Live in the Philippines

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What would you do?

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As you can imagine, I get a ton of e-mails, day in and day out.  No day goes by that I get fewer than several dozen e-mails through this site.  Some e-mails are friendly.  Some are not.  Some ask for assistance with things that I can help with.  Other e-mails seem to ask for assistance, but I am at a loss for what I can do to help.

Last week, I got such an e-mail where the person who e-mailed me seemed to be asking for my assistance in some way, although not specifically saying how I could help.

Today, I thought I’d share the e-mail (but not using any real names), and ask you what you would do if you were in the situation.  Here is what I received:

Hello, I’m a regular reader of live in the Philippines (though I don’t comment),and would like to share a story with you.

My husband is a Filipino (I am from Europe), and trained abroad as a specialized surgeon before coming back to settle in the Philippines. How naive of him to think the 15 years he spent studying medicine would enable him to make enough money to support decently his family!!!

Well, that would probably be the case if patients were fair and recognize his work. Unfortunately that’s not always the case, and today is the last straw for me.

He’s working in several hospitals, some public, some private. We both agree from the beginning that considering the income of the people going to the public hospital, his fees would be considerably lower there. In fact some families are not even able to pay for these “special” fees, and we totally accept that : that’s our way to help the less lucky people.

But today it’s a private patient (i.e. a patient going to a private hospital) who is telling him “sorry, but he doesn’t have the money to pay for the bill, thanks for the operation”.

Enough!!! How does he think my husband is paying for HIS bills? The groceries? The house rent? Even the gas for him to go to the hospital and saving his life? If you choose to go to a private hospital, can’t you think about the fees that will have to be paid? Is it unfair from my husband to ask to be paid for the hard work he is doing?

And what motivation does it give to the guys studying medicine right now? Well, only the motivation to finish their studies in some countries where they will be recognized as valuable people who deserve a salary.

My husband is more than understanding when it comes to financial problems, but people really need to learn to be a bit more responsible about their choices, and the impact it can have on their future and the future of their countries. I know this is nothing really new, but still it hurts to realize you’re taking for a complete fool.

Sorry for my rant, I feel so frustrated for my husband and my family right now, and you were the only “ears” I could express my anger to. And I thought you could help me a way or another to put things in perspective…

OK, so this fellow went to Medical School and got his license to practice medicine.  Certainly, he spent a lot of time and money becoming a doctor.  He offers his services at a discount to the poor (perhaps even free?).  But, in this case, a person with no money checked into a private hospital, got the operation, but could not pay.  What do you think?

Let me share what I think.

I feel in some ways that there is more to the story than what is being told.  The number one reason I think that is because in the Philippines, usually the fee is demanded up front before something like surgery is done.  Either fee up front, or in some way it must be known that the money is available.

That said, I do feel that the person who wrote this e-mail to me seems to be sincere, although very upset.  I don’t think she is making up the story, she seems too sincere for that.

What should the doctor do?

Reader Interactions

Comments

  1. Maybe he can submit his bill to the hospital. It seems that the hospital always gets their fees up-front in the Philippines, so perhaps the hospital should pony-up for the surgeon’s bill.

  2. That is an interesting case. I too would have to know more details about what was said or agreed upon. If it were the same as here in the USA then a person would either have to pay a co-pay with insurance or full rate up front unless payment arrangements were made prior to the surgery. But it is not in the USA it is in the Philippines and I know the laws are different.

    I am not sure what type of advice someone might be looking for but perhaps a lesson learned could be taken from this. Next time insist on money upfront even if the services are being offered at a discount price. Business is still business and they are obviously not doing this for free.

    • Hi Darin – Wow, thanks for sharing that. Is that the way things are in the States now? In my years of living there, it always seemed that whatever medical care was needed was taken care of and payment was worried about later. I guess things have changed!

      • Yes, I had to go to the ER this past year. It was the hospital where I work and I used my insurance so there was a $75 ER co-pay. The insurance took care of about $800 and I had to make payments on $450 for my deductible. So yes I guess somethings have changed.

        You should leave paradise and come back to the US sometime. LOL!

          • Hi Bob, There are sighns posted in just about all Emergency rooms here in the U.S.,that states you will not be refused medical treatment based on your ability to pay! It’s against Federal Law!

              • Exactly Bob, I’m not saying that people abuse it here…..They just don’t have a clue about anywhere else in the world! Pretty good country,I guess? Can’t wait till next year to get back to Leyte!……Bravo on A.J.!

      • Bob…There are many ER’S in the USA that take people in that have no money and in a lot of cases do not receive any money for their services.Unless the law has changed a ER can not refuse some body that is brought in for care. Of course they I am sure try to get paid and some states have Medicaid that provides Medical coverage to low income individuals and families. Some hospitals write off a certain amount as charity and etc.Now as far as a person all ready knowing what is wrong with them, and trying to go in and get care…not sure about that if it is not a Emergency! As far as what this Doc that this post if about I belive he will have to decide on what he wants to do, I belive that is a decision he will have to make. It could be that you did not get all of the story or the rest of the story……on all of this……iteresting post….

          • Sounds like that to me to Bob that is was not emergency care…It could be this Doc has a big heart and is content and happy comming back to the Phillipines to do his part or do what he feels he wants to do…Maybe this Doc and his Wife are not on the same page on a lot of things…..who knows.

      • Bob

        Usually before getting surgery or something like that done, they will ask for your insurance info and get it approved before the procedure is done. In my case i have excellent insurance provided through the government where in most cases have no out of pocket expenses whatsoever. I have a story to tell about a friend that lives in Metro Manila who needed Gall Bladder Surgery. She was getting it done at a public hospital, but they would not do it until she had the money to pay in advance. So when she finally got the money they kept postponing the surgery for different reasons. She was in such agonizing pain for much of the time, but had no other choice. So she finally got the surgery done after a month and a half of waiting. So after the surgery was completed they found out she had lost the use of her right hand and is going through therapy for that. I just cannot comprehend this.

        • sounds like malpractice, i had my gall bladder removed also, as soon as it was known what the problem was, i had liposcopic surgery 3 days after i went in to meet the doctor who would do the operation, happy my insurance paid it, the bill was almost 19,000 dollar’s, 90 mins after the operation i was able to walk on my own, lipscopic is really nice 🙂 ( the hospital or doctor should atleast be paying for your friends therapy at the very least ) hope your friend gets better soon god bless.

          • I am a cardiologist in Jamaica. Less than 5% of pop have any health insurance. Everyone pays up front for all services. I do approx 10% charity work per day[zero fee] I choose the cases. I have no problem paying my bills ,my living standard is no different compared to when I lived in Cleveland ,Ohio. Any good cardiologist from the Phillipines who would like to join me are welcome . I need an associate. Must speak good English.

            Glen Lalljie MD

    • That is NOT how it is in the United States unless it is elective surgery. If the surgery is elective and non life threatening then payment arrangements upfront would have to made. Many members of my family are in the health care business here and I asked all of them.

      If the surgery is emergency and MUST be made to save the person or alleviate serious pain then the surgery will be performed, payments arrangements made later. Many many many people in the United States go to emergency rooms for just this reason…to get medical care and NOT have to pay for it until later. Usually these people do not have insurance.

      I dropped my health insurance awhile back, I had kidney stones (horrible pain) and I went to the emergency room. I got terrific treatment and did not have to pay a dime upfront. NOTHING.

      However, when I got the bill the pain from that bill was worse than the kidney stones. Health care in America is first class….if you can afford it. Ouch, I will be paying this bill for quite some time.

  4. Ok, so I read the article several times. Then sat down and gave it some real hard thinking. First comment would be, why did the Family move back to the RP when they knew already the standard of living? As a Doctor, they do not have a single patient per day, especially when one is a Surgeon who has been trained overseas. The overseas trained ones are in most demand and the most expensive. Like all Doctors in the RP, they first check the wallet before checking x-rays and blood pressure. It is wonderful and kind that they give of their time to the poor and needy, we all do it, and we could all do it a little bit more. But seriously, when a simple Thyroid surgery is billed at P250,000, a removal of a blood clot in the brain is about the same rate. One would not have to do many surgeries per week. But this seems to be not mentioned. So….. what really is the “expectation” of the Families standard of living? In the tradition of the Philippines, why did the Doctor not file a case against the patient so as to collect his fees? Come on people. I think some days that the national sport of the Philippines is filing cases. So am I sympathetic? Yes, I feel sorry that someone feels upset and angry, but, she won’t be going to her nipa hut in a squatters village to sleep with the cockroaches, rats and disease. We all have bad years, then we have better years. This is life. If it is truly so horrible, then we each have the choice to move on. At least those of us whom can afford it, such as Doctors and Lawyers and Politicians…..sigh…

    Their has also been discussion of a public health system, other than Phil Health. Maybe it is about time to take some of Imelda’s ill gotten gains and put it finally to good use?

    So I will sit on my fence and watch it all play out. Get over it and learn for tomorrow.

    http://ferdinandmarcos.wordpress.com/2009/06/23/chronology-report-of-ferdinand-and-imelda-marcos/

    • Hi Bob Newnham – I think it’s important to remember that Doctors have costs. If a doctor charges P250K for an operation, that does not mean that he takes home 250k to his family. He has to pay for office space, staff, and other expenses. You mentioned filing a case, and it being a national sport here (which I disagree with, BTW)… which would also mean that the doctor must pay for malpractice insurance and such. So, he is not getting 250k for the operation… his costs have to come out of that too.

      • the staff a surgeon will use is very expensive, in many case’s believe it or not anesthesiologist makes almost as much as the surgeon. if a operations cost’s 250k that doctor will be lucky to get 50 to 70k of that, so if that man paid nothing, that doctor would owe his staff and have actually lost money by helping that man

  5. Bob,
    one can only speculate on such an e-mail. Did the woman simply feel the need to blow off some steam? Was she hoping that “Dear Bob” would give advice that she could show to her husband and say, “You see? Even Bob agrees with me!” Perhaps, the husband came back to the Philippines with no concerns about making money & just hasn’t let his wife in on his benevolent character. Perhaps he needed a cover story because he left the money with his #2 or at a casino. Heck, one could speculate endlessly. If he was trained abroad, did he work abroad for several years after finishing his residency? Who knows. Maybe the woman married him because he was a med student & is upset that she is not yet the proud owner of a convertible Rolls Royce.

    As you seem to average about 8 new Facebook friends per day, I can well imagine that your e-mail inbox is constantly overflowing. Take a couple of days off and look-out, you’ll be snowed-under!

