In the early times in the Philippines, illnesses and sickness were treated only by using herbal and medicinal plants. Quak doctors and faith healers were also at boost during that time. Because the culture and beliefs to the anitos and natural phenomenon were very strong that is why most of the people during that time depends their life to them. In the present time these practices of using herbal and medicinal plants were still present specially among the indigenous tribes and other places that were not been affected much by the colonization of different foreign countries.
In addition to that the use of medicinal and herbal plants had also a great development because of the engagement of the Philippines to trade-off of to its surrounding countries like China, India and to the Malay people. By the 15th century where in the Philippines was colonized by the Spaniards, because of the systematic and purposeful destruction and occupation of the Spanish to the Philippines, the country left only little accounts of history regarding its medical practices of its natives before.
Spain did not only want to build colony in the Philippines, they also want their new colony become an independent country that could stand on its own even without the support of the King of Spain that is why they introduce to the Philippines what are the importance of Healthcare is so they started building and founding hospitals. The missionaries and governor-generals built hospitals as well as orphanages after establishing more schools and colleges in the country.
Then after introducing their religion to Philippines people were converted as Christians and continue to practice being Christians. Because Christianity is humanitarian social welfare was an important goal in the Philippines as a colony. As early as the 16th century, the sick and the needy among the natives were given special care and attention. The very first hospital built in the Philippines in the year 1565 was a military hospital at Cebu. After six years it was transferred to Intramuros in Manila until when the Americans come to the Philippines by the 19th century, it was named as Sternburg Hospital in the year 1898 but during the World War II it was destroyed.
In 1578 a Franciscan lay brother named Juan Clemente founded the first hospital in Manila it was only made out of bamboo and other raw materials. By 1596 it was named and from this hospital developed the present Hospital de San Juan de Dios and become the hospital for teaching by the Unibersidad de Santo Tomas or known today as UST, another is the San Lazaro Hospital, now called Jose Reyes Memorial Hospital, two of the leading medical institutions in the country today.
Other early hospitals opened in Manila were the Hospital de San Gabriel in 1588 and the Hospital Real (Royal Hospital) in 1612. Hospitals were also established in the provinces. Among these were the Hospital de Aguas Santas in Los Banos, Laguna in year 1602, the Hospital de San Jose in Cavite by the year 1641, the Leper Hospital in Laoag in 1814, the Leper Hospital in Cebu in the year 1850, Brokenshire Integrated Health Ministries Inc. which is one of Davao City’s hospital, Chinese General Hospital, Philippine General Hospital and Baguio General Hospital.
Like other schools here in the Philippines most of the hospitals are also built during the Spanish era wherein most of it was founded by the religious orders to extend efforts for caring for the sick by building hospitals in different parts of the country. The first recorded exploratory laparotomy in the Philippines was done at the Hospital de San Juan de Dios by the Philippines’ finest surgeons in 1900. During this time surgical instruments were washed and polished with the belief that the brighter and shinier the instrument, the less danger there was of producing contamination.
During the Spanish possession, surgery was being practiced by Spanish barber surgeons, Chinese physicians, Dutch surgeons and physicians of various nationalities, although the type of surgery is not known. The Philippines was at the center of a busy trading route in Southeast Asia, even before the Spanish colonization. B. Classification of Hospitals in the Philippines 1. Government or Private: Government Hospital – operated and maintained partially or wholly by the national, provincial, municipal or city government or other political subdivision, board or other agency thereof.
Private Hospital – privately owned, established and operated with funds raised or contributed through donations, or by private capital or other means by private individuals, association, corporation, religious organization, firm company or joint stock association. 2. General or Special: General Hospital – provides services for all kinds of illnesses, diseases, injuries or deformities. Special Hospital – primarily engaged in the provision of specific clinical care and management.
It must have an ancillary and support services appropriate for the given service capability. 3. Service Capability: The DOH classifies hospitals into four levels depending on service capability, as detailed in DOH Administrative Order no. 2005-0029. Each hospital level is briefly described below: • Level 1: An emergency hospital that provides initial clinical care and management patients requiring immediate care. Clinical services include general medicine, pediatrics, obstetrics, nonsurgical gynecology, primary clinical laboratory, first level radiology and pharmacy.
