Healing our health system

By Herman M. Lagon

You know something is wrong with a health system when getting admitted feels like winning a raffle. A bed becomes good news. A working machine feels like a blessing. A vacant room is almost a luxury. Families arrive at public hospitals already frightened by fever, pain, stroke, cancer, or an accident, only to discover another source of anxiety: May bakante pa? May doktor? Gumagana ang machine? Magkano ang hindi sagot? Illness is difficult enough. We should not have to survive the hospital system while trying to survive the disease.

The numbers give those familiar scenes a disturbing scale. Our public hospitals are often asked to do too much with too little space. Southern Philippines Medical Center has reportedly handled around 2,000 patients despite having 1,500 beds, while Fabella Hospital reached nearly 184 percent occupancy in 2025. Somewhere inside those percentages is a family waiting and hoping that a bed becomes available soon.

I do not expect public hospitals to be hotels. Most Filipinos do not. We are not asking for scented towels, chandeliers, or a breakfast buffet. We ask for things considerably less glamorous: enough beds, clean toilets, functioning laboratories, available medicines, reliable diagnostic equipment, reasonable waiting times, and enough health professionals to attend to patients properly. “Public” should describe who a hospital serves and how it is funded. It should never become another word for pwede na iyan.

Equipment is another painful part of the story. The material cites a COA finding involving ₱405.5 million worth of medical equipment that remained idle, undelivered, uninstalled, or unused at the end of 2024. An idle machine sounds like an accounting problem until you are the patient waiting for the test it was supposed to perform. Then it becomes another trip, another referral, another fare, another missed day of work, and perhaps another dangerous delay.

Location matters just as much. A hospital bed in Manila is of little comfort to a farmer, fisher, or pregnant mother several hours away from the nearest capable facility. In a 2019 Inquirer column included in the materials, medical student John Dexter Canda described communities in Zamboanga del Norte where residents traveled one or two hours to reach a provincial hospital; some reportedly stayed home instead because the trip would consume money needed for food. In health care, distance is sometimes more than inconvenience. During a stroke, complicated delivery, or serious accident, kilometers can become minutes a patient does not have.

This is why “build more hospitals” is necessary but incomplete. A ribbon-cutting is easy to photograph. Keeping a hospital running for the next 20 years is less photogenic. It needs doctors, nurses, medicines, working equipment, maintenance, ambulances, and reliable funding. A budget tells us what government plans to spend. What matters is whether patients eventually receive better care.

Then there are the people inside those buildings. Our nurses and other health professionals are admired around the world, which unfortunately makes them easier for the world to recruit. Earlier data cited in the materials showed how low pay, heavy patient loads, insecure employment, delayed benefits, and better opportunities abroad contributed to nurses leaving. We cannot spend years training excellent nurses, watch other countries offer them substantially better lives, and then act surprised when they board the plane. Calling health workers “heroes” is lovely. Heroes also have grocery bills.

PhilHealth, of course, remains crucial, and recent efforts to expand benefits deserve recognition. But universal membership and universal health care are not quite the same thing. A PhilHealth card cannot insert an IV, operate an MRI, create an ICU bed, or place a specialist in an underserved province. Neither does insurance automatically remove the financial fear surrounding serious illness. The material cites estimates that households still shoulder roughly 45 percent of health expenditures out of pocket. A ₱500,000 medical bill can wipe out savings accumulated over years, force families to borrow, or turn tuition money into hospital money overnight.

There is something deeply Filipino about what happens next. Families message relatives abroad. Friends organize fundraisers. Coworkers pass envelopes. Someone posts a GCash number on Facebook. Patients approach government offices for guarantee letters and medical assistance. These acts of damayan are beautiful. But perhaps we should ask why so much improvisation remains necessary when illness strikes. Compassion should complement a health system, not routinely compensate for its gaps.

Government deserves credit where it is due. PhilHealth benefits are improving, facilities are being built, and programs for medicines, prevention, scholarships, and specialty care are expanding. Our health workers also keep doing extraordinary work with what they have. The issue is not whether anything is improving. It is whether improvement reaches ordinary patients soon enough.

And bigger budgets do not automatically mean better care. Money matters, but so do staffing, planning, maintenance, and accountability. A shiny new hospital means little without doctors. An ambulance without fuel is just a parked vehicle. A pharmacy without medicine is merely a room with shelves.

Seven years after Universal Health Care became law, perhaps we should ask a simpler question. When Nanay needs emergency surgery or a child is gasping for air, can the family get help quickly? Is there a bed? Is the equipment working? And can treatment begin before somebody starts calculating what the family can sell?

That is my idea of a better hospital. Nothing luxurious. Just enough people, equipment, medicine, space, and compassion to give every patient a fair chance without financially wrecking the family.

We are very good at making do. We wait, adjust, borrow, squeeze into crowded spaces, and say kaya pa. That resilience has carried families through difficult times, but it should never become an excuse for accepting less than decent health care. When we enter a hospital frightened and vulnerable, we should not have to bring extraordinary patience along with our PhilHealth card.

We deserve better hospitals. More importantly, we deserve a country where good health care is so ordinary that receiving it no longer feels like getting lucky.

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Doc H fondly describes himself as a ‘student of and for life’ who, like many others, aspires to a life-giving and why-driven world grounded in social justice and the pursuit of happiness. His views do not necessarily reflect those of the institutions he is employed or connected with.