  6. If ever there was a country that needed a national health service it is the Philippines The doctors ,nurses etc are there but only the wealthy can afford care. My wife is a very highly qualified nurse with both Philippino and British degrees and when we can we try to do things to help – we have organised operations ,done clinical work in a poor barangay and generally helped when there were opportunities to do so.We do things ourselves as giving to charities – with some exceptions- is not cost effective – too many spend huge sums on administration – ie salaries of executives.I have found that if an expat gets involved that local doctors feel obliged to help – they seem to feel that they should show the foreigner that they will do the same as them .After a while I found that I could use a kind of moral blackmail to get things done. I am sure that many expats do charitable work – if not -they should.The only problem is anything you do has to be done very quietly as if it became known then you will be swamped by people at your gate seeking help.

    • Hi Bryan – I think that everybody deserves to have at least some level of medical care, however that would be handled financially. I personally tend to believe in the free market myself, but in some cases, the very poor, that is not necessarily the solution.

      • Bob -having a national health service does not prevent those that can afford it to have private health care. Have a look at the figures of infant mortality, child mortality and longevity – the USA with no socialised medical care, has figures worse than some African countries and Cuba. The rich (or well insured ) have access to the best health care in the world but surely a country with the comparative wealth of the USA should do better. On a cost basis the UK health service is half the cost per patient than the USA with better results.The real reason that there is no NHS in the USA is that too many private medical organisations are making huge sums of money.
        Although British I dont qualify for free health care as I spend too much time outside the country,my wife however works part time for the UK National Health Service so I know a little about it and have had treatment in the past with no complaints.Do not believe the nonsensical stories that were published in the American press and media when your president was trying to pass his health care bill – most of what I read were blatant lies.
        As an aside – I hope to visit Davao during my next visit to the Philippines in late January -perhaps we can meet up for a coffee – will let you know when I have definite dates.

  7. First of all, I am happy that this woman has found a place to vent her frustration. Feelings are always valid and need to find expression, even though the thoughts and beliefs that generate them may sometimes be in error.

    Whether or not her thoughts are in error is not for me to judge. I know very little about her circumstances, and even less about the thoughts and feelings of her husband, the doctor, whose circumstances she shares to a large degree.

    The great underlying truth that comes to my attention as I read this woman’s letter, and empathized with her fear and desperate frustration, is that we always create our own reality.

    Most people do not like to hear this, but, whether by deliberation or by default, we attract into our lives those things and circumstances that are consistent with the complex lens through which we view the world and the role we play in it.

    This lens is shaped by the compounded effects of our thoughts. And the great liberty and travail of the human condition is that we choose those thoughts.

    So the fundamental solution that I would offer her is the same as the solution that I learned (and continue to learn) when I finally allowed myself to become teachable: we are all 100% responsible for where we are in life.

    As long as as she thinks that the responsibility for her feelings is even 1% the fault of that patient who failed to pay his medical bill, she will miss the lesson and remain the victim.

    Few things in life are really “all or nothing”, but some things are, and this is one of them. It is amazing how much blame a person can pack into that 1% of non-responsibility. It is simply human nature.

    How to change one’s thinking is a message in itself. I will not get into that now. But I will remind the reader of the old saying “When the student is ready, the teacher will appear”. In other words, when we are seeking a solution as urgently as this woman seems to be seeking, we find the means to the solution. And we follow the solution when we find it.

    If we do not seek, find, and follow the solution, it means that our level of despair was not sufficiently motivating. In such a case, the problem will repeat itself, giving us a new opportunity for surrender and growth at a later time.

    • You are right, Dave, it is always a good thing to have a way to vent your frustration. If you let it build up, it will really blow out eventually. Whatever the solution, I hope that the writer finds peace.

    • Dave- I’m not so sure that the kids born in the Manila slums, who have insufficient food to eat, no medical care and no chance to go to school would agree with you that – as you put it-
      we are all 100% responsible for where we are in life.

    • Dave– philosophically (& metaphysically, if you will), quite true, and I agree with you. I do get what you mean. Few, however, have the luxury or gift to address their difficulties on some other level than the rut or vicious cycle of despair in which they’ve been stuck.

  8. I am not so sure national health care would woek there,go check out public schools in the smaller towns.

  9. Since the writer of the email is a daily reader maybe she will shed light on the subject for us. Also in the U.S. they can’t refuse to help you but if you don’t pay there are other things that will be done to the non-payer such as filing for liens against property and reporting to credit agencies thus ruining a persons credit. If you show an attempt to pay in the states even say $10 a month they will deal with it but don’t try to go out and buy a house or auto while that bill is hanging over your head.

  10. Hi Bob,
    Sounds like a disgruntled foreign lady,who dislikes living in Phils,having a rant.

    Anyone who has ever been self employed or run a business in any country,will know that occassionally you will get an awkward/arrogant customer who refuses to pay.
    Unless you can seize back the goods,which in this case you can’t,then you have to sue through the courts,extra expense,hassle and work.

    Being in the Phils,he could file estafa charges against the patient,however,i think it would be wise to check out the background of the patient before doing so,as there is always the possibility of other repurcussions if the patient is of serious dubious character.(You ain’t in Kansas no more).
    In the worst case scenerio,you just have to write it off and put it down to experience,sometimes sh*t happens.

    It appears it was a routine operation,not a life/death emergency,so in the future for routine surgery,he should ask for a sizeable deposit or money up front.

    I do however suspect there may be more to this story than meets the eye.
    regards,Chas.

    • Ya Chas…You ain’t in Kansas with the Tin man and Dorothy, but there maybe is a a Wizard there some place in the Philipines and heck, maybe even a Yellow brick road some place…But then carabaos can fly so…who knows there could be more to the story than meets they eye…..

