Angioplasty in Manila
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A coronary angiogram (Source: wikipedia.org)
My heart froze. I love my husband and I’m concerned about his health and welfare, but at this very moment my brain zipped straight to our pocketbook. We moved back to the Philippines four years ago and have managed beautifully without health insurance except for PhilHealth; but now the stakes were high, with the cost of angioplasty said to be upward of a million pesos. I wondered if this was the start of our descent to bankruptcy.
Angioplasty is a procedure in which a balloon is inserted through the groin into a coronary artery by means of a catheter and the narrowed or blocked segment of the artery is widened, allowing blood to flow uninterruptedly. Sometimes a metallic coil, or stent, is also necessary to open the obstructed segment, and this is the part that gets even more painful pocket-wise.
Many hospitals in the country offer angioplasty packages, so one has an idea of the basic cost of surgery including doctors’ fees. At Capitol Medical Center where we were, the package was P300,000 ($6,700). Stents used in the procedure, however, were an additional P100,000 or $2,200 each, so because Bert might need seven stents, our cost could easily shoot to over P1 million.
Capitol Medical Center (Source: capitolmedical.org)
The possibility made me sweat profusely although fortunately, we had enough in the bank to cover the amount. We had just sold a small piece of property and in addition, we had an emergency fund. When we came to Manila, we decided that instead of paying thousands monthly to a health insurance provider and still worry about their coverages, exclusions and payment procedures, we would just put money in the bank and draw from it when necessary.
Health care—its quality and cost—is the number one concern of many overseas Filipinos contemplating a return to the country. Many stories have been told about wealthy families losing every peso they had to doctors, hospitals and medications because a family member suffered a severe and lengthy illness. This nightmare, I’m afraid, could happen to anyone in almost any country in the world that does not have universal health care. It is not uniquely Filipino.
A new neighbor of ours, an older couple, moved back to Manila because her husband, a doctor, had become pretty ill and needed fulltime medical care. They said that even with insurance and all the discounts and perks his being a physician afforded, they still stood to go broke in the US. In Manila he has caregivers every hour of every day and he has excellent doctors. There is no reason to doubt Filipino doctors in the Philippines. After all, most Filipino doctors overseas get their education here first.
Capitol Medical Center’s Cardiac Catherization Laboratory is a modern facility that could match those in the US. It is where my husband had his coronary angiogram and where he was now having his angioplasty. We were extremely happy with his invasive cardiologist, Dr. Vergel Quiogue, who performed both. He was not only competent, he was also caring and he took our financial concerns to heart.
“The stakes were high, with the cost of angioplasty said to be upward of a million pesos. I wondered if this was the start of our descent to bankruptcy.”
Filipino doctors in general are very conservative and will keep patients in the hospital as long as possible “for observation.” My brother-in-law, for instance, whose angiogram in another hospital showed nothing wrong with his arteries, was asked to stay in the hospital for two nights for observation. Bert’s cardiologist, on the other hand, treated his angiogram as an outpatient procedure. “How do you feel?” he asked three hours after the procedure. “Fine,” Bert said. With that, Bert was allowed to go home. We saved much anxiety and several thousand pesos from a hospital stay.
The hospital’s coronary angiogram package, by the way, was P55,000 ($1,200). It may be a good idea to shop first because rates are quite different per hospital. At the Philippine Heart Center, for instance, it is P67,000 ($1,500) and at St. Luke’s Hospital it’s P60,690 ($1,300) plus hospital stay.
Two days after the angiogram we were back in the hospital for the angioplasty. We insisted that it be done on a Monday because the last time Bert had surgery was on a Thursday, and although his urologist had said there would be a two-day observation period, he took the entire weekend off without a visit, which meant Bert could not be discharged until Tuesday, a day after the doctor finally went to see him. We were not happy, to say the least, about having stayed in the hospital three additional days needlessly.
We had been told that we needed to pay the hospital P200,000 or $4,500 cash in advance during admission. Capitol Medical, like most private hospitals, does not take checks, and my local credit card limit did not go that high. That means we were expected to carry at least P200,000 cash and that is quite a wad of P1,000 bills. It is a very unsafe policy, but that’s what we had to deal with. I also argued why we needed to pay any amount in advance since they would not let Bert leave the hospital without settling his account anyway. But hospitals are shrewd merchants and as such, they want their money first.
