Frail kidneys and frail systems

By Omid Siahmard
Bulatlat.com

KORONADAL CITY — Maria*, 50, a public school teacher surviving on entry-level pay, surrenders over one-third of her monthly salary to the unrelenting cost of kidney failure. This comes even after PhilHealth, the administrator of the country’s National Health Insurance Program, expanded its hemodialysis coverage from 90 sessions to 156 sessions yearly.

“I buy my maintenance medicines in small quantities,” said Maria, who has been undergoing dialysis for three years. “I simply can’t afford buying a month’s supply all at once.” 

Maria was only 17 when she was diagnosed with diabetes, the leading cause of kidney disease locally and internationally, according to the Philippine Society of Nephrology. She was struggling through undergraduate studies and financial hardships at the time, unaware of how the diagnosis would affect her life in the years to come.  “I did not know much about the long-term outcomes of diabetes back then,” she told Bulatlat. 

Over and above the lack of health education, the financial strain brought by the high cost of antidiabetic medications made treatment compliance nearly impossible for her. As a result, her blood sugar levels became chronically uncontrolled, and by the age of 30, she was already put on insulin therapy. Maria was told to strictly adhere to this treatment regimen if she did not want her kidneys to fail. This significantly took a toll on both her mind and her already stretched pocket. 

Access to insulin can dictate the fate of individuals living with diabetes. For Maria, years of struggling to maintain access to this life-saving medication has brought her chronic kidney disease to its final stage. End-stage renal disease cannot be reversed. Without kidney transplantation, survival depends entirely on dialysis – a treatment procedure that substitutes for the kidneys’ functions. “If I had the money to buy a constant supply of my medicines, I know I wouldn’t be here,” she said. 

For the vast majority of Filipinos living with chronic diseases, economic insecurity adds a layer to their suffering – being placed in the endless cycle of worsening illness and impending bankruptcy. This is also the point where healing becomes even more elusive, as the illness now does not only constitute failing organs, but also a declining state of mental well-being.

Maria’s life, for example, has become a constant act of planning ahead, securing medications for the coming weeks, anticipating emergencies, and preparing for possible hospitalizations. The stress of this persistent vigilance has eroded her quality of life, sometimes even more debilitating than the disease itself. 

At the private dialysis center in her locality, she met 37-year-old Alvin Andiam, a fellow public school teacher. Alvin was diagnosed with hypertension eight years prior to being advised to undergo dialysis. Like Maria, he had no idea that his lifestyle disease would reshape his life and tether him to a lifetime of thrice-weekly dialysis sessions.

Maria and Alvin access dialysis treatment through PhilHealth. The insurance agency covers all sessions of ESRD patients year-round. This coverage includes their monthly laboratory tests, dialyzers, and certain medicines to manage anemia. This expansion only took effect in 2024. Prior to this, the insurance corporation only covers 90 sessions a year. “Before, I needed to pay out-of-pocket for dialysis after the 90th session, the dialyzer, and the monthly laboratory tests,” Alvin said. “All of these would cost more than what I earned in a month.”

When asked whether these expanded benefits gave him significant financial relief, Alvin offered a hesitant affirmation. “I still have to personally spend for my daily medicines,” he told Bulatlat.

Iron supplements, phosphate binders, and Vitamin D analogs are only some of the maintenance medicines that patients with ESRD need. According to Alvin, these would amount to up to P10,000 a month.

Maria and Alvin are both entry-level teachers at a public high school and earn roughly P30,000 monthly. However, due to the need to take out multiple loans to cover urgent medical expenses, their take-home pay is now barely half of their original income. In order to secure their daily medicines, they need to seek financial aid from different offices.

Since Maria has limited mobility due to her ailment, she relies on her husband, John*, a freelance PUV driver, to seek financial assistance from various government agencies. “I go to the Provincial Capitol, DSWD, and the Congressional office for MAIP (Medical Assistance to Indigent Patients program),” he said. “I usually start lining up as early as 4 a.m.” 

John shared that they receive P2,800 from the provincial government and between P3,000 to P5,000 from DSWD every three months. Through the MAIP, they get a monthly assistance of P3,000. Aid from the city government, meanwhile, is sporadic and depends on the availability of funds. 

While navigating this monthly and quarterly cycle of seeking aid is exhausting for John, he noted that there are several others who struggle even more with the system.  “Many of those who are lining up for aid are in more dire situations – some can’t even read or write and are unfamiliar with the requirements,” John explained. “So I make it a point to assist them since I already know the process.”

Alvin, on the other hand, lives alone, and must line up for aid by himself – also early in the morning before his shift begins. Otherwise, he might miss a day’s wage. Beyond the physical toll, he says this routine eats into his sense of self-worth.  “Having to constantly line up and seek assistance just so I could survive another week or another month feels dehumanizing,” he lamented, his voice edged with suppressed frustration. 

The promise of PhilHealth is to provide comprehensive health care services to all Filipinos by offering financial risk protection. For every patient with end-stage renal disease, this support translates to up to P990,600 in dialysis treatment costs annually. This amount is being paid directly to the health facility providing the service. 

Data from the Department of Health reveal a striking difference between government and private healthcare institutions in their capacity to deliver services. Of the 696 free-standing dialysis centers nationwide, only 28 are government-run while 668 are privately owned. In the SOCCSKSARGEN region, only two government dialysis centers operate compared to 12 in the private sector. 

This situation not only underscores the apparent imbalance in the country’s healthcare infrastructure, but also exposes the flow of public funds, whether it’s government subsidies or public insurance contributions. When the public healthcare system is weak and overtaken by the private sector in delivering services, the government is increasingly functioning less as a healthcare provider and more as a purchaser – channeling public funds into private institutions to fill the manufactured gaps in our system.

For Maria and Alvin, the routine continues as they await further changes in health policy. “I believe medical needs must be directly available in government facilities,” Alvin said, expressing disappointment over the current system.

Maria added, “I always find it ironic that we need to seek subsidies from various government agencies just to access services that the government itself is supposed to provide.” (DAA)

*Names have been changed to protect their identities.

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