The costs of COVID-19: Dealing with soaring hospital bills amid grief
Nothing is expensive if a person’s life is at stake.
But for some families who had members who were hospitalized due to COVID-19, settling huge hospital bills has gotten in the way of recovery or, in worse cases, dealing with the grief of losing someone.
When Jayson Biadog decided to bring himself to a private hospital in Mandaluyong last February after days of flu-like symptoms, the cost of hospitalization was the furthest from his mind.
“Hindi ko alam na ang mahal pala dun (I didn't expect it was expensive there),” he said in a recent interview with PhilSTAR L!fe. “Nung second day, gusto ko nang lumipat (ng ospital) kasi P92,000 na ‘yung bill ko (On my second day, I wanted to transfer because my hospital bill already reached P92,000).”
Jayson said he was discouraged by his nurses, who noted the challenging situation in public hospitals and the risk of having to transport him while suffering from severe symptoms of COVID-19.
He relented, recognizing the capability of the hospital to take care of his needs at a crucial time of his life. “Sabi nila, ‘yung pera pwede mong kitain, pero pag namatay ka, di mo na (mababawi) ‘yun (They told me that money can be earned, but life once lost can not be regained).”
Discharged after 11 days in the medical facility, Jayson’s bills soared to over P600,000 – an amount that he did not have that time.
Fortunately, more than half was covered by the Philippine Health Insurance Corp. (PhilHealth), while another P150,000 was settled by the health insurance provided by his company.
He signed a promissory note for the remaining amount, adding that a friend was able to talk to a hospital official regarding his case, allowing him to leave without having to settle the remaining balance.
Compounding grief
Jayson’s hospital bill, expensive as it is, is just a small fraction of what others have to deal with.
A recent Philippine STAR report noted how the Abong family in Cavite racked up a hospital bill totaling close to P5 million after the prolonged confinement of the head of the family, Rodolfo, in the intensive care unit (ICU).
While most members of the family who contracted the viral illness recovered, Rodolfo passed away after a month-long battle with COVID-19 and severe pneumonia.
“Any amount of financial support will go a long way for us,” said Rodolfo’s eldest son Kevin, stressing that COVID is no joke.
In Laguna, a family is also dealing with grief while they complete paperwork needed to secure financial assistance from different government agencies.
'We did not realize that it will be this much.'
Dan (not his real name) said they did not expect the hospital bill to reach P1.9 million when they brought their mother to a private hospital after she contracted COVID-19. She passed away two weeks later.
“We know it was going to be costly because anybody who stays in the hospital, especially the ICU, that’s going to generate some costs. But we did not realize that it will be this much,” he said in an interview.
“We heard stories in the past, some folks who stayed in the hospital garnered about a million… We know it’s going to be much, but we didn’t expect it to be two million,” he added.
While they were able to secure a discount since their mother was a senior citizen, much of the bill remained unsettled, with the hospital requiring the family to assign their car as a collateral in their promissory note.
Going through the bureaucracy of securing financial assistance is a double-edged sword, said Dan, who admitted being not familiar with the local processes as he spent most of his years outside the country.
“It kinda helps you move forward because you’re busy dealing with certain things. But at the same time, you’re not grieving properly,” he added.
Healthcare support
For decades, hospitalization in the Philippines meant having to line up at offices of politicians and government agencies – most notably the Philippine Charity Sweepstakes Office – to ask for financial support to settle bills, secure expensive procedures or buy medicines.
According to the National Economic and Development Authority, 54.5% of the total health payment in 2017 came from Filipinos’ own pockets, with medicines and drugs as main contributors.
In 2019, President Duterte signed Republic Act 11223 or the Universal Healthcare Law, automatically enrolling every Filipino citizen into the national health insurance program provided by PhilHealth.
But even before the new law could take off, the pandemic happened, putting another burden on the already deteriorating state of the healthcare system in the country.
While confinement and hospitalization in public hospitals are generally free, the limited number of hospital beds has left many families with no other option but to bring their loved ones to private hospitals.
While confinement and hospitalization in public hospitals are generally free, the limited number of hospital beds has left many families with no other option but to bring their loved ones to private hospitals.
Based on current guidelines, PhilHealth only covers a certain amount for COVID-19 patients confined in private hospitals: P43,997 for mild pneumonia in the elderly or those with co-existing conditions; P143,267 for moderate pneumonia; P333,519 for severe pneumonia; and P786,384 for critical pneumonia.
