ORIGINAL ARTICLE

Policy Analysis on Determining Hospital Bed Capacity

in Light of Universal Health Care
Ma. Esmeralda C. Silva, MPAf, MSPPM, PhD,1,2 Ma-Ann M. Zarsuelo, RND, MSc,1,3
Marianne Joy N. Naria-Maritana, MD,1,3 Zenith D. Zordilla, MD,1,3 Hilton Y. Lam, MHA, PhD,1,3
Michael Antonio F. Mendoza, DDM, MA,1,4 Ara Karizza G. Buan, RMicro,1,3 Frances Karen A. Nuestro, PTRP,1,3
Janvic A. Dela Rosa, RND1,3 and Carmencita D. Padilla, MD, MAHPS5
1
University of the Philippines Manila Health Policy Development Hub
2
College of Public Health, University of the Philippines Manila
3
Institute of Health Policy and Development Studies, National Institutes of Health, University of the Philippines Manila
4
College of Dentistry, University of the Philippines Manila
5
University of the Philippines Manila

ABSTRACT

Background. Through the years of improving quality health service delivery, hospital bed capacity in the Philippines
has remained to be a persistent challenge. In light of the aim of the Universal Health Care Act to protect and
promote the right to health of every Filipino, one metric used to identify areas that are in most need or are under-
served, is the number of public hospital beds vis a vis the catchment population.

Methods. The systematic review of literature was utilized to generate a policy brief presented to the invited
stakeholders of the policy issue for the roundtable discussion participated by all key stakeholders of the policy
issue. Evidence and insights were thematically analyzed to generate consensus policy recommendations.

Results. With the current hospital bed availability and maldistribution, the Philippines still faces compounded
issues in addressing healthcare demands. Currently, the request for increasing bed capacity is done through
legislation. In context, this request is also parallel in expanding service capacity through the allocation of more
funds and personnel. The ratio of private and charity beds must ensure to have equity among all patients of varying
segments of the population. Enjoining private hospitals to share bed capacity for public service was also explored
given appropriate subsidies.

Conclusion and Recommendation. To ensure equity in health service delivery, it is imperative to assess, strategize,
and conduct prioritization of the needs of government hospitals for increased bed capacity, considering the
distribution, socio-demographic profile, and health needs of the catchment population.

Key Words: bed capacity, hospitals, service capacity, privatization, Philippines

Introduction

Through the years of continuous government endeavors

to improve quality health service delivery, hospital bed capacity
in the Philippines has remained a persistent challenge. In
anticipation of the implementation of the Republic Act
11223, otherwise known as the “Universal Health Care
Act,” the change in the health system landscape is hoped to
address this gap and strengthen the improvement in allocative
Corresponding author: Ma-Ann M. Zarsuelo, RND, MSc efficiency of hospital beds to facilities in need. This will
UP Manila Health Policy Development Hub warrant better delivery of accessible and quality services to
National Institutes of Health
University of the Philippines Manila
its catchment population. As stipulated in Section 2 of the
623 Pedro Gil St., Ermita, Manila 1000, Philippines Act, it aims “to protect and promote the right to health of
Email: [email protected] every Filipino and instill health consciousness among them.” 1