• Level 2: A non-departmentalized hospital that provides clinical services such as general medicine, pediatrics, obstetrics, surgical gynecology, secondary clinical laboratory, first level radiology and pharmacy. • Level 3: A departmentalized hospital that provides particular forms of treatment, surgical procedure and intensive care. Clinical services provided include general medicine, pediatrics, obstetrics, surgical gynecology, tertiary clinical laboratory, secondary level radiology and pharmacy. • Level 4: A teaching or training hospital that provides clinical care similar to Level 3 as well as sub-special forms of treatment.
Clinical care is also similar to level 3 as well as sub-specialty clinical care as well as third level radiology. II. Performance of the Industry A. General The Philippine health care system consists of government and private health, diagnostic, and treatment facilities spread unevenly across the archipelago. Government health facilities tend to focus on providing preventive, curative and rehabilitative services while private facilities provide direct personal care that is curative and rehabilitative in nature.
The government health care system, which is mostly directed towards the low-income groups, consists of barangay health stations, with a midwife, and rural health units. As in other dynamic societies, the role of hospitals has constantly evolved and expanded to meet the growing needs of the population as well as to harness the hospital’s potentials given its unique position as an institution in society. Some views, opinions and observations on the role of Philippine hospitals are presented below.
Stressing the interrelationship between the hospital and other health and non-health services thus, expenditures for preventive health services should comprise a large component of the total health expenditure. Health status may be significantly raised if all preventive measures are exhausted so that the relatively high cost curative measures, those that hospitals are meant to provide, can be minimized. It is therefore necessary to assess the improvement in health status brought about by hospital services. A general hospital has the four basic services: pediatrics, surgical, medical and obstetrics-gynecology.
A special hospital, as defined in R. A. 4226, “deals exclusively with specific organs of the body like the Philippine Heart Center, National Kidney Institute, and other certain conditions just like the San Lazaro Hospital for infectious diseases, or even certain groups of the population like the Philippine Children’s Medical Center. The size or bed capacity also determines the classification of hospitals. Primary hospitals are those with less than 25 beds, secondary are those with 25 to 99 beds, while tertiary are those with 100 and more beds.
An additional classification found under RA 4226 is according to ownership and control. Hospitals could be private, under the Department of Health, or under other government agencies like military hospitals. Private hospitals continue to be one of the vital institutions that provide health care services to the majority of the Filipino population. In 2009, 60% of the hospitals are privately-owned. With regard to utilization, 48% of the population who needed inpatient care is confined in private hospitals.
Even with their large contribution, these institutions are also affected by the political, social and economic dynamics of the country which, in return, may disrupt viability, sustainability and investment. For Metro Manila, 72% of all its hospitals are privately-owned. Bulk of the beds in the whole country is concentrated in this region. Also, a large proportion of Level 4 hospitals are located in Metro Manila. Quezon City has the most number of hospitals, while Valenzuela City and Pateros do not have any. Metro Manila has quite a number of Level 1 and Level 2 private hospitals, comprising 63% of all private hospitals in the region.
Interestingly, only 11% are Level 3 hospitals and 34% are Level 4. Like other enterprises, for-profit or not-for-profit, hospitals in the Philippines are essentially engaged in the conversion of resources into desired outputs in the process of production. As in other production processes resources can be combined and utilized in various alternative ways to produce the same set of outputs. The decisions involved in the conversion of resources into outputs are called managerial decisions. Taken broadly, this includes the activities of planning, organizing, implementing, and controlling the conversion process.
In economics, managerial decisions can be evaluated in terms of the efficiency by which resources are utilized to attain the goals of the organization. A hospital’s performance is difficult to measure because of the high degree of subjectivity. In general, it may be said that the objective of a hospital is to provide quality patient care while maintaining the financial viability of the organization. There are, of course, other objectives related to other activities of specific hospitals such as research and training.