The rest is often shouldered by the family or in some cases, by a private health maintenance organization, insurance company, or financial assistance from politicians or government agencies.
In April, following reports that some patients have been placed in tents due to lack of space in hospitals, PhilHealth said they are reviewing their existing policies to better respond to the “extraordinary demands” brought about by the pandemic.
“PhilHealth fully acknowledges the current situation where patients are temporarily placed in tents because hospitals can no longer admit them in regular hospital beds,” it said.
“PhilHealth guarantees that COVID-19 patients are entitled to health insurance coverage for RT-PCR tests, isolation in accredited community isolation units, and hospitalization for mild to critical cases of COVID-19. Be it COVID-19 or not, patients should be afforded with all the financial help as guaranteed by the Universal Health Care Law,” added the state health insurer.
Expenses
The amount of expenses incurred by COVID patients depends on various factors, from the type and location of the hospital to the length of stay and the severity of the illness.
In most cases, those confined in public hospitals only have to shell out a fraction to cover expenses not shouldered by PhilHealth, such as medicines that are not available at the hospital and that the family has to procure using their own money.
According to the Department of Health, Remdesivir – an investigational drug for COVID-19 that requires compassionate use permit from the Food and Drug Administration – costs between P1,500 to P8,000 per 100mg vial, although there have been reports of overpricing due to high demand.
At the usual adult dosing of 100mg for five days after an initial 200mg, the cost can easily reach up to P50,000 just for a single drug.
Expenses further skyrocket in private hospitals, which make up most of the healthcare institutions in the country.
Most private hospitals do not publish their room rates, but some reports note that confinement at the intensive care unit can cost around P3,500 per day, with some patients having to pay as much as P6,000 in some institutions.
Laboratory tests and use of ventilators and other machines may cost hundreds of thousands, on top of professional fees that could even reach over a million after being confined for almost two months.
And room rates are just a fraction of what makes up the total expenses. Laboratory tests and use of ventilators and other machines may cost hundreds of thousands, on top of professional fees that – in one case shared online – could even reach over a million after being confined for almost two months.
Patients also have to shoulder medical supplies and, in some of the reported cases, even the personal protective equipment used by health personnel looking after the patient.
While there are free ambulance services available in some local government units, the surge in COVID cases often affect the demand, prompting some families to tap the services of private providers.
Cost of ambulance services can range from P4,000 to P20,000, depending on the location and additional expenses such as hazard pay, PPE and medical supplies used during the transfer.
Best possible care
But thinking about the cost is often at the back of people’s minds when life is at stake.
Dan said it never crossed their mind to transfer their mother to a public hospital despite the growing hospital bill while she was at the ICU.
'At that point, we’re emotional and we wanted the best for her, and it doesn’t matter how much the cost.'
“At that point, we’re emotional and we wanted the best for her, and it doesn’t matter how much the cost. We thought that it would be difficult knowing that hospitals are getting filled up and resources are limited in terms of bed, medical staff and even medicine at some point,” he said.
“I think the fact that nanay got into the hospital at the time she did, they were able to accommodate her, we thought that it is okay to stay here. Because if we tried to pull her out and bring her somewhere else, she may have to fight for a bed or other resources available,” he added.
Wake-up call
In the case of Jayson, he hopes that his experience would serve as a wake-up call for those who do not take the pandemic seriously, saying he does not want others to go through what he did.
“Hindi naman ako naniwala sa COVID talaga, sabi ko malakas ako. Hindi ako nagba-vitamins… Hindi ako nagsa-sanitize ng pagkain (I did not really believe in COVID, I thought I was strong. I was not taking vitamis. I was not sanitizing food),” he recalled.
And then he started exhibiting symptoms, which worsened as days went by. “Akala ko mamamatay na ako (I thought I was going to die),” he said, noting how it was traumatic to deal with it alone in the hospital.
Calling it his second life, Jayson said he has adopted a healthier lifestyle since and decided to return to Bacolod and just work from home to minimize risks.
“You need to take it seriously,” he advised others, saying it is more difficult and expensive to deal with COVID once you contract it. “Invest in your health kasi ‘yun ‘yung number one priority.”
Life, after all, is not the only possible cost of COVID-19. (with Allane Mondodeño Orendez)