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 Hospital Bed Capacity

Health facilities in the country are classified into resulting in the use of three records. In total, 24 full text
three levels; from Level 1 offering basic medical care and records were included in the literature review.
equipment, Level 2 hospitals add on services with surgical The review of literature was driven by the following
care and Level 3 hospitals offer specialized medical care. discussion questions based on the deliberation of the UP
Based on the 2018 statistics from PhilHealth, the distribution Manila Health Policy Development Hub, as the research
of the both DOH and PhilHealth accredited health care team, and the Department of Health, as the primary agency:
facilities were: 42% Level 1 facilities, 18% Level 2, 6% Level 1. What is the international experience on service/ private
3 hospitals, and 35% infirmaries.2 Sixty-one percent of the bed split in the government hospitals? What is the
facilities were privately-owned and 39% were government- Philippine experience on the bed capacity of hospitals
owned.2 When compared to the 2017 PhilHealth statistics, both private and government?
wherein the distribution is 65% private facilities and 35% 2. What are the effects of increasing the bed capacity and
public facilities.3 Meanwhile, the distribution of hospitals service capacity on budget allocation in the Philippines?
across the level of facilities almost remained the same in 3. What are the implications of the medical tourism
2017 and 2018. the number of government-owned facilities campaign, particularly specialty hospitals in the
declined in a year.3 As for PhilHealth accredited facilities in Philippines?
2018, there were more accredited privately-owned hospitals
(n=1,170), than government-owned (n=758), which are Results of the literature review were utilized in crafting
mostly Level 1 hospitals, providing also the basic healthcare the policy brief presented to the participants to give
services.2 Thus, according to the aim of the UHC Act, background knowledge on the policy issue through the
accessibility to quality healthcare needs efficient mapping conduct of a roundtable discussion on November 29, 2018,
of health facilities to ensure timely and functional referral organized by the UP Manila Health Policy Development
of patients. This rationalizes the need to invest more in Hub (UPM HPDH) in collaboration with the Depart-
government hospitals to ensure accessible yet affordable ment of Health (DOH). Insights, expertise, and ground
healthcare services while encouraging private hospitals to be experiences from multi-sector stakeholders enriched the
engaged in the service delivery network. discussion that deepens the understanding of the strengths,
One of the measures stipulated in the Law is to identify gaps, and challenges of the policy issue.
which areas are in most need or underserved. One metric
is to determine the number of beds provided by the public RESULTS AND DISCUSSION
health facilities.1 Moreover, Section 29 of the Act states that
the “Department of Health shall develop the framework International Experience on Service / Private bed
and guidelines to determine the appropriate bed capacity split in government hospitals
and the number of health care professionals of public health Health, in the neo-liberal ideology, becomes a private
facilities based on need.”1 This initiative is geared towards commodity that is left to the market rather than the state/
the attainment of equity wherein “distribution according to government. In an article by Smith, private hospitals in
the need” is applied in health policy decisions.4 developing countries have problems not only in physical
distance but also in functionality.5 Moreover, displacement
METHODS of demand and/or dislocation of or unavailability of
resources happen due to inadequate financing, weak policy
Pre-work research planning and having a weak administrative and management
To generate evidence for the policy tools to be used systems. With low funds, comes inadequate equipment,
in the stakeholders’ policy forum, a systematic review of medicines, facilities and the number of staff, who might also
literature was conducted. A search through PUBMED using be inadequately trained. According to WHO (1999), an
the keywords “health facilities bed capacity” showed 24,262 equitable and efficient system of financing health services
results, “health facilities bed capacity” and “Philippines” should be publicly funded through general or earmarked tax.5
yielded three results. Another search through PUBMED In a study by Jeurissen and Maarse, privatization is
was done using the keywords “Public Hospitals” and considered by other countries to address the following
“Privatization” which showed 335 results. The results were recognized problems in public health systems: (1) poor
then filtered by articles published from 2000 to 2018 and its incentivization and work arrangements; (2) weak capital
contextual significance to the topic of interest. In total, eight investments; (3) lack of patient responsiveness; and (4) short-
full-text journal articles were reviewed and included. Google term political interferences.6 However, privatization in the
Search using the search words was also utilized yielding healthcare setting is an ambiguous concept, a complex issue.
to eight official reports, one presentation, one news article, This study found that privatization in Sweden and Spain are
and one consolidated data from the website of national different even if they both have devolved health systems.6
government agencies. For pertinent laws, Official Gazette Privatization in Sweden is demand-driven (to improve choice
and websites of involved Departments were searched, and patient responsiveness) while in Spain, privatization

