The PhilHealth Benchbook requires all hospitals to have a publicized Patients’ Rights and Responsibilities.
Each hospital can come out with its own version as long as the following are included (based on PhilHealth Benchbook):
1.2b Patients’ rights include rights to: (a) good health (b) to information its confidentiality (c) privacy e.g. visual and auditory (d) participate in care decisions (e) withdraw consent without prejudice to care (f) second opinion.
1.2c Patients’ responsibilities includes: (a) to provide the hospital with truthful and complete information (b) to heed hospital regulations (c) to be an active partner in regaining and maintaining health (d) to ensure that their healthcare is paid for.
Last year, 2017, when I was trying to help a private hospital in the north formulate its Patients’ Rights and Responsibilities, I suggested a balance in the responsibilities and rights on patients’ hospital bills, meaning there must be a counterpart on the patients’ rights.
In the Philippines, all the Patients’ Rights and Responsibilities that I have seen so far include a declared responsibility for the patients and relatives to settle their hospital bills. There is no corresponding declared rights on hospital bills. Not stated but just implied, the patients and relatives have the right to examine and receive an explanation of their hospital bills. What I suggested last year is to put an open statement like this: patients’ right to be billed accurately.
January 13, 2018, I encountered a situation which convinced me all the more all hospitals should bill patients accurately.
This patient underwent a breast mass excision under local anesthesia and on outpatient basis. I told and assured her before the operation her hospital expenses could be covered by the PhilHealth benefits of P5,200.00 (no need for out-of-pocket payment). Before I left the operating room, I asked the operating room clerk how much was the hospital bill of my patient. She said P9,000 +. I was taken aback by her answer. I investigated. The laboratory department gave a charge of P7,600 for the histopathology of the 3-cm breast mass. Before the operation, I computed the histopathology charge to be only around P2,100 to P2,400 for small to medium-sized specimen (based on experience with this hospital).
I called up the laboratory department and inquired further. I was told by the laboratory department clerk the specimen “looked big.” Therefore, she gave a charge for a large specimen (P7,600). “What? The specimen was just about 3-cm.” I said. I then asked her what were the bases for classifying specimens into small, medium and large. I was expecting she would give an answer in term of numerical values such as more than 4 cm would be considered large; less than 2 cm would be considered small; etc. She could not give me such kind of an answer. When I said I would cancel my request for histopathology because the charge was unreasonable, she right away told me to wait and would ask her colleague in the laboratory department. When she came back to me, she openly admitted she made a mistake and would just make a charge of P2,700 (medium-size specimen). In answer to my query on how the size of the specimen was being classified, she said any specimen that could not fit into the 100-cc plastic container being used in the operating room would be considered large. I was not contented with the answer but I left it at that for the moment since she had offered to adjust the charge (P2,700 for medium specimen). The total bill came out to be P4,924.57, still within the benefits of PhilHealth.
If I did not question the hospital bill, the patient would have shelled out around P4,600.00. Patients usually do not know the bases of the charges. They usually pay as billed. Some will question. Majority will not.
This is the very reason for my advocacy to include in the Patients’ Rights to be billed accurately.
It is correct to declare that patients have the responsibility to settle their hospital bills but it should also be stated that the patients have the rights to be billed accurately.
Side recommendations for physicians:
Physicians should help in the checking of charges of their patients’ hospital bill.
Physicians should be patient-advocates.
I took pictures of the specimen plastic container being discussed above: