THE PHILIPPINE GENERAL HOSPITAL IN DILIMAN

    BACKGROUND and RATIONALE

    The Philippine General Hospital was created by the Philippine Commission Act of 1608 in 1907. Its mandate was to serve the poor Filipino. It opened its doors to the public in September 1, 1910 under the Department of Interiors with Dr. Victor Heiser as the first director. In 1939, President Manuel L. Quezon placed the control of the hospital under the Dean of the College of Medicine. Immediately after the war, July 1, 1945, the Department of Public Health took control of it and its rebuilding, and in 1947 President Manuel A. Roxas transferred it back to the University of the Philippines System designating PGH as its teaching hospital. The separation of the position of the Dean of the College Medicine and Director of the Hospital was effected in 1954 with an Executive Order of President Ramon Magsaysay.
    The UP Manila Health Sciences Center was established with Republic Act No. 3163 in 1967. On December 21, 1983, Executive Order No. 11 asserted the mandate of PGH as primarily teaching and service as its secondary function.
    In 2001, Regent Victor Reyes opined that the growing challenges of health care to the public made it necessary to redefine the primary function of PGH. In its 1153rd Meeting, Aug 30, 2001, the Board of Regents approved the amendment of the policy of function of PGH.
    “The primary function of the Philippine General Hospital is the care of the sick and injured of the community. As the largest government facility and referral center, it must endeavor to remain abreast of medical care and hospital operations.
    A concomitant responsibility of the Philippine General Hospital is the expansion of knowledge through educational endeavor and scientific research. As the clinical venue of the College of Medicine and other academic units, it must function as an integral part of the university in undergraduate and graduate education.”
    This fell in place with the expansion of the services of the hospital, having built a 400 bed private hospital and a Faculty Medical Arts Building, it was meeting head on the challenges of serving almost 600,000 patients a year. Currently, PGH stands in a 10 hectare site within UP Manila, employing more than 4,000 employees to run its services and needing an Internal Operating Budget of almost Php4 Billion to make it function efficiently and effectively.
    With the Universal Healthcare Program supported by PhilHealth, partial funding for the hospital operations has been more consistent and sufficient. This, coupled with the share of PGH in the funds generated from Sin Tax, the Department of Health sub-allotments and other funding coming from various offices in government, enabled the hospital to deliver the most advanced health services with no out-of-pocket expense from the patient.
    With improvement of health care delivery, more patients are seeking the services of PGH. In 2016, census of patients rose by 25,000 from the average of 580,000 in the past ten years to 605,000 in 2016. 50% of patients were noted to come from the NCR region, 30% from the Calabarzon and the remaining 20% from the rest of the country, including the ARMM and Bontoc Province. It is predicted that as more advanced equipment and procedures/services are being installed in PGH much more patients will be flocking in. Hence, there is a real need to establish another facility to further expand the services and expertise of PGH.

    PROPOSED HOSPITAL BASIC FUNCTION/PURPOSE

    The PGH in Diliman is not envisioned to duplicate what is existing in the current facility in Manila. It should seek to complement and enhance the capabilities that are present now. An example of this would be, since the Eye Center is already in Manila, to position the Ear Center in Diliman. We can also create totally new intstitutes that will collaborate with existing units in UP Diliman, not found in UP Manila, like putting up the Institute of Sports Medicine which can be linked with the College of Human Kinetics and the Varsity Athletic Program. Expanding it even further, we can forsee a future wherein medical innovations and even manufacturing will be done in Diliman capitalizing on collaboration with Engineering and other sciences. Since PGH Manila already has 1,100 charity beds and is poised to expand it by 500 more, it should be agreed upon that the majority of service patients should remain in Manila. In the vicinity of UP Diliman, government specialty hospitals have been established to take care of various illnesses. These are the Philippine Hear Center, the National Kidney and Transplant Institute, the Lung Center, the Philippine Children’s Medical Center, the Philippine Blood Center (still not fully functional). The National Brain center is envisioned by DOH to rise in the NKTI lot. The East Avenue Medical Center is the DOH general hospital now geared more towards health delivery in the other surgical services. The Department of Health is planning on making EAMC its “Megahospital” in Luzon upgrading it to 1,500 beds eventually (current of 600), as they have done with the Southern Philippines Medical Center in Davao and will do in the Vicente Sotto Medical Center in Cebu. PGH Diliman should be planning for services not found in these national agencies. These are Oncology/Hematology, Neuroscience, Developmental Medicine and Disaster Management. It should also be the foremost Research Hospital, considering that all the disciplines of learning are in the UP System. Taking advantage of its proximity to the colleges of Engineering and the other Sciences, PGH Diliman will be an ideal place for generating innovations and breakthroughs in Medicine. It should be emphasized, though, that government resources can be optimized further by collaborating with the other agencies surrounding it both for clinical and research activities. This should avoid redundancy of functions and endeavors. PGH Diliman should be the hospital that the government does not have yet, a “Triple A” facility that will compete in form and function with the top private hospitals in the country and learning institutions abroad. At the same time, it will still keep the expenses of patients within reasonable levels, since such services carry exorbitant prices in private hospitals. Developing a high standard facility accessible to the nonpaying public, with no distinction between who pays and who does not, will be a “social coup” of sorts. As is being done in PGH Manila, the 400 bed private rooms partially subsidize the 1110 public beds, lessening the dependence on outside funding. If PGH Diliman can do the good mix of patients, a well-planned private service can fund ALL the charity beds. Public Private Partnership (PPP) projects are very good models for these operations. No government health facility has a dedicated service for research. Creating a formal Clinical Research Unit will be a first and will also augment the income of the hospital. This will be generated from Clinical Trials and grants that use the facility. In terms of governance, PGH Manila should still be the “mother unit”, at least in the initial stages of development of services in PGH Diliman. Credentialing and certifying medical personnel should still be done in Manila until such time Diliman has gained the “critical mass” of specialists. Eventually, Diliman will have its own Director, separate from Manila, functioning under a unified Board of Advisors.