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follows a supply-driven approach (efficiency, cost savings).6 significantly affected.9 At the same time, privatization could
However, in both countries, the study noted the “non- lead to additional costs for the community in accessing care
role” of the private “not-for-profit option” in the reform. It due to increased price mark-ups and loss of services that are
was also mentioned that in the Netherlands, two not-for- unprofitable for healthcare providers. This study showed that
profit healthcare organizations are successful, particularly privatization did not cause any statistically relevant changes
in-patient satisfaction, administrative costs, and outcomes.6 in bad debt and charity care.9
In a study by Ramamonjiarivelo et al., hospitals It was highlighted in the Jeurissen and Maarse study that
experiencing financial distress are more likely to become the important consideration in privatization is its impact on
private.7 It further discussed that making a hospital in the public-private mix in providing healthcare.6 However,
financial distress into a private facility could financially the limited international experience of having private wards
benefit the hospital as it attracts financial capital.7 Moreover, in public hospitals points to a possibility that these wards
local governments were relieved, employment loss was may promote inequity.7 To better understand the impact
prevented and residents’ access to care was preserved.7 of privatization in healthcare provision, the study proposed
Teaching hospitals and those with high occupancy rate, are to look into the balance between the public and private
also less likely to be privatized.7 Decision on converting sector; whether the success of the private sector incentivized
public hospitals into private facilities are often linked to public providers to achieve better performance.6
a falling budget of the state/ local government. In a case In the case of the Tygerberg Hospital, private wards are
study of Tygerberg Academic Hospital in South Africa, not likely to be removed. Hence, to prevent ward bias and
private wards in a public hospital were aimed by the public lose the positive aspects of privatization, it is important to
sector to generate revenue and wider benefits to the public protect the system.8 The management and the government
health system.8 This further led to better access for the need to ensure that there is a system that guarantees that
disadvantaged groups of people, retain health personnel, costs are monitored and that a surplus is generated to benefit
and develop models of service delivery.8 Ramamonijiarivelo the entire facility.
et al. noted that privatized hospitals tend to be smaller, and
the occupancy rate became lower.7 However, in the case of Taking stock: Hospital Beds in Government
Tygerberg Hospital in South Africa, even if private ward Hospitals in the Philippines
admissions comprised only 2.5% of total admissions from According to the 2016 data from the Philippine
the year it was implemented, it contributed to 30% of total Statistics Authority and Department of Health, the number
hospital patient fees. To prevent reverse subsidy where the of government hospitals across all the regions of the country
public health sector will fund private wards, immediate ways is less than those of the private hospitals (Table 1).10
such as accurate billing and reducing debts are minimized.8 Accordingly, hospital beds were lower, except for NCR. This
However, in the same hospital, public sector doctors and might be attributed to the concentration of specialty and
specialists are not allowed to engage in private practice. With referral hospital in the Region, which is also evident from
this, resources are not diverted from the public to the private its high average beds of 182.3.10 In general, the average
wards. Private wards in a public hospital have the potential beds per hospital in the country is 83.1.10
to act as a model on how service should be delivered. Following the Republic Act No. 1939, Section 6,
Private ward bias is prevented by having good governance legislated in 1957, all government hospitals shall devote 90%
arrangements.7 Furthermore, in a study by Villa and Kane of its bed capacity as free or charity/ service beds.11 Charity
that assessed the impact of privatization of public hospitals bed is defined as a bed in a hospital that is exclusively for the
in the three states of the United States, privatization led to confinement of patients classified as Class C or D based on
statistically significant results of increased operating margins, the Administrative Order No. 51-A s. 2000, and indigent
the decline in non-operating margins, and reduction of patient patients, as certified by a social worker.12 Ten percent of
length of stay, while bed occupancy rate was not statistically government hospitals’ total bed capacity can be devoted to