      • Well I would say that yes, being self employed you are at risk on this kind of problem.
        The only difference is that on most of the business (I really don’t like to think about health care as a business), you can quite easily check your potential customers financial abilities.
        When it comes to health care, it’s quite hard (at least for my husband) to refuse to perform a life saving operation

        • Hi Mylene – In some cases it is quite difficult to check on people’s financial status, since most of my clients are abroad, and I’ve never met them personally. But, I agree that if I were a doctor it would be quite difficult to refuse somebody care, if it came down to financial ability.

  12. Bob,
    Seems to me that the lady left out a lot of key information and that their marriage is probably on the verge of going in the tank. From what I have read, most doctors in the Philippines, even the really good ones, earn far less than their counterpart in the States or in most countries of Europe. If they are struggling financially, as it appears (if you read between the lines) the knowledge that her husband could earn much more working just about anywhere outside the Philippines must be a heavy burden for her.
    Recently I read that for years, doctors have been leaving the Philippines in order to take nursing jobs abroad and then they are able to send more money home for their family as a nurse than they were making as a doctor. For such a noble profession, that in itself is a crying shame — a problem the government should address but they never will.
    In answer to your question, “What would you do”, well there really is nothing you can do short of taking on the role of spiritual advisor or marriage counselor, either of which I am sure you would not want to do.

    • You are right Rich, doctors here earn a small amount compared to their counterparts abroad. And, indeed, a lot of doctors from here become nurses in order to emmigrate!

      • Hi Bob,

        This is a nice discussion to a difficult problem. It’s sad that Doctors have to leave their profession for a job in another country to be able to support family. The best and brightest are leaving a country that they love for a position below their skill set. I am having a health issue and was talking to a bus supervisor friend about it. I was shocked to learn he was a doctor from his country. He gave great advice and I felt that I had a free office visit (in my office).

  13. Well I know of a person here in Kidapawan City who was sent to jail for owing 9,000p to a person they had borrowed the money from. Converted into NZ$ (where I come from) that is a princely sum of NZ$278 (US$208). In NZ for that kind of debt you MAY be taken to court and you would either pay it back at something ridiculous of $1 per week or you would do some community service such as cleaning up rubbish one time per week for a specified time.
    When I heard of this case of a person (that I know) being sent to jail for 9000p I texted my wife and told her to go to Western Union to collect 9000p and give to the husband to get his wife out of jail.
    So my recommendation would be that either you report the person and have them sent to jail or be compassionate and either work out a deal to get the money back or barring that pass it off as learning in the school of life.

    • Yes, Richard, estafa is a serious crime here, and you can go to jail for it, without a doubt!

      As for me reporting the person – well, firstly I don’t know the names of anybody involved, where they are located or anything. Also, I would not want to become involved to that extent.

  14. Well, I read this letter with a lot of sympathy. I have several close friends who are doctors here in the Philippines. They do have a lot of expenses, plus the BIR is on them in very unpleasant ways. My friends also help the poor all the time, waiving their fees and giving our med samples to those who cannot afford much. It is often the ‘rich’ who are the biggest deadbeats, like this lady said.

    Sometimes it is because they are living the life of the rich and are extremely in debt and overexteneded, sometimes they just are users and run up bills they never entend to pay, as a way of life. Legal action takes forever, and if the deadbeats are from a wealthy, or well known family, the doctor will never collect, and will be out the legal fees as well.

    Here are two example from people I know:

    1. The husband of a very wealthy, corrupt politician had a heart condition and a rare (for here) blood type. The family is landed and rich and powerful. They went to the USA for medical treatment and ran up a huge bill. The man died anyway of a burst anurysm. The widow put on poor clothes, wept and carried on, pleading poverty and being stranded in a foreign country, and got off scott free!

    2. A wealthy, landed, politically entrenched family. This older couple had three sons, all of them raised as spoiled rich boys (señoritos). The father fell ill and was in a hospital in a city 2 hours away, in ICU. The mother has arthritis and doesn’t travel. Everytime the oldest son was sent to pay the doctor and hospital bills, he spent 2/3 on himself and only paid 1/3 of the bills. Meanwhile, the second son, a drug addict, was cutting down the family coconut plantation and selling the wood to support his drug habits and high lifstyle. Son number three was the best of the lot and came home from abroad to try to make a go of the family fish ponds, only to have his brother show up and harvest his prawns two days before the planned harvest date. They probably still own the doctors and hospital large sums, but once the patient is dead it is a lot harder to collect.

    So, Doctor’s wife, I understand and you have my sympathy! I know that this is the way it is here in the Philippines. It is also hard to ask for money up front, risking offence and causing the patient to lose face, if you don’t know for sure they are deadbeats. Many make this the job of the secretary in the front section of the office, but once a patient is admitted, it is a lot harder.

    This is another big reason why doctors choose to immigrate abroad, even as nurses, to make enough money to live on. Being a doctor in the Philippines is no picnic, and fees collection, corruption and hospital politics, make working abroad look good.

  15. I don’t want to come into too many details here about our private life (don’t want to bring any problem on my husband).
    First thing: I kind of regret having mentioned that I am not a Filipino by birth, as it has in fact nothing to do the problem as I see it.
    I.e. a person chose to have a semi-elective operation in a private hospital, but in fact knew from the very beginning that he could not pay for the bills.

