Without the White Coat
Unveiling the myth: Inside the HMO
It was an opportunity that was to given to me by my medical colleague in the counseling skills seminar that we have in Antipolo City and as their VP for medical affairs, I can never turn down her offer to be the medical coordinator of her HMO(Health Maintenance Organization) in Iloilo City. In the beginning, it was just a matter of learning the ropes and then the realities inside the world of the HMO. The first time I had an encounter with an HMO was when I was hired (contractual service) by a power company as their retainer physician or company doctor. That was the time I saw what was happening on one side of the HMO, the side of the patient or for short its "members"(subscribers). However, I never saw the other side of the coin - the accredited HMO physician or doctor.
I slowly found out that everything that is said about the HMO, from the issues of a menial amount for consultations to "aged" reimbursements.(hopefully they are not forgotten or plainly "misplaced"), are true. If it is instant cash you are looking for, you better kissed the HMO good-bye. If your planning to get your "much" needed vehicle this year, better look for another route of income-generating ventures. For companies which are financially strapped when it comes to their budget for the healthcare of their workers and employees, an HMO can be a blessing. With affordable premiums and free consultations or "no-cash out" involved, an HMO can be more beneficial.
The question is that "are you getting quality care or services" when you have an HMO?
It may be one reason that a lot of medical specialties have their own "internal" understandings not to be accredited with HMO since the specialties are the "rule and guide" of competencies, accreditations and qualifications in their specialty organization. For the graduates of residency training programs, it is pushed, shoved and survived to accept jobs in HMO clinics and facilities. For a start, they have to earn a living too.
How do we view the Filipino HMO members? It just run true in Filipino mentality that what is placed in is what you take out. If the Filipino HMO member had put in 100 pesos of his hard earned money as premium for the HMO, "always" expect that he/she will get the 100 pesos back in form of consultations and laboratory requests, which are not even requested by the physician and being confined in the medical institution for a night or two to have his "executive" check-up. The rationale that he already paid his premium. These situations are just too far to comprehend for somebody from the US, comparing that the HMO have started there. The HMO card is used by its member wisely and not to the point that we have to use it up.
In Iloilo City, the HMO members really knows how to use their cards to the point that "unnecessary" diagnostic test are ordered in the discretion of the member just to suffice that she have to have a mammogram yearly for a benign mass or cyst of the breast. The question of utilization is always parallel to the abuse by its members. They keep on changing HMO companies yearly which never satisfies their urgency to have all the diagnostic exams they want every year. This is a form of " hypochondriacs" or it is just innate inside all Filipinos of not being aware or being taught of the right way to use their HMO card, in case of emergencies or an urgency for a medical consultation. Maybe, we are just plain " vintajuso" or just merely taking advantage of the situation.
I never dream that that the HMO industry in the Philippines will collapse. I will just be reaping a lot of money for its stock holders and CEO. For the poor accredited HMO physician, all he’ll get are just "chicken scrap" or "feedings" from the HMO company. We can never compromise the patient care, HMO or not. What really counts is that the patient in front of us, whether he have an availment form or not. What matters as physicians and doctors is to take "care" of them.(Remember the word CARE. It is not cure or treat). HMO patient or not, they are all human beings that we call patients who need a physician’s attention and care.