Table 1. Distribution of hospital beds by ownership and group of island, 201610

Governmentb Privateb Total Average beds / Beds / 10,000
Group of islands Populationa Total beds
Hospitals Beds Hospitals Beds hospitals island group population
NCR 12,877,253 48 17,221 115 12,502 163 29,723 182.3 23.1
The rest of Luzon 44,592,844 217 15,573 410 21,103 627 36,676 58.5 8.2
Visayas 19,373,300 80 6,757 87 8,439 167 15,196 91.0 7.8
Mindanao 24,135,775 89 7,820 178 12,273 267 20,093 75.3 8.3
Philippines 100,979,172 434 47,371 790 54,317 1,224 101,688 83.1 10.1
Average beds/hospital 109.1 68.8 83.1
Sources: Philippine Statistics Authority, 2016a, Department of Health-HFSRB, 2016
a b

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paid or private beds. As of 2010, in the Philippines, there premium contributions or prepayment either to HMOs or
are 730 government hospitals. These hospitals have a total PhilHealth; (3) government’s budget appropriations for
of 49,372 beds. As of 2011, out of 684 hospitals, 83.6 % are public health care facilities and including PhilHealth; and (4)
managed by the local government units, 75 are retained by the taxes of household and firms to fund budget appropriations
DOH, 28 belong to the military, five are university hospitals (Figure 1).15
and four are from the government.13 In 2019, the Department The identified components resonated with the study
of Health, National Health Facility Registry reported done by Lavado et al., which stated that the sources of
that 1,456 hospitals across the country were government- income among government retained hospitals include out-
owned comprising 32 percent. Magnifying its composition of-pocket payments, PhilHealth reimbursements, fees from
by geographical distribution, 58% of these hospitals are in training and certification, Philippine Charity Sweepstakes
Luzon, 17% in Visayas, and 19% in Mindanao. The ratio Office (PCSO), and rental income (Figure 2).16
of the Philippine population to a government hospital is It was noted that there is a decline in the total budget
projected to be 229,306:1.14 This demonstrates a lack of beds of DOH allocated for hospitals.16 In the hospital budget,
with a great gap to the WHO recommended two beds per the largest share goes to payment to hospital personnel.16
1,000 population.15 Accordingly, the shares for the maintenance and other
In the policy discussion, a representative from the Health operating expenditures (MOOE) were reduced. On the
Facility Development Bureau (HFDB) of the Department greater scale, it is noted that the DOH is spending more than
of Health reported that a Philippine System Development half of its budget for the improvement and/or maintaining
Plan exists. With the aim of the UHC Law to provide its tertiary level hospitals.16 In 2003, DOH retained hospitals
quality and equitable health care, structural resources such managed to keep its income because of the special provision
as health facilities must be sufficient to secure sustainable in the 2003 General Appropriations Act (GAA).16 Instead of
operations. Currently, the hospital bed to population giving it back to the Bureau of Treasury, hospitals are allowed
ratio is one of the bases in determining the placement of to utilize it for MOOE.16 Allowing this income retention,
facilities. The representative further stated that regional provided sustainable means to mitigate the shortage of
offices will do mapping of the existing government and funds. Moreover, the same study said that there appears to
private facilities in their specific areas. be no clear criteria in allocation for the hospital budget.
In the past, budgets were based on the number of beds in
Resource Management in the Government a hospital but as hospitals turn into having more complex
Hospitals in the Philippines and complicated cases, this was not applicable anymore.
According to the book entitled, “The Philippines Health Hospitals that manage complicated cases, such as regional
System Review” (2011), financial flows in the health sector centers and medical centers, get lower per bed allocations
have four types: (1) out-of-pocket payments from household than those who have less complicated cases in extension
to providers of health care; (2) household and firms’ and district hospitals.

Out-of-pocket payments

General Taxation
Budget Appropriation
Government

Households
Premiums Budget Appropriation
Premiums

Premiums Insurance Payments Health Care

PhilHealth
Providers
General Taxation
Firms

Premiums
HMOs & Insurance Payments
Premiums Private
Insurance

Figure 1. Financial flow.

Source: Romualdez AG, Dela Rosa JE, Flavier JA, Quimbo SA, Hartigan-Go K, Lagrada L, David L. The Philippines Health System Review. Health
Systems in Transition.