    Second thing: I checked a couple of facts with my husband, and it seems that on some points he disagrees with you.
    1. None of the surgeons he is in contact with ask for up-front payment.
    2. No, a doctor, a surgeon, or even an overseas trained surgeon is making millions a day, or a month, or a year.
    Once again, I don’t want to go into too many details, that’s why I won’t tell about my husband’s specialty, but he is far from being busy every day, even if he would be if he was working in a different country. Yes, there are times when he has 2 or 3 operations on a same day, but there are quite a few days a week that he is staying at home. Not his choice. Some people need the operation, but don’t have the money to pay for the hospital fees. So they just choose not to have the operation (and then some of you might tell us that he should do the operation for free then, which he would probably do if the patients had at least the money to pay for the hospital bills).
    3. The patient knows the fees before the operation, and agrees with it (and no, there is no contract signed).

    I asked my husband an update about this particular patient. He was released from the hospital, almost one week after he was supposed to go out: the hospital would not let him go before he paid the bills. The point is: the longer he stays in the hospital, the more he has to pay. So as not to put too much money burden on the patient, we agreed that the hospital discharged him even if he didn’t pay for my husband’s fees. We’ll see if he will finally pay us as agreed or not.
    Could my husband sue the patient? Well, probably. But we won’t (and we didn’t even think about it, to be true).

    A few more things: it was a shared decision that we move back here. Are we happy about our decision? Yes, thanks. Any regret? Nope. Am I banging my head against the wall because a patient did something that I think is unfair? No, I have better things to do. Do we have a communication problem in our couple? Is our marriage on the verge of going in the tank? No, thanks. I totally support my husband when he does most of his operations in a public hospital (i.e. very low fees, or no fee at all), even when it takes a (small) toll on our family life (i.e. night calls for emergency or week-end procedures). Are we in the Philippines to make money? No, that is certainly not what pushed us to come back here. Are we aware that we are living in far better conditions that most of the people in the Philippines? Absolutely, that’s why we are trying to give back to the community a way or another (and believe it or not, my husband is the one who is stopping me from giving even more).

    Mike (comments at 7.13 am), you really made me laugh with your comments. You couldn’t be farther from the truth on all the points you mentioned. Thanks for the laugh!!!

    Once again my point was not to complain about my life in the Philippines when I sent the email to Bob, I don’t even think I was looking for some answers or advices, because there is not much that can be done. (The only answer that I would like to get is from the guy himself: why did you go for private hospital if you could not afford it, when the same operations could have been done in a public hospital by a similar doctor for cheaper fees?)
    I was more thinking about the young guys/girls in the medical school and what they might decide after hearing about these experiences.

    As you are all probably aware, there is a leak of “brains” from the Philippines to the wealthier countries, it hurts deeply the medical sector (qualified doctors or surgeons choosing to work as nurses), and it’ll be even worse in the years to come. Can the Philippines afford this? Absolutely NOT.
    What would make them stay here? Working in decent conditions (I’m talking about the hospital equipment), for a decent salary (once again in our specific case, we’re not trying to become billionaires, or we should not have chosen to come back to the Philippines).
    I have to say that having unpaid bills on a too regular basis (especially from families that assessed they could pay for the bills, since they chose private service versus public hospital) could certainly be the trigger that make them decide to look for greener pastures…

    I feel sorry if some people think that I am heartless, demanding, or just “in the wrong marriage”. Writing (and even more writing in a foreign language) is not the easiest way for me to share my feelings.

    • Hi Mylene – I am happy that you decided to leave a comment and add a bit more clarity to the situation. I do hope that everything works out well for you and your husband.

      BTW, I don’t think you are heartless, Mylene, just concerned for your husband, and hoping for the success in his enterprise. I also don’t think that you are in a heartless marriage.

      I wish you the best!

  16. The doctor should grow a brain. I have had many health issues and see Doctors quite often and despite their low fees ranging from 300p to 1500p for an office visit there is not one among them all that doesn’t make over $100k to $200l + from both office and in-hospital treatment. I mean even on a typical day they might see 30 or so patients so that might be 9,000 to 30,000p a day just on office visits NOT including hospital related care which is where the real money is. I’m sorry but that is serious money in the Philippine and you would have to be brain dead not to make money here. Find yourself another doctor LOL

    • Thanks for suggesting that my husband is a brainless person, that’s always a nice thing to read.

      And do you know personally all these doctors, to be so sure about the money they’re making? Have you ever heard of turnover compared to profit? How much rental and other costs do they have to pay for their office or their clinic in the hospital?

      • I apologize. My wife calls me brainless all the time so I take the phrase for granted sometimes. Yes I will say it again that all the docs I know who have helped me make over $100k annually and their contemporaries do the same. They are located in Makati Medical and St. Lukes and Asian in Alabang. They all have very busy waiting rooms and their visitation fees are set. They also do lots of work in the hospitals with patients where the bigger money comes from. The numbers are the numbers. I also have a doc in the province. She gets 900p a visit and her waiting room is also packed on a daily basis and she floats between two hospitals alternating daily. She specializes in ECG and EKG as well as ultra sound. The point is the money is there for docs that want it. I am being redundant. Check it out yourself and you will see it is not difficult as a Physician to make this kind of money here in the Philippines. I am sure if Bob went to Davao Doc he would find the same after only little research

        • Thanks for your message.
          To be honest, my husband is far from making the money you’re mentioning. And once again, billing $100k annually doesn’t mean you get it all on your bank account (you have to pay for the clinic, the staff, taxes and so on).
          My husband came back only recently to the Philippines, it takes time (a lot of time) for him to get recognized by the specialists and get referrals from them (no referral = no operation), as they tend to refer their patients to the “older” surgeons.
          So yes, some doctors are making a lot of money (Filipino standards), but it’s much more complicated for some others.
          Not getting the payment from patients who allegedly can pay them (opting for private hospital) could just be the last straw to push the doctors to leave the country.