    INFRASTRUCTURE

    Planning the structure of PGH Diliman necessitates knowledge of the surrounding hospitals. Established government specialty facilities are the PHC with 354 beds, NKTI with 247 beds, PCMC 250 beds, Lung Center 210 beds. The largest general hospital is EAMC with 600 beds. There is a limited presence of big private hospitals within a 5 km radius of Diliman. Most are 100-200 beds and are generally secondary hospitals. Deducing from this information then, PGH Diliman, to make an impact in health delivery in this area should not be less than 600 bed capacity. In planning the hospital, it would be best to benchmark against the established private facilities nearby namely the Medical City and St. Luke’s Global City whose standards are claimed to be the best so far. Medical City stands on a 1.5 hectare footprint, currently with 600 beds (upgradable to 800) generating more than 100,000 sqm of hospital service area. SLMC Global City has the same land area, currently at 600 beds (upgradable to 1000) with 154,000 sqm of hospital service area. Both hospitals have allotted between 160 to 200 sqm per bed, in terms of hospital service area. PGH Diliman should be planned as a “megahospital” too, eventually being the biggest and most advanced government center in the northern part of the city. It can start with 600 beds which will be mixture of private (50 %), public (40%) and research (10%). For a high standard facility, the ideal service area allotment per bed is 160 sq m. This will translate to 100,000 sq m of service areas (patient rooms, laboratories, operating theaters, ICUs, Outpatient facility, etc). Roughly comparing this with the 2 private institutions, a minimum of 2 hectares will be needed for its footprint. If eventually a 1,500 bed hospital is envisioned, at least another hectare is needed. To put things in perspective PGH Manila occupies 10 hectares in UP Manila, having only 120,000sqm of hospital service area for its 1,500 patients. Its basic design is 2 floor pavilions spread out in 6 hectares, augmented by the 7 floor Central Block, and the 3-storey Outpatient building within it. PGH Diliman will be vertically designed needing less land area. This makes construction and maintenance more efficient. At the current DOH recommended construction budget of P 35,000 per sqm, the structure alone will cost around P 3.5 Billion pesos. Furniture and equipment will be another Php 3 billion. If land is still available, the most ideal location will be away from the heavy traffic area of Katipunan and CP Garcia. The Commonwealth Avenue side of the campus will be more ideal. There is less congestion on that part and the presence of the Ayala Techno Hub affords alternative access to the restaurants and leisure facilities. The BPOs will also provide the potential clients for consultation and admission. It will be best if this is built along the line of the existing gym as access can be from Commonwealth and from within the campus as well.

    STAFFING AND FUNDING

    The most ideal set up is that the government funds the construction of the building as well as its capital outlay for equipment and personnel services through the General Appropriations Act. However, given the current difficulty of acquiring plantilla positions for hospital staffing and the complexity of furnishing the hospital with all necessary equipment, a combined mode of providing financial support may be more practical for this project to proceed at a faster pace. The infrastructure component can be submitted with the UP System Budget for GAA funding and the operating expenses, including personnel and equipment, can be outsourced as a PPP project. This partnership with financial institutions can still result to lower charges compared to other private institutions and some income for the system because of the land equity of UP, which the investors will not have to put money out for.