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Hospital Bed Capacity

Total Funds Available for DOH-retained Hospitals (100%)

GAA (80%) Hospital Income (20%)

Out-of-pocket payments
DOH-Budget (70%) Special Purpose Funds (10%)
PhilHealth reimbursements

Other SPFs Others (PCSO, training

Direct Release Sub-allotment PDAF
(Calamity Fund, MPB, PGF) fees, certification fees,
(67%) (3%) (1%)
(9%) rental income, etc.)

Acronyms: GAA - General Appropriations Act; PDAF - Priority Development Assistance Fund (Pork Barrel); MPB - Miscellaneous Personnel Benefits
Fund; PGF - Pension and Gratuity Fund; PCSO - Philippine Charity Sweepstakes Office

Figure 2. Source of funds.

Source: Lavado RF, Sanglay-Dunleavy A, Jimenez J, Matsuda Y. How are government hospitals performing?: A study of resource management
in government-retained hospitals.

Service Capacity vs. Bed Capacity Sustainability of healthcare facilities depends on the various
mixture of responses to the economic, technological, social
A. Bed capacity and environmental needs of the community. Dealing with
The Philippines is facing the problem of inadequate bed these can help improve the sustainability of hospitals no
capacity, with only four out of 17 administrative Regions matter what their size is.18
meeting the requirements.15
Bed capacity in the country is reported to be unevenly Implications of Increasing Bed Capacity on Budget
distributed throughout the regions, with the most number of Allocation
hospital beds concentrated in the National Capital Region The Philippines is considered as lacking when it comes
(NCR), numbering over 27,779 or 2.47 beds per 1,000 to bed capacity. In 2010, the private sector outnumbers the
population. The second-highest number of hospital beds government-controlled hospitals, though the government is
was noted in Cordillera Administrative Region (CAR), in control of more than 50% (49,372) of the total number
numbering 2,472 or 1.52 beds per 1,000 population.17 of hospital beds (98,155) in the country.19
These numbers are one of the many indicators of unequal To accommodate the growing population of the country
distribution of the health facilities in the Philippines. Thus, and to deliver better health care services for the people across
the burden of transportation costs is increased, on top of all regions, it is imperative to lay down strategic actions to
personal medical expenses. mitigate problems in insufficient bed capacity.15 Currently,
The private sector has more hospitals established with increasing bed capacity is done via legislation. Request
60.90% (n=961) of the total number of hospitals compared to to increase the bed capacity would compete with other
the government sector with only 39.10% (n=617).16 This gap proposed bills in Congress. Thus, in 2016, Senate Bill No.
implies the financial accessibility to the hospital bed. During 1143, otherwise known as the “DOH Hospital Bed Capacity
the RTD, one representative from the Philippine Society Rationalization Act” was introduced, giving authority to
for Quality Inc., increasing the number of PhilHealth beds the Department of Health to establish and approve the bed
to cater more patients while minimizing the out-of-pocket capacity of its retained hospitals and for other purposes.20
expenditure of the patient. According to the PhilHealth This bill gives the authority to the DOH to increase the
claims data in 2018, PhilHealth supported around 33% of bed capacity of its retained hospitals and create guidelines
the average cost of being confined in a hospital which is in evaluating and approving the need to increase the
estimated at PhP 10,388.10 bed capacity.20
The task of effectively deliver health care in the country In the devolved healthcare system of the Philippines,
is not only measured by the bed capacity of a health provincial and district hospitals are funded by the provincial
facility. In the study of Pantzartzis et al., they assessed the government and city or municipality local government unit,
efficiency and sustainability of delivering health services respectively. Mainly, the hospital chief submits financial
in the hospitals in Europe by measuring the bed capacity request to be reviewed and approved by the local chief
of the health facilities in an area.18 Findings showed executive under the financial parameters of the LGU.15
that the number of hospital beds did not determine the However, health budget allocation is not rigid, hence, criteria
efficiency and clinical performance of delivering health care. are flexible. Nevertheless, for hospitals, budget allocation