In this study, the focus will be on the more general objectives. Hospital performance will be measured through indicators such as death rates and patient satisfaction for quality, and liquidity and profitability for its financial viability. Hospitals, like most other organizations, do not operate in isolation. Various factors surrounding the hospital and even within the hospital affect its degree of success or failure in attaining its objectives. These factors include the nature of its resources (capital, human, technology, etc.
), competition, markets like consumers and government regulations and incentives. External factors, other than government, also affect the performance of hospitals. These include their cooperation and competition among each other, technological development, socio-cultural factors, hospital networking, and health care financing. Internally, hospital performance is directly affected by the background of its decision makers, its planning processes, its organizational structure, its implementation and control systems, and the quality and quantity of its resources, among others.
Hospital performance, both in the technical and financial aspects, is subject to the change in conditions. The economic affects to the demand for hospital services as well as the hospitals’ access to the resources needed to meet these demands. The major economic factor affecting demand for hospital services is personal income. It is estimated that 70 to 80 percent of the Philippine population is medically indigent; another 5 to 10 percent can pay for basic health care out-of-pocket, while only 5 to I0 percent can afford to pay for catastrophic illnesses.
Higher income levels do not necessarily mean a proportional increase in demand for hospital services but it increases the demand for higher quality services. This also means an improvement in the consumers’ capability to pay for better service. A continued increase and improvement in the distribution of personal income will therefore mean a shift in the demand from low rate to higher rate rooms in hospitals, allowing hospitals to improve their rate of cost recovery.
According to the latest report in 2006 by NSO, private hospital sector employed a total of 77,088 individuals, an average of 123 employees per hospital. Majority of these employees are in NCR and CALABARZON, where most of the private hospitals are concentrated 68% of private hospital employees are female. Paid employees refer to all persons working in the establishment that receive pay and those working away from the establishment paid by and under the control of the establishment. These include those who were on sick leave, paid vacation or holiday.
These do not include consultants, home workers, workers receiving pure commissions only and those on indefinite leave. With about 1. 2% of the employees are unpaid and this pertains to those working owners who do not receive regular pay. These also include apprentices and learners without regular pay and persons working for at least 1/3 of the normal working time of the establishment without regular pay. This is prevalent in the health sector due to a substantial number of registered nurses who agree to work in hospitals even without salaries in exchange for work experience.
The Philippines’ Department of Health (DOH) is the principal health agency in the Philippines. It is the executive department of the Philippine Government responsible for ensuring access to basic public health services to all Filipinos through the provision of quality health care and the regulation of providers of health goods and services. The recent change in political leadership provides the Philippines with the chance to revitalize the health care system.
This is in line with the administration’s thrust to prioritize delivery of services to the masses and improve the quality of life of all Filipinos, especially the poor. The differences in health status among various groups and regions in the country have widened through the years. These disparities indicate deficient economic and social policies, showing the need to reprioritize interventions to promote equity, fairness and immediate action. Unnecessary and unfair gaps in the health care delivery system that deprive the poor of access to basic services must be reduced.
The system must work efficiently to reach the highest possible health standards that can be shared by all Filipinos, given the limited resources available for health. Although socioeconomic differences significantly influence health status, the equitable distribution of quality health services is an important measure of fairness in the country. Revitalizing the health care system must be seen within the broader context of several forces affecting the delivery of basic health services in the past two decades.
Among these factors are the devolution of health services to local governments, passage of national legislation for universal coverage for health through social insurance, the epidemiologic shift and current double burden of disease brought about by the rise in degenerative diseases and the re-emergence of previously controlled infectious diseases, demographic trends pointing to longer life span, greater number of adolescents and youth, rapid urbanization, industrialization, environmental degradation and climate change.
Under these realities, the health sector must work to attain a common vision of health for all Filipinos. Its mission is to ensure accessibility and quality of health care to improve the quality of life of all Filipinos, especially the poor. This year the Health industry in the Philippines has a budget of 33. 3 billion pesos. Well basically it is not for the hospitals or health care alone but most of it is allotted for healthcare subsidy to the less fortunate. With the budget of the country for health only a very little percent are given to private general hospitals.