    • Thomad – I think you are being a bit harsh. Keep in mind that the doctor also has to pay his staff, building, buy equipment and such. Not all of that money that is paid for the visits is profit!

    • also think about this, she did not say her husbands exact area of expertise, however he will do operations, so he is probably a surgeon, or a specialist, and most of them do not see people for regular doctor visit’s and check up’s.

      that stuff is for a general practitioners.. surgeons make money from operations, not by getting mass quantity’s of check ups.

  17. regrettably there seems to be only one way forward, your husband should insist on payment in advance in every instance, both public and private. if that proves impossible, go back to the country he trained in and practice there.

    or your husband can work for a pittance and let his family suffer.

    look, i know this sounds hard, but sadly it is reality.

    • Well, I don’t think you sound hard, very realistic. The other reality is that it means that less and less doctors / surgeons will be available in the Philippines, as I already mentioned.

      And once again, I wanted to share this story not about our particular case (my husband is not the only breadwinner in our family), but as an example of a situation that can make an already fragile health system even worse.

      • Mylene

        Thanks so much for the info. I commend you and your husband for being dedicated to your profession even though your not compensated properly. Its a breath of fresh air from alot of doctors who just worry about money.

  18. There are so many ways to skin a cat (so to speak). If you want to recover money on account of the doctor’s bill owed to you, go to court and file a civil case for claim of sum of money or maybe even file a criminal case of estafa.

    Although the new law that prohibits detention of patients for non-payment of hospital bills is already in effect, it offers a remedy where the patient will be required to execute a promissory note which shall be secured either by a mortgage or a guarantee or co-maker.

    Check out the law. http://www.lawphil.net/statutes/repacts/ra2007/ra_9439_2007.html

      • Yes, sorry I forgot to thank you, Claudette.
        In this particular case, I’m not sure the law you mention applies, as it specifies “That patients who stayed in private rooms shall not be covered by this Act”.
        As I mentioned earlier, we might be brainless people but not totally heartless, and agreed that this private hospital releases the patient after he paid for the hospital fees, even though he has not paid us (any extra day in the hospital means more money for him to pay).
        And we are absolutely not willing to sue the patient (we suppose this person is not as well off as he thought he was when he made the decision to go for private service, and don’t want to put him in a more difficult financial situation)

          • @ Mylene, I think it is a matter of interpretation. I will say though as a disclaimer that this is a relatively new law and most likely there is no jurisprudence properly interpreting what is meant as “patients who stayed in private rooms are not covered by this Act.”

            What I mean simply is that the law “may” mean that unlike someone staying in a ward or semi-private room one who stays in a private room may be detained altogether until they pay the hospital and doctor.

            Also private room is not the same as a private hospital. You can be in a ward but still be in a private hospital and still be covered by the law.

            If it is any help, to give you an example that actually happened even when the law was not yet in effect. A friend of mine had her sister hospitalized at The Medical City because it was the nearest hospital to them when there was a medical emergency. Her sister was diagnosed with hyperthyroidism and she was really in a bad condition already. They rang up a bill of half a million in a matter of days, and she could not be transferred without danger to her life.

            But they did not have the money anymore to pay. What they did was execute a promissory note in favor of the doctor and hospital to pay the remaining amount in staggered payments.

            Admittedly initially a lawyer had to make a demand letter in favor of the hospital, but what everything was settled without need of a court case.

            • Thanks for taking time to clarify this point, and share the story of your friend’s sister.
              I think it is an appropriate way to deal with this kind of problem, even if part of me thinks that considering it was not her decision to choose this hospital in the first place (you mention that it was an emergency), the hospital could be more understanding about the billing and the payment.

  19. Hi bob seems like the poor ol doc is getting ripped off ,here we have a public system as well as you can have private insurance as well ,if you are in dre straights a surgeon will ooperate without hesitation in a public hospital to save your life normally you would be sent to a private hospital by a specialiust who is working there as a resident they do ask if you have private health insurance if they cosider you need surgery ,i dont so all my operations have been done in training hospitals ,i am still alive and didnt cost me a cent but the doctor got paid by hte government for the surgery ,if he is any good tell him to apply to come to australia we are short of good doctors here not enough training alocated by previous governments ,he will make a good living and will always get paid
    chris

    • Hi Chris – As I am sure you are aware, the USA has not had a public medical option in the past. Even with the new coming “Obama care” it is not really a public option anyway, but seems to be moving that way. I am personally more of a “free market” guy myself, but I guess we will be getting a taste of the more public type care in the future. We shall see how it works for the USA. Here in the Philippines we have PhilHealth, although that is quite limited.

  20. Hi ! Mylene,
    Welcome aboard, i’m glad you joined us here on LIP, i am an OFW and i went for general check-up every time i went home so are there OFW’s went to your husband clinic for medical check-up? If so, how long does it takes to pick up the result?.