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 Hospital Bed Capacity

depends on the number of beds.16 This then translates to and partners. The health service providers must have
increasing bed capacity to increased budget allocation. Should the capability of facilitating the care of patients
the authority to increase bed capacities will be approved by the and organize needed services for the population.
DOH, it would be strategic if criteria or guidelines on budget 8. Accountability and efficiency, the health services
allocation for the health facilities would also be reinforced. must be well managed to avoid wastage and
Since increasing bed capacity of hospitals resource is maximize the use of resources available. People
hefty, one discussant from the government sector shared assigned in the delivery of health services must be
that a feasible approach is to invest in first-line or primary responsible and accountable as they have been given
health facilities for timely initial medical intervention and the authority to command services and facilities.21
to decongest the demands in higher-level hospitals. With
the progression of telecommunication, a representative In the study of Yang, two main components for
from the Philippine Society for Quality Inc., suggested measurement of service utilization were proposed: first is
exploring telehealth services as a complementary platform the distance of the health facility (average number of health
in delivering facility-based health services. facilities in the location, or the distance of the closest facility
in the catchment population); 22 the second is defined as the
B. Service Capacity demand of the health service provided (e.g. crowding of a
Service capacity is the ability of a particular system to health facility).22
deliver the service intended and to match the demand of the For the validation of such standards presented, a
beneficiaries. It has multi-factorial consideration in decision reporting system must be organized. To validate and monitor
making such as the “capacity management, type of demand, the maintenance of the set standards, a routine health facility
altering or improving available resources, modification on reporting system must be put into action. Data gathered
the product offering and pricing, and capacity flexibility.”11 in this type of reporting include key outputs from routine
The WHO proposed several dimensions to consider when it reports on services, care, and treatment administered. The
comes to good health service delivery to ensure that every data can be gathered within a set time period, based on the
citizen can benefit and participate in a well-functioning functioning of the services and the average availability of
health system. As proposed by the WHO, there are a total the health workers. With the data routinely collected, the
of eight key characteristics in increasing health service in government will have extensive and inclusive information
an area;19 that can be used in analyzing trends and changes in the
1. Comprehensiveness, the availability of all kinds of delivery of health services.
health services, as needed by the population.
2. Accessibility, how services are delivered to the target Implications of Increasing Service Capacity on Budget
population, considering the factors of any form of Allocation
geographical barriers, costs and time to avail such There is a paucity of data on the financing status of
services. It is focused on how “close” health services government hospitals in the country. On Health Sector
are to its target population. Reform Agenda (HSRA), early studies showed that most
3. Coverage, the design of the health service would LGUs spend approximately about 70% of their budget on
cover everyone in the social hierarchy in a health on personal care, mainly hospitals.23 Around 80% of
specified area. the hospital budget is mainly devoted to personnel salaries.
4. Continuity, the delivery of the health service does One of the alternatives in hospital reform espoused by
not stop at a certain point, it should encompass all the HSRA in 2000 was corporatization. This approach aims
kinds of health conditions and all kinds of health to provide public hospitals with fiscal and management
services and levels of care until the patient is brought autonomy.15 Increasing service capacity would also mean an
back to normal living. increase in budget allocation and retention.
5. Quality, ensuring that the delivery of health services The number of beds of a health facility does not necessarily
is of high quality, effective, safe, and centered on the equate to performing better clinically.19 To improve the
care of the patient above all else. delivery of healthcare, the Philippines must not only expand
6. Person-centeredness, the services that are delivered the bed capacity of its health facilities but also expand the
are “centered on the person and not the disease” the services that are provided. Thus, budget allocation needs to
health services availed are responsive to the needs consider both the provision of appropriate bed capacity and
of the person and are included in the design of service capacity across the country.
the health care system.
7. Coordination, the health service delivery must have The implication of the Philippine Medical Tourism
good coordination with its branches and can help Program
one another when it comes to collaboration with The government has also taken steps to support the
other health care facilities in a specified country local health care industry to attract foreign markets. The

