AIDS treatment hubs in the country.
Some PLHIVs enrolled in San Lazaro Hospital, and who were interviewed for this article claimed that they already asked about the “missing” services that other hubs are offering. They were, however, only told to discuss the issue with the PhilHealth coordinator/s assigned at the treatment hub. Some followed the advise; but the services continue not to be offered.
The disparities in the services received by PLHIVs do not only happen in treatment hubs in Metro Manila.
In Davao City, a PLHIV – who also works with the Mindanao AIDS Advocates Association Inc. – similarly said that viral load count is not offered to PLHIVs, even if they, too, pay the same PhilHealth amount. To his knowledge, only those who enrolled after April 2014 get free viral load count; though only once, upon enrollment.
He admitted that there is a feeling of “lugi (not getting what you paid for)” for not being given the viral load count, particularly since they know it can be offered since “gi-offer na man sa Manila (it is already being offered in Manila).” But as far as they know, “walang (there is no) VL machine in Davao, so it can’t be offered here because of this”.
Meanwhile, in Cagayan de Oro City, a PLHIV, who is a volunteer at the Northern Mindanao Advocates Society (NorMA), said that viral load count is also not given to those enrolled in the treatment hub there. Again, they are required to pay the same PhilHealth amount, since “pareha ra man ginabayran sa PLHIVs (all PLHIVs pay the same rate),” he said.
The NorMA volunteer added that there was even a time when “nahudtan ug reagent (the hub run out of CD4 reagent), so even the CD4 count was delayed.” Nonetheless, at least as far as CD4 count is concerned, “naayo na gamay karon (it has bettered now)”, but as far as viral load count is concerned, “nganga (we wait for nothing).”
Because of the inconsistencies in the services offered by treatment hubs, there are PLHIVs who “shop around” – that is, they look for hubs with “the most number of services offered,” he said. “Pero maayo ra kung tanan ka-afford mubalhin ug (But it’s not as if everyone can afford to move to another) hub. For those who can’t, suffer jud (you really suffer).”
For Hontiveros, situations like this “cannot be tolerated, it has to be corrected. The point of generating demand through an institution like PhilHealth creates the obligation to make the supply side available and accessible to the members or patients. So we have to correct that.”
RAISE THE ISSUE
Outrage Magazine coordinated with the office of Dr. Rosario Jessica Tactacan-Abrenica, HACT head of the HIV/AIDS Pavilion of San Lazaro Hospital, to get the facility’s position on the issue; but was forwarded to the office of Dr. Winston Go, Medical Center Chief II of San Lazaro Hospital. No response has been received from the latter’s office as of press time (The response/s of Dr. Go will be included in a follow-up article on this issue, along with the positions of other people also involved in HIV-related work in the Philippines – Ed).
But in San Lazaro Hospital, one PhilHealth coordinator who asked not to be named stated that “sa RITM lang libre ‘yun. Dito kasi, matagal na namin naayos ‘yung mga PhilHealth papers ng mga pasyente at na-submit na namin sa admin ng San Lazaro. Siguro natagalan lang (the viral load count is only free in RITM. Here, we’ve long prepared the documents of the PLHIVs and submitted these to the administrators of San Lazaro Hospital. Perhaps the inclusion of viral load count is just taking longer).”
For PLHIVs dissatisfied with the services rendered by their treatment hubs; or even if they have concerns, Hontiveros said that “members can write us (about the situation). They can also send proof of having been made to pay for a benefit package that is supposedly covered by the policy.”
This way, PhilHealth can “get back to the hospital and we will penalize them. Sisingilin namin sa kanila ng doble ‘yung ginastos ng pasyente (We will make them pay double what the patients paid). We really go after hospitals, including or especially government hospitals that don’t extend the mandated services of the PhilHealth institution,” Hontiveros said.
For Paolo, this is a welcome development. He just hopes “it doesn’t take forever”.
PhilHealth may be reached at (+63 2) 441 7444 or (+63 2) 441 7442, or email firstname.lastname@example.org.
Outrage Magazine is one with the PLHIV community in demanding for a uniform implementation of TCS services, particularly as mandated by PhilHealth.
*NAME CHANGED TO PROTECT THE PRIVACY OF THE INTERVIEWEE