    • Hi Rebecca, sorry I can’t help you, but I’ve to say I have absolutely no idea. I guess it really depends on the type of check-up (blood tests, X ray or others)

  21. Hi Bob – If I were the doctor, I’d tell the patient that unless he pays me what he owes, I keep the x-ray that shows that maybe I left a tool inside him and maybe I didn’t.
    😆

    Seriously, I thought the hospital collects the upfront – Hey Doc, get a legal professional and go after the hospital. If they want to be charitable, they can be so with their own money, not yours!

  22. people do not value service, its a sad state. they have no concept that the surgeon has costs and expenses too. healthycare should be available too all undoubtably, but to check into a private hospital and not pay the surgeon is theft, no different to stealing a computer from a shop.
    i have my own pharmacy here in the uk, yes the national health service delivers healthcare free at the point of service in over 95 per cent of cases, but in the small numbers where people need to pay, i am suprised you dont hear the screams of protest from there.
    help the poor and vulnerable, yes, but if you say you can pay, then do so. i would imagine you have a similar problem bob, people do not value time and expertise as they should

  23. Hi Mylene – have you spent much time in the Philippines ? If you had you would know that paying bills is not something that Filipinos do if they can avoid it! It is not only doctors that suffer from this – it seems to be a national sport seeing how long you can get away with it. It seems to be that if you can wait for a bill or loan to be paid you really do not need the money anyway.

    • But on an ethic point of view, do you think this kind of “national sport” as you write it is something wrong, and that should be addressed?
      And in that particular case, we’re not talking about somebody living in a nippa hut or out in the streets.
      As for your last sentence, it could be the start of a whole round of other discussions. Like “how does the guy know that I don’t need the money?”. Or “where is the line between needing money and needing money to help your relatives or friends?” for example

      • Mylene – of course it is wrong and is one of the things that drag the economy back,but it is a fact of life in the Philippines.It does not seem to be a matter of rich or poor – all strata of society seem to practice it. The way things work in the Philippines just has to be accepted – in the 25 years since I first came to the country I have seen absolutely no change to the ethics here – the same morality exists. It is a beautiful and easy part of the world to live as a foreigner but you have to accept the not so good parts as well.Most of the bad things affect local people and few impinge on the way we as guests live. Regard your experience as a lesson learned and be more carefull in future or surely it will happen again.Do not even think about filing suit unless you want to spend years and a small fortune fighting it.

        • To be honest, I was not totally aware before arriving in the Philippines that not paying the bills was a national sport (I guessed that as here as in so many countries, people will try not to pay taxes, but didn’t think that it extended as well to private fees). And I think (I hope) that it is only true for a minority of people.
          And here you might blame me for not doing my research before moving to a new country…
          The Philippines will stay a beautiful and easy part of the world to live as a foreigner as long as the basic necessities are available.

  24. The original email to Bob is an internal marital squabble over how best to handle the finances which cannot be resolved from the outside. Obviously the husband is happy with the way he’s doing it and she is not. She probably wants him to be more assertive in the collections department and he probably wants her get off his back.

    • David I think you hit the nail on the head with the big hammer on all of this…and with all marital squabbles, they have to be resovled by the people involved.

    • Hi David – I did not read the e-mail as it being a marital squabble. In the e-mail it seemed that both the husband and the wife were concerned about how things had happened. Mylene even posted a comment here saying that it was not a fight between her and her husband.

    • And then again, before reading between the lines, try to just read what is written in the original message. Did I write anywhere that my husband and I don’t agree?
      If I was to read between the lines, I would say from your message that you seem to have indeed this kind of problem in your couple.
      Dan, do you need some advice or counseling about this? I could offer my help to help you find a way to solve it, just by showing how I and my husband totally agree with it comes to finance management.

      • Mylene..no I do not need any counseling or advice about any of your problems…and I am not trying to solve your problems..Only you can solve your own problems..If you all ready no how to solve your problems then I am sure you are on your way to total happyness…

    • David, I agree with you… I read the email and based on how the story was told, It’s just a marital problem….
      (I don’t usually read articles because my comprehension is not that good…)

  25. Bob,

    I would suggest you start a column similar to Dear Abbey but specialize on giving advice to wayward expats you have the wit and the personality for the one liners

    I’m sure you would have a lot of avid readers that would sign in daily to read you advice column. Maybe ad it on to this blog similar to the forum area

    Expats have a problem ask Dear Bob solutions for all

    Take Care

    Tom / Roxas City

  26. We had a family member have surgery here at a private hospital (CSMC) in the metro. Here is how it went:

    1. The doctor’s fee was not paid up front. We were given a package estimate (including the main surgical team, the cardiologist, and anesthesiologist).

    2. After the surgery a bill was presented to the patients room from the surgeon’s secretary.

    3. When it was time to check out of the hospital, we went to the doctor’s clinic and paid (he did accept a personal check).

    4. We had to present the receipt from the doctor to the nurses station before the would discharge (remove the IV, etc).

    5. When physically leaving the hospital, the security guard checked our clearance which showed that all hospital & doctor fees had been paid.

    So essentially there were two checks made by departments that showed the bills had been settled prior to being able to leave the hospital. While I know that they made a law now stating that hospitals cannot keep people for non payment of bills, I would assume that this is not a very common occurrence. It is worth noting that we had a few appointments leading up to the surgery, but otherwise there was no check by the doctors regarding our ability to pay. He could have made some assumptions perhaps based on jewelry or whatnot, I guess.

