An Urgency to Improve Nurse’s Salary through PhilHealth’s

Professional Fee

Russel Reyes

Randie Asuncion

Emilio Aguinaldo College

November, 2020
ABSTRACT
For the past eight months, Philippines and the world has experienced a massive
pandemic cause by the Corona virus. No one is prepared, not even the progressive country,
that’s why our country took the hit really hard. In a different perspective, this pandemic had
shown us the ongoing problem in our medical and healthcare field. We needed so many
nurses as the front liners in hospitals, clinics and rural health units to assist and intervene with
the increasing cases of people getting infected with Corona virus. No one wanted to admit at
first that most of our tenured nurses are already working in progressive countries. The
number of nurses that we have right now is no longer proportional to the Filipino population.
Sad, but most of the good nurses and even doctors took opportunity working abroad because
of the shortcomings happening in the medical profession for decades and decades. Because of
the ongoing effects of the pandemic, it dawned on us that there is an urgent need to improve
the work conditions of our nurses. Proper recognition in terms of the benefits and salary our
nurses are getting should evidently need to turn a new leaf and the main question is as to
how.

INTRODUCTION
Filipino labor migration was originally intended as temporary intervention to ease
unemployment (Villalba 2002). During the 1950’s going abroad's main objective is to obtain
more advanced training and to improve the quality of healthcare in the Philippines (Corcega
et. Al. 2000). The objective was to help our medical professionals to survive during the time
that economic depression is worse for themselves and their families.
However, widespread global nursing shortages increased by the late 1990’s. United
States, UK and other developed countries made recruitment offers more attractive and
permanent making it more enticing for Filipino nurses to grab the opportunity. Did the labor
migration for nurses stop over the years? Experiencing the global pandemic has shown us that
the number of nurses in the Philippines has impacted our healthcare facilities vastly. The ones
really suffering are the ordinary citizens that get hospitalized.
There are vital “push factors” why Filipino nurses choose to work abroad and not
serve their country. Poor working conditions and low pay are one of the factors that drive
nurses out of the country. There are also “pull factors” why some nurses would choose stay.
We have seen the advantages and disadvantages of labor migration over the past decades.
The trend started for a good cause and we have not maintained the main objective as a
temporary relief. Our intervention should have progressed to a viable recommendation so
“brain drain” can be alleviated eventually. The delay has taken so long that the main problem
was not significantly resolved.
We as one nation are not going to focus on the problem. It is about time that we
Filipinos should think of ways to alleviate the ongoing challenges and support our nurses so
they would choose to stay and serve their fellow Filipinos. Now, a greater challenge is
presented to us as how to make it happen. From a medical perspective side, PhilHealth should
include nurse’s professional fee in the charges set in the patient’s medical bill same way with
the doctors and specialists.
STATEMENT OF THE PROBLEM
Addressing the existing gap on nurse’s salary through Philhealth can alleviate the
current shortage of nurses in the Philippines. A lot of interventions can be considered but one
thing that can be recommended for nationwide use is through our national medical insurance,
PhilHealth. An effective recommendation should be established to help our nurses motivated
to stay in our country and serve our people in need.
(1) How can we utilize PhilHealth effectively to improve the salaries of nurses in
public and private hospitals?
(2) What role does PhilHealth provide in securing the professional stability of nurses
in the Philippines?
(3) What program and policy responses have been considered, proposed, and
implemented by different stakeholders in the Philippines to address work migration of
nurses?

OBJECTIVES OF THE STUDY

This study aims to provide in-depth information on the migration of Filipino nurses and the
impact this has on individual migrants, their families, professions and the nation as a whole.
Specifically, the study sets out to:
(1) Explore the reasons why health workers opt to migrate or stay in the country;
(2) determine the impact of health worker migration on the country’s health system, in
terms of the working conditions of the remaining health workforce and the health service
provision;
(3) Analyze existing PhilHealth policies and practices to connect the gap on the
standard medical bill component;
(4) Recommend strategies and practices for socially acceptable management of
nurse’s migration through our local medical insurance, PhilHealth.

SIGNIFICANCE OF THE STUDY

Although the Philippines have a well-known track record in this area, there is still a
lot of information available to summarize the overall migration experience. By analyzing
existing data in the country, the study seeks to establish the magnitude and patterns of nurses’
migration. Such information will lend itself to relevant policy making and development at the
national and international levels. It will eventually help the country’s weakness in the medical
field and sustain the needs of the patients in all levels whether public or private institution.
When changes are created and implemented, we are aiming for quality professional life for
nurses locally.
SCOPE AND LIMITATIONS OF THE STUDY
The field data results only report empirical nurses’ migration patterns within the
selected study area. The patterns and practices documented in the study are deemed to be a
reflection of major nurses’ migration practices and trends; however, due to the limited sample
and methods utilized, the results cannot be generalized to reflect the nurses’ migration
patterns of all areas in the Philippines. With the purposive sampling and design used, it is
hoped that the present research highlights significant patterns and practices of health worker
migration that will be valuable in informing policy decisions and management strategies
addressing this issue. Since 1950’s, researches were made and recommendations were given
but the resolutions needed were not imposed and taken into action. With the given objectives
of the study, policies of PhilHealth are reviewed to benefit the nurses working locally,
extending to the nurses abroad.

REVIEW OF RELATED LITERATURE

Many of our