After paying the P200,000 deposit I went back to Admissions and the clerk looked at me and said, “Do you know that the angiogram will cost about P350,000?” “Yes,” I said, “Why?” He responded, “That means you still need to pay an additional P150,000 now.”
I hit the roof. “No!” I screamed, “I was told that P200,000 was all I needed for deposit and that’s what I paid. You’re not getting a peso more from me!” The man was visibly shaken. He cowered, excused himself and went to his supervisor. Minutes later he came back with the all-encompassing line: “Pasensya na po (Pardon me).” He said they would grant us an exemption. I gave a heavy sigh and waited for an orderly to show us to our room.
We loved Bert’s cardiologist. Later in the afternoon before surgery he came to see me in the waiting room and asked if I had any concerns. I said I trusted him completely but was worried that this procedure would put a huge dent on our finances. He put a hand on my shoulder and said, “I know. And I will do everything to make sure the tab does not run too high.”
When I told this story to friends later on, I was told that that was un-Filipino. “What do you mean?” I said. The response was that “wealthy Filipinos do not normally talk to their doctors about costs. They just pay whatever.” “And that’s probably why doctors just send them off to go through countless expensive lab tests and procedures without regard to their need or cost,” I concluded. I found it incredulous that anyone would be too proud to talk to their doctor about money.
I watched the surgical procedure on TV in the waiting room but did not really understand what was going on. At about 6:30 p.m. it was over, and Dr. Quiogue came out to enlighten me. “It was a very difficult surgery,” he began. “There were blockages that were too difficult to get to, but I tried my hardest and finally got to them.
“The first one was easy. When I put a balloon in the artery, blood flowed beautifully, which means I did not need to place a stent there.” What he was saying was that recognizing the prohibitive cost of stents, he did not use them unless absolutely necessary. Some blockages were cleared by just placing balloons and some could be resolved through medication. But although he used alternative solutions for clearing arterial blockages, he never once compromised my husband’s health. “How many stents, Doctor, were used?” I asked. “Two,” he said. “Two!” I was so happy I jumped to my feet.
The angioplasty procedure (Source: wikipedia.org)
I went to see Bert and he was still groggy, but I told him the good news. “Two stents is a whole lot better then seven!” He spent the night in ICU and by next morning he was anxious to either return to his room or go home. His cardiologist came and took out the bandages and sent him to his room. After noontime Bert changed to his street clothes by himself and said he was ready to go home. “Ha ha!” I laughed. He may have felt great, but we weren’t going anywhere until the doctor said so.
The doctor arrived at 6:30 p.m., exactly 24 hours since his surgery, and said Bert could go home. We were amazed. It was almost unfathomable that his heart surgery just required an overnight stay in the hospital.
But first we needed to pay the bill. I had P800,000 ($17,800) cash in my purse to make sure I had enough to cover any amount needed without my having to go to the bank again. I was anxious to get the cash off my hands, although not entirely to the hospital.
The bill came to P477,655 ($10,600)—about half the amount we had anticipated. Moreover, discounts for senior citizens and some expenses covered by PhilHealth came to P38,620 ($860), bringing our balance or the full cost of Bert’s angioplasty down to P439,034, or a little less than $10,000.
The experience taught us how important it is to have open and honest communications with your doctor not just about health, but also about money. Most hospitals in the Philippines have a sliding scale scheme, which means charges are based on one’s capacity to pay. The better your hospital room, for instance, the higher the charges. Book a suite and you’ll be billed like a rock star.
I have read that in the States, angioplasty costs an average of $45,000 for patients without insurance. Ouch! That makes the cost in the Philippines seem like chump change, but of course that’s an unfair comparison. The reality is that heart surgery is expensive anywhere in the world and if you don’t pay for it from your pocket, you pay for it in other ways like high insurance premiums or high taxes.
Meanwhile, in the Philippines we will keep putting money in a bank account designated exclusively for medical and emergency use. More importantly, we will eat healthier and walk around the block a few times each day.
Bella Bonner
Bella Bonner, UP Mass Comm graduate, moved back to Manila after 30 years in Texas and is trying life as an urban farmer. Between growing arugula in her neighbor’s yard and making artisan cheeses, she contemplates on raising goats in her own yard. Would her neighbors agree?
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