This document outlines an indigent patient help program presented by Dr. Reynaldo Joson at an annual conference. It discusses the challenges hospitals and private practitioners face with indigent patients who cannot afford medical care. It describes Dr. Joson's approach in his private clinic of providing value-based care and assistance to indigent patients. It also summarizes the indigent patient help program he established at Ospital ng Maynila Medical Center's Department of Surgery, which relies on donation-funded supplies and funds to ensure indigent patients receive needed treatment without delay or deprivation due to inability to pay. The presentation concludes by inviting representatives from Manila Doctors Hospital and Manila Med to discuss their indigent patient help programs.

1. Indigent Patient Help Program –
Mine, Ours, Yours
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Annual Conference of Tripartite Training Institution in Manila
March 27, 2015

2. Indigent Patient Help Program –
Mine, Ours, Yours
In all hospitals in the Philippines,
both government and private,
there will always be indigent patient incidents.

3. Indigent Patient Help Program –
Mine, Ours, Yours
Likewise,
in the practice of our medical / surgical profession,
we will encounter indigent patient incidents.

4. Indigent Patient Help Program –
Mine, Ours, Yours
What are indigent patient incidents?
These are the incidents in which the patients
don’t have or don’t have enough money
to secure the medicines, supplies, and tests needed
for their medical management
if these cannot be given for free.

5. Indigent Patient Help Program –
Mine, Ours, Yours
Setting of indigent patient incidents?
• hospital’s emergency department
• inpatient services department
• outpatient department
• private medical clinic of an affiliated physician
• more common in government hospitals

6. Indigent Patient Help Program –
Mine, Ours, Yours
The “indigent patient incidents” are
primarily a result of the
presence of indigent patients
in the community
(Philippines, provinces, cities, municipalities, etc.)

7. Indigent Patient Help Program –
Mine, Ours, Yours
Indigent patients are present in the community
• because of the inherent presence of citizens
• who are jobless
• not working to earn
• struck by unfortunate events in life that drain
their financial resources and reserve, etc.

8. Indigent Patient Help Program –
Mine, Ours, Yours
In short,
there will always be a segment of the citizenry in any
community in the Philippines which consist of
indigent patients.

9. Indigent Patient Help Program –
Mine, Ours, Yours
The “indigent patient incidents” are
secondarily a result of
increasing costs of healthcare
compounded by absence of hospitals
which can continuously give out
totally free medical services.

10. Indigent Patient Help Program –
Mine, Ours, Yours
The “indigent patient incidents” are
tertiarily a result of a
national health insurance system (specifically,
PhilHealth)
which cannot cover all
the medical expenses of every citizen
whenever the latter get sick.

11. Indigent Patient Help Program –
Mine, Ours, Yours
There won’t be indigent patient incidents in the
community
if all individuals and families are
economically productive and
have a system to adequately meet
the demands of current and future medical
expenses.
This scenario, however, is extremely difficult, if not
possible, to achieve.

12. Indigent Patient Help Program –
Mine, Ours, Yours
Controlling the costs of healthcare
and
strengthening the national health insurance system
can only mitigate and reduce the
number of indigent patient incidents.

13. Indigent Patient Help Program –
Mine, Ours, Yours
There will always be indigent patient incidents
in our midst,
in our hospitals, whether government or private,
and
in our private clinics.

14. Indigent Patient Help Program –
Mine, Ours, Yours
The presence of indigent patient incidents is
a daily challenge
to hospitals (both government and private,
but more for the government ones)
which have limited resources and budget for free
services, medicines, and supplies to give out.

15. Indigent Patient Help Program –
Mine, Ours, Yours
It is a bigger challenge for the government hospitals
because of the citizens’ expectation that these
hospitals should cater to all indigent patients in the
community using taxes paid to the government.

16. Indigent Patient Help Program –
Mine, Ours, Yours
For both government and private hospitals, the
challenge is not limited to the quantity of free
services, medicines, and supplies they can give to
indigent patients in their midst.

17. Indigent Patient Help Program –
Mine, Ours, Yours
More importantly, the challenge is on the indigency
associated quality and ethical issues.
Specifically, these are,
• there should be NO delay in treatment because of
indigency reason and
• NO patient is deprived of proper medical/surgical
treatment because of indigency reason.

18. Indigent Patient Help Program –
Mine, Ours, Yours
For private practitioners with indigent patients in
their clinics,
the challenges mentioned for the hospitals are
essentially the same though in lesser degree and
urgency.

19. Indigent Patient Help Program –
Mine, Ours, Yours
The private practitioners are not expected to have
stocks of medicines and supplies in their clinics that
can be given to indigent patients for free when the
latter consulted them.
What are usually and given free are the free
consultation services and advices when there are
indigent patients in the private clinics.

20. Indigent Patient Help Program –
Mine, Ours, Yours
The issue of delay in treatment because of indigency
reason is not that great as compared to that in a
hospital setting because usually patients seen in
private medical clinics are not in life-threatening
condition.

21. Indigent Patient Help Program –
Mine, Ours, Yours
Likewise, the issue of deprivation of proper medical /
surgical treatment because of indigency reason is
not that great compared to that in a hospital setting
because there is usually time to refer the indigent
patients to appropriate institutions with indigent
patient help programs.

22. Indigent Patient Help Program –
Mine, Ours, Yours
The phenomenon of the indigent patient incidents
is a reality and a challenge
that all of us, working in the hospitals, both
government and private,
and running a private clinic,
have to face and must know how to manage.