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Hospital Bed Capacity

Table 2. Hospitals under the Philippine Medical Tourism Program, 201319

Private Public Total
Location
Number Beds Number Beds Number Beds
Metro Manila 11 4,371 5 2,107 16 6,478
Batangas Province 1 220 — — 1 220
Cebu 3 1,210 — — 3 1,210
Davao 1 250 — — 1 250
Total 16 6,051 5 2,107 21 8,158

Table 3. Hospitals under the Philippine Medical Tourism Program, by location, ownership, number of beds, and
accreditation status
Hospital Location Ownership Year Est. Beds Int'l Accred. PHIC Accred.
East Avenue Quezon City G 1978 650 — —
Lung Center Quezon City G 1981 210 — —
National Kidney and Transplant Institute Quezon City G 1983 247 ISO COE
Philippine Children's Quezon City G 1979 200 — COE
Philippine Heart Center Quezon City G 1975 800 AC COE
Capitol Medical Center Quezon City P 1974 300 — —
St. Luke's Quezon City P 1903 650 JCI; TEMOS COE
The Medical City Pasig City P 1967 500 JCI COE
Cardinal Santos San Juan City P 1974 235 — COE
Manila Doctors Ermita, Manila P 1956 300 AC; ISO COE
UST Hospital España, Manila P 1945 800 — —
Makati Medical Makati City P 1969 570 JCI, ISO27 COE
St. Luke's GLobal City Taguig City P 190328 60029 JCI30 COE
Asian Hospital Muntinlupa City P 2002 217 31
JCI COE
Las Piñas Doctors Las Piñas City P 1982 100 — —
Parañaque Doctors Parañaque City P 2007 99 — —
St. Frances Cabrini Sto. Tomas, Batangas P 1982 220 — COE
Cebu Doctors Cebu City P 1974 300 Trent COE
Chong Hua Cebu City P 1957 660 JCI COE
Perpetual Succor Cebu City P 1950 250 Trent COE
Davao Doctors Davao City P 1969 250 ISO —
Grand Total — — — 6,051 11 14
Sources: PMTP; HealthCORE (2011) profiles; Websites of NKTI, St. Luke's Global City, St. Frances Cabrini, Perpetual Succor, etc.

Philippine Medical Tourism Program was launched in 2006 come to the Philippines as tourists at first then decide to go
and envisions that our local global health care industry will to the hospital to avail of medical services”.24 Stakeholders
contribute a quantifiable amount to the Philippine economy and beneficiaries of this program are not only confined in
and all improvements in the quality of life, increase the privately owned institutions but also involve government-
number of institutions offering advanced medical services owned institutions.
suitable for Global Health Care, as well as the generation A study by Picazo on Medical Tourism showed
of job opportunities in the industry of medical services and that 16 private hospitals (11 from Metro Manila, 1 from
other related industries thereby increasing the productivity Batangas Province, 3 from Cebu, 1 from Davao) and five
of the workforce in the country, and allowing it to expand government hospitals are under the Philippine Medical
and upgrade to have more visitors from other countries Tourism Program, and are all situated in Metro Manila
who will avail of medical services in our institutions and (Table 2).13 The government hospitals involved in the
at the same time, ensure that the quality of those hospitals program had a total of 2,107 beds.13 The hospitals involved
currently offering services that meet globally-recognized are listed in Table 3. The medical tourism industry had PhP
standards, and are making these services equitably available 80 billion gross revenues in 2009 and about PhP 53 billion
for both local patients and medical travelers. Medical gross costs.13
tourists are defined by Dr. Tiongson, program manager of It is noted that five of the hospitals involved in the
the Philippine Medical Tourism Program, “as people who program are accredited by the Joint Commission Inter-