    I would suggest perhaps he moves to a different private hospital for his surgeries. Also if this happens frequently to him, have the patient sign a PN before the surgery stating both the amount due, and the penalty per month if not paid (including attorney’s fees). The cost for a PN would be the notary fee of P100-P200 and obviously you just need to add it on to their cost.

    It is awesome that he is practicing medicine here versus a more financially lucrative position abroad. Major props to him.

    • Thanks for sharing your experience, and confirming a few points about the process.
      About the ability to pay, I know my husband discusses about it with the doctor who refers him the patient, since he is the one who knows more about the patient’s background. There is also the assumption that if the patient is opting for a private hospital, he is more likely to be able to pay for the fees (we are not talking about emergency procedure here).
      In the case of the patient I was talking about at the beginning, the hospital would not have released him if we had not agreed to wait for the payment (we don’t want to add unnecessary financial burden to this person).

      As for practicing abroad, yes he could earn more money there, but our family would loose much more on many other aspects.

      • Mylene – Your husband seems to be a man of principle and I hope he does not become disillusioned with working in the Philippines as too many of the brightest and best leave for more lucrative jobs elsewhere.If too many of the brightest leave,over the years the gene pool will become depleted and a nation of the mediocre will result.

        • Bryan G:

          A while back on this posting, you said that “some African countries and Cuba have better medical services than the US”, are you serious or just been watching too many Michael Moore “documentary”?

          Mars

          • Mars Z – if you read my post you will see that is not what I wrote What I did say is that in spite of the best health care in the world being available in the USA it has infant mortality,child mortality and lifespan figures worse than some african countries and Cuba – these are WHO figures.I do not think the WHO gets its figures from Michael Moore. The reason for these figures is that a large proportion of the American populace cannot afford good medical care -30% of the population have no medical insurance . In Cuba for example every barrio has clinics and medical care for all. The facilities are no way comparable to that in the USA but they are available to all.

      • “… if WE had not agreed to wait … WE don’t want to add unnecessary financial burden …” ????????????????

        I think we’ve come full circle and discovered the cake is being eaten.

  27. I also believe that it is more likely than not that you and your husband have a difference of opinion as to how best to handle the finances in this regard, in other words, a marital squabble. You may both agree on the basic facts but still disagree on how to handle it which could be why nothing gets done, nothing changes. If he gets on and shares with us his agreement with you in the matter, I will concede the point. Currently we are only getting one side of the story. I’m sure you’re stating it exactly as you see it. But it’s still one side.

    “ … before reading between the lines, try to just read what is written in the original message. …” “ … How naive of him to think the 15 years he spent studying medicine would enable him to make enough money to support decently his family!!! …”

    Ok, at first I thought this was just meant to be sarcastic humor. In other words, of course your husband thought that he could make enough, perhaps not get rich, but make enough. But now, with your latest statement I don’t know what you mean. If he WAS naïve then I guess you were both naïve and need to reevaluate your expectations.

    To clarify my earlier statement about eating your cake: if both you and your husband are in agreement (not just a marital squabble) about the finances, you can either change your behavior or stop complaining (having your cake and eating it too).

  29. it’s free medical in non private hospital’s in the united states, if there is anyway they can bill you they will, but if your homeless or have to low of income the hospital takes the hit but in a regular non private hospital any serious injury or operation ( required ) would be done ( but nothing cosmetic ), private hospitals are only forced to treat a patient if they are going to die without medical attention, but as soon as said patient is stable enough to move to a regular hospital they would be… and also private hospital would also have to help a women that is in labor ( in the process of having a baby ) … it is illegal for a hospital to turn her away . for a private practice it’s the doctors job to get payment up front, or partial payment or sent up a monthly payment scheme, if this doctor is just doing operations and then just hopes without any contract they will pay he needs to quit trusting people so much, because like my mother says for so many things, why buy the cow when the milk is free ? ( if they can’t afford the service, tell him to go to the cheaper clinic )

  30. that is maybe just my state’s law in Minnesota for hospitals. i assumed it was the same everywhere, but after a little more reading, seems other states do require upfront $$ but not here in Minnesota.

  31. when i was living there 10 months i had a few gf’s during that period of time, the one i had living with me the longest was working and had a great job by most Filipino standards, she earned about 30,000 to 35,000 peso a month.

    she requested a personal loan for something, i give to her, then next month another personal loan, ( never paying me back ) mind you i am paying for everything already electric water all food transport entertainment and she makes 30 to 35k a month and is asking me for money lol…

    anyway when she ask’s for a 3rd time and for a larger amount 6000 peso for her aunt’s daughters baptism and birthday party.i said i will do it, but this time i want her to pay me back and i took her 30,000 peso iPhone as collateral.

    she paid me back, but i am fairly sure it was only because i had the collateral lol.
    i would not say its a national sport to avoid paying debt’s, but if they are not strongly encouraged to do so, then yes its a good chance you will never be paid.

    • Hahahahahha thats one thing for sure about some of them sweet Fillipinas…they have a big book in their mind of all the things that they use to get you to give them some money….everything from my Moms funeral to my great cousin on my grandfathers side needs a little money for her studies and anything and everything inbetween them 2 I listed….

      • haha yeah, i was thinking it was bola, but to my surprise i was invited to that baptism and birthday party, and everyone there treated me like royalty for sponsor it..

        even thou it was just a loan to my gf they did appreciate it, but with me paying all bills i don’t know why she was always asking for loan, but i did find out she was sending nearly all her salary to her parents , save some for yourself omg. i got some money but i am not filthy rich 🙂