Aside from the people it is allotted also to the improvement of the healthcare system in the country. The only part of the private general hospital in that budget is when the government give fund to the different studies conducted regarding health and healthcare system by the private hospitals or schools. Top three players I. St. Luke’s Medical Center St. Luke’s Medical Center (SLMC) has provided high-quality healthcare for over a century. It was founded in 1903 with a mission to provide outstanding out-patient care.
Today it is the foremost and most admired hospital in the Philippines and an acknowledged leader in Asia. St. Luke’s delivers on its mission of healing by gathering less than one roof the finest medical expertise, the most sophisticated medical technology and facilities, and a deep-rooted culture of compassion. It supports this mission with research and continuing education for those who serve. The total dedication to quality and caring of the St. Luke’s family is what distinguishes the hospital as a center of healthcare excellence in Asia.
The 650-bed hospital is home to ten (10) Institutes, eight (8) Departments, and twenty-three (23) Centers. These centers of excellence bring to the Philippines the latest medical advances and treatment modalities. Over 1,700 hospital-affiliated medical consultants see out-patients in more than 450 private clinics. SLMC is the undisputed leader in virtually all medical specialties, including cardiovascular medicine, neurology and neurosurgery, cancer, ophthalmology, and digestive and liver diseases. It is the first choice of medical and health-related practitioners and patients for executive check-ups.
SLMC receives patients from around Asia, Micronesia, the Middle East, Europe and the United States. With its rich legacy of excellence and a second new and modern facility at the Fort Bonifacio Global City, SLMC is in a position to realize a bolder vision of the institution as one of the top five hospitals in Asia by 2010. II. The Medical City The Medical City (TMC) is a tertiary care hospital with over forty years of experience in hospital operation and administration. Its world-class care complex serves some 40,000 in-patients and 400,000 out-patients annually.
TMC has a medical staff of over 1,000 physicians who are established experts in their various fields of specialization. This core of professionals is complemented by a 2,200-stronf human resource complement, engaged in allied medical, administrative and support services. It is under the name Professional Services, Inc. At the heart of TMC’s service philosophy are new paradigms of hospital care addressing the entire continuum of health needs, and the patient as an equal, informed and empowered partner in the pursuit and preservation of health.
TMC is accredited by the Joint Commission International (JCI), the world’s most prestigious accrediting body for international health care organizations. The facility is located on a 1. 5-hectare property along Ortigas Avenue in the business district of Pasig City, Metro Manila. It is composed of 115,000 square meters of floor space and includes two Nursing Towers, which can be fitted for up to 800 beds, joined by a Podium, bridge ways, and a Medical Arts Tower. The 18 floors of Medical Arts Tower house 280 doctors’ clinics and select commercial spaces.
Located within the six-floor Podium are diagnostic intervention facilities, as well as support and administrative offices. The three-level basement parking accommodates over a thousand vehicles. The complex is also equipped with a broad range of state-of-the-art-security features, an advance building management system, and biosafety features incorporated into sensitive patient areas. III. Makati Medical City Makati Medical Center is one of the top medical research and training facilities in Asia, and the Philippines’ premier hospital.
Our decades of innovation and service to our patients, their families, and our community show our deep commitment to providing outstanding patient care, pioneering significant research initiatives, and training new generations of healthcare providers who can proudly continue our tradition of excellent health service with a heart. Makati Medical Center has earned the distinction of being one of the best-equipped hospitals in the country and in Asia. We have the most capable staff that extends the best quality medical care to our patients, regardless of race, creed, or economic status.
MakatiMed there is no distinction in the way we provide health services. We treat our charity cases in the same way we treat our wealthy patients: with respect, courtesy, and the best treatment possible. Before our tie-up with the Makati City government for the Makati Health Program (MHP), we had our own charity program in Makati and other cities, municipalities, and provinces. Their training program has become a magnet for the country’s best and brightest medical graduates. Our school of nursing likewise assures patients of high-quality care from well-trained professionals.