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 Hospital Bed Capacity

national ( JCI) and two other hospitals are accredited by least ten percent (10%) of its bed capacity for charity beds
Accreditation Canada International. Among these accredited needs to be strictly implemented. Its implementation should
hospitals, one is government-owned–Philippine Heart be monitored both by the Private Hospital Association and
Center. It further stated that with cross-subsidization by the Department of Health.
carefully done, medical tourism can bring enormous benefits
to health facilities of the government that are poorly funded.7 Option 2: All public hospitals to gradually phase
Medical tourism brings benefits to the Philippines out private accommodation
as hospitals strive to improve in terms of their health Despite the limited literature, both in the local and
services and professionals to meet the standards for international settings, having private accommodation in
accreditation. Further, it is one way of earning funds public hospitals has been evident to aid in generating
and providing jobs to the economy. However, medical revenues. Hospitals under financial distress, benefited from
tourism means attracting foreigners to come to our country private accommodation in terms of gaining financial capital,
to avail of services, which may lead them to take up our relieving local governments from increased budget allocation
already insufficient number of hospital beds, clinic time or subsidies. With higher revenues, the retention of health
slots, and services. personnel was also higher and access to care for its residents
was preserved.7 Hence, gradually shifting to hundred
RECOMMENDATIONS percent charity beds would call for more robust evidence
and stakeholder’s discussion with hospital associations, local
Based on review of literature and discussion, the government units, and professional societies, among others.
following are recommended for the options identified by the Fiscal feasibility should be highly examined to ensure that
DOH, in determining hospital bed ratio. secured and sustainable funds will be maintained without
compromising quality care and a balanced workload of
Option 1: DOH to determine the appropriate ratio personnel. Advance implementation on selected sites might
More studies are needed to evaluate if the existing be implemented to determine its fiscal and managerial
provision of RA 1939, stating that public hospitals can have feasibility to timely address arising challenges and gaps.
10% of their total bed capacity be devoted to private beds,
should be continued in light of the anticipated improved Option 3: All new public hospitals to be built has
financing scheme and aim to provide affordable quality no private accommodation
health care of the UHC Law. This includes reviewing Health investments through infrastructure building
financial sustainability, patient absorptive capacity, and would mitigate inaccessibly of services particularly in the
allocation of health investments. underserved areas, grounded by geographical proximity.
According to the 2016 data, the geographical distribution With the total phase-out of private accommodation in
of beds showed the highest access to hospitals in NCR with these hospitals, the population is expected to be protected
23 hospital beds per 10,000 people, while only 8.2 in the from financial risks, contributing to improved service equity.
rest of Luzon, 7.8 in Visayas, and 8.3 in Mindanao. Hence, However, hospitals should have sustainable funds to keep the
it is imperative to determine the adequate ratio of beds operations at full standard quality. Further, the administration
vis a vis the population and distribution of hospital levels should be equipped with financial capacities to efficiently
to ensure functional and efficient service delivery system. manage the operations without depleting resources. For it
Further, needs assessment of the area based on the health to be successful, the sources of funds, its proper allocation
outcomes profile should also be examined to determine if the and utilization should be determined and consulted to all
demands of the captured population are adequately catered, involved stakeholders. As stated by Wadee and Gilson, a
particularly those vulnerable and marginalized segments of system that monitors costs and that a surplus is generated
the population. This will address inequities in the availability to benefit the whole facility needs to be ensured by the
and accessibility of hospital beds. management and the government.8
Due to the increasing number of private hospitals
across the regions of the country, its inclusion in the Statement of Authorship
service delivery network, as encouraged in the Law, would All authors participated in data collection and analysis,
be remedial action to augment gaps in service provision. and approved the final version submitted.
Further, contracting out services to private facilities
including hospital beds can be explored, particularly to Author Disclosure
the underserved groups, in consideration of the proximity, The authors declare no conflicts of interest.
capacity, and accountability of the private provider to the
target population. The Administrative Order No. 2007 - Funding Source
0041, formulated as part of the DOH FOURmula One This project was funded by the DOST DOH AHEAD-
(F1) for health mandating private hospitals to devote at HPSR.

VOL. 54 NO. 6 2020 ACTA MEDICA PHILIPPINA 675

Hospital Bed Capacity

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