23. Indigent Patient Help Program –
Mine, Ours, Yours
We must admit that all these years all hospital administrators,
the entire physician workforce from all the clinical medical
departments and all private practitioners have always been
trying their very best to manage the “indigent patient
incidents” by assisting the indigent patients in securing the
needed medicines, supplies, equipments and diagnostic tests
to be done from various sources.
They should be commended for their
compassion and resourcefulness.

24. Indigent Patient Help Program –
Mine, Ours, Yours
A question I pose:
is there a structured, comprehensive, effective and
efficient indigent patient help program that we can
adopt to mitigate our coping, if not to use the word
struggling, with the indigent patient incidents in our
midst?
If there is none, let’s brainstorm and share
experiences with the goal of coming out with such a
program.

25. Indigent Patient Help Program –
Mine, Ours, Yours
I will start the ball rolling by presenting my
experiences, thoughts, perceptions, opinions, and
recommendations on an indigent patient help
program in my private clinic and for Ospital ng
Maynila Medical Center Department of Surgery.
After me, we will listen to the indigent patient help
programs from Manila Doctors Hospital and Manila
Med.

26. Indigent Patient Help Program –
Mine
In my private clinic,
every now and then,
I encounter indigent patient incidents.
I always try my very best to help to make sure these
indigent patients get the medical management they
need.

27. Indigent Patient Help Program –
Mine
Below are the measures that I had done and will
continue to do as indicated for indigent patients
consulting in my clinic.

28. Indigent Patient Help Program –
Mine
• Practice value-based health care services
which is providing services in such a way that the
cost of the health care management is kept to the
lowest minimum possible or most reasonable
expense possible
while continuing to maintain and improve quality
and safe outcomes.

29. Indigent Patient Help Program –
Mine
Value-based health care services emphasizes the
importance of
• accurate clinical diagnosis to avoid unnecessary
expenses
• no unnecessary paraclinical diagnostic
procedures
• no unnecessary treatment procedures
• no unnecessary drugs and miscellaneous
expenses
• but still maintaining quality and safe outcomes

30. Indigent Patient Help Program –
Mine
Value-based health care services emphasize
the use of management options with minimum
possible or most reasonable expenses
yet maintaining and safe outcomes.

31. Indigent Patient Help Program –
Mine
• Help them with recommendation of measures on
how to minimize the costs of medical
management
(which diagnostic centers to go to; which
hospitals to be admitted; room accommodations;
which doctors to go to in case of referrals; etc.)

32. Indigent Patient Help Program –
Mine
• Encourage them to use the benefits from
PhilHealth.
• Treat and operate on them with the least or
affordable professional fees. If indicated, give pro
bono services.

33. Indigent Patient Help Program –
Mine
• Give them medical and surgical supplies, if I
have.
• Assist them in getting into government hospitals,
if needed.
• Assist them in getting external sources of help
like Philippine Charity Sweepstakes Office
(PCSO) and other institutions.

34. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)

35. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
I started an Indigent Patient Help Program in 2001
when I became Chairman of the Department of
Surgery of Ospital ng Maynila Medical Center.

36. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
Managing patients without the needed medicines
and supplies can be very frustrating and depressing
for the physicians, especially during emergencies.
This was the main driver for creating the Indigent
Patient Help Program of the OMMC Department of
Surgery.

37. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
The other driver for the Program was the need to
provide quality and safe patient services even for
indigent patients.

38. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
The objectives of the Indigent Patient Help Program
of OMMC Surgery have been:
1) NO delay in treatment because of indigency
reason and
2) NO patient is deprived of proper surgical
treatment because of indigency reason.

39. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
The program consists basically of the
Indigent Patient Help Boxes
which contain stand-by surgical supplies and
medicines to be used for indigent patients when the
inventory of the hospital is depleted.

40. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
Each resident has an Indigent Patient Help Box
whose inventory has been maintained through
donations from external benefactors, consultants,
and alumni.

42. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
Each resident has an Indigent Patient Help Box whose
inventory has been maintained through donations from
external benefactors, consultants, and alumni.

43. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
The program also consists of a
stand-by emergency fund
to be used for emergency purchase of supplies that
are not available in the Boxes.

44. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
Another aspect of Indigent Patient Help Program is
to get external donors for needed surgical
equipments like cautery and suction machines that
cannot be supplied by the hospital.

45. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
• Providing cost-effective management, not only to
avoid premature depletion of funds for “indigent
patient incidents” of the hospital but also to
control the medical expenses of the patients.

46. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
• Giving advices on how to minimize the costs of
medical management
• (which diagnostic centers and other hospitals to
go to in case diagnostic and treatment
procedures are not available in the hospital;
which doctors to go to in case of external
referrals; etc.)

47. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
• Encouraging them to use the benefits from
PhilHealth.
• Assisting them in getting external sources of
financial help like PCSO and other institutions.

48. Indigent Patient Help Program –
Ours (OMMC Department of Surgery)
• Conducting free in-house surgical missions (such
as Operasyon Bosyo and Kanser sa Suso) using
funds from external donors.

49. Indigent Patient Help Program –
Yours (MDH; MCM)

50. Indigent Patient Help Program –
Mine, Ours, Yours
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Annual Conference of Tripartite Training Institution in Manila
March 27, 2015