Their decades of innovation and service to our patients, their families, and our community show our commitment to providing outstanding patient care, pioneering significant research initiatives, and training new generations of healthcare providers who can carry on our tradition of excellent health service with a heart. B. Number of players/competitors in the industry According to the Department of Health under the Bureau of Health Facilities and Services the Philippines has a total of 1,796 licensed hospitals in the year 2009. It is a total of 96,141 beds service the entire Filipino population or a 1 to 800 people ratio.
CALABARZON has the most number of hospitals followed by Central Luzon and National Capital Region (NCR)/Metro Manila. On the other hand, Autonomous Region of Muslim Mindanao (ARMM) has the lowest number. Sixty percent (60%) of all hospitals are privately-owned or classified as private hospitals. CALABARZON has the highest number of private hospitals followed by Central Luzon, while ARMM has the lowest number. C. Market Share Private General Hospital or Hospital Industry is under the Health and Social Work Industry classification. It is one of the smallest industries in the Philippines aside from Agriculture, Fishing and Mining Industries.
According to the National Statistics Office (NSO) on the 2008 Annual Survey of Philippine Business and Industry (Preliminary Results) latest figures of the market share of Health and social work industries is 0. 86%. Hospital activities and medical and dental practices earned the highest revenue amounting to 58. 1 billion pesos or 97. 3%. The shares of social work were 1. 6 billion pesos or 2. 7%. Hospital activities and medical and dental practices also spent the biggest cost with 44. 2 billion pesos or 97. 6%. Lastly, the remaining 1. 1 billion pesos or 2. 4% were spent by social work industry.
Industry DescriptionPercentage 1. Agriculture, Hunting and Forestry0. 82 2. Construction2. 45 3. Education1. 43 4. Electricity, gas and water6. 68 5. Financial Intermediation9. 95 6. Fishing0. 19 7. Health and social work0. 86 8. Hotels and restaurant2 9. Manufacturing45. 77 10. Mining and quarrying0. 78 11. Real Estate, renting and business activities 4. 82 12. Transport, storage and communications7. 17 13. Whole sale and retail trade15. 81 14. Other community social and personal service activities1. 29 On the top three companies in the Private General Hospital Industry, St.
Luke’s Medical has the highest market share in the industry with 8. 6%, next is the The Medical City which is 5. 08% and lastly is the Makati Medical City with 5. 03% market share while others are 81. 29%. Market Share = total revenue of the company Total revenue of the industry * 100 I. St. Luke’s Medical Center 5,135,782,959 59,700,076,000 * 100 = 8. 60 II. The Medical City 3,032,239,965 59,700,076,000 * 100 = 5. 08 III. Makati Medical Center 3,002,193,808 59,700,076,000 * 100 = 5. 03 IV. Others 48,529,859,268 59,700,076,000 * 100 = 81. 29 D. Type of product/service produced.
Private General Hospital commonly offered almost all of the services in the hospital from emergency care, healthcare to personal care and up to special type of illness and diseases. There are three types of services offered by the private general hospital: the Medical Services, Ancillary Services and Administrative Services. A. Medical Services 1. Department of Surgery This department is responsible for major and minor operations such as the removal of cysts and warts, appendectomy, orthopedic cases, etc. It is furnished with instruments, equipment and supplies to meet the medical needs of the patients.
These include anesthetic agents, drugs, and supplies to combat shock and hemorrhage, special lighting for illumination of the operating field, sterilizing facilities, and many others. 2. Department of Pediatrics This department is responsible for the prevention, diagnosis, care, and treatment of children’s diseases. It embraces the care of all children less than 21 years of age, including the new-born, except, however, in cases involving contagious diseases and orthopedics. This section is composed of the immediate care room for the new-born – one for babies born in the hospital and another for those born outside.
Low birth weight infants and full term ones that are weak are confined in the nursery until their conditions permit home care; otherwise, the new-born stays only for two to three days after birth. 3. Out-Patient Department This is the connecting link between the hospital and the community, and is charged with the following functions: (1) maintenance &good health, (2) disease prevention and promotion of community health, (3) health education, and (4) care of the sick and family welfare. It participates in the training of the resident staff and the medical students.
Aside from the prenatal clinic, this department also has clinics for well babies (for growth and development as well as immunization); sick babies both premature and mature ones; gynecology clinic with the sterility, tumor and cancer detection clinics; dental; and nutrition clinics. 4. Department of Gynecology This department is concerned with the diagnosis and treatment of its woman patients with conditions affecting the female generative organs. It is also concerned with preventive and promotive functions as in cancer detection, including breast cancer, and lactation management. B. Ancillary Services
1. X-Ray Unit The X-ray service is one of the most important facilities of the hospital. It provides service to all the hospital patients. This facility has been a valuable adjunct in the management of medical, surgical, obstetrics, pediatrics, and gynecological cases. Certain provisions, however, are made to protect patients and employees against over exposure to X-ray radiation, radiation from radium and other radioactive substances. 2. The Pharmacy Service The Pharmacy service provides the drug and medicine requirements for both in-patients and out-patients. 3. The Dental Health Service.
The Dental Health Service provides and maintains standard dental health services to hospital patients. Aside from the care of in-patients, this service also takes care of patients in the out-patient department. 4. The Nursing Service The Nursing Service provides safe, effective, and well-planned nursing care for patients in the medical departments of the hospital. This service includes activities pertaining to the care of patients, technical care or the carrying out of treatment prescribed by the physicians, and those relating to prevention and rehabilitation. It is also involved in research work for the improvement of patient care.
5. Laboratory Department This department provides facilities for the application of scientific techniques for the diagnosis and control of diseases and for the scientific investigation of clinical phenomena associated with the disease. This department performs all laboratory examinations and provides facilities that will help arrive at the correct diagnosis. The services include fecalysis, urinalysis, blood chemistry, and anatomical pathology. It is also responsible for the bacteriological examination in the different units of the hospital, like the operating room, delivery room, series, central formula room, and the central supply unit.
6. Anesthesia Unit The Anesthesia Unit of the hospital provides and maintains standard professional anesthesia service to operative and delivery cases. It is concerned with two specific functions: a) to render patients insensible to pain; and b) to provide supportive therapy for surgical patients before, during, and after the operation. C. Administrative Services 1. The Administrative Services The Administrative Service directly supervises the following sections: business, personnel, cashiering, dietary, linen and laundry, property and procurement, maintenance and motor pool, dormitory, housekeeping and security.
2. The Accounting Service The Accounting Service maintains a recognized system of accounting and is responsible for all accounting data and the financial records of the hospital including cost analysis and billing. 3. Budget Office The Budget Office is responsible for providing assistance to the management of the hospital in the preparation of the annual, quarterly and other levels and types of budgets. It also monitors budgetary overruns and other discrepancies from the approved budget. E. Type of competition existing.
Private General Hospital or Hospital Industry has a very tight competition among its number of players because medical and health care are essential to everybody. They always have high demand because sickness and health are uncertain and all consumers are affected by it every now and then. Private General Hospital or Hospital Industry has a monopolistic competition existing. It is monopolistic because hospitals are the only firms that offer medical and health care services. There are many firms in the industry but the only difference is the different or special services offered by the firm.
Even though they are all private general hospital, competition exists on the quality of services offered by different firms/players of the hospital particularly the private general hospital industry. F. Degree of competition among players Hospital Industry has a very difficult or tight degree of competition among its players because since it has a monopolistic type of competition, the players/firm of the industry is almost close to each other. Even though it is a monopolistic type of competition no firm/player dominates among others because they all have close market share in the industry.
Competition exists on the quality of services given by a certain firm/players and the technology and other factors used in production of its services. Competition will also engage its players to cross-subsidization. With this not only the consumers will benefit but the firms/players as well. It can move the price of the services offered and at the same time enhance its quality of services offered. G. Pricing behaviour used by the players for revenue generation Firms belonging to the Private General Hospital Industry are price searchers.
They can control their price, make it higher or lower and still consumers will pay they services, their goods and services are perfectly inelastic because there are no perfect substitute to it. Unlike the price takers, price searchers have no limitation and may possess substantial market power. But even though price searchers have freedom on the prices of their goods and services yet they still need to search on how they can have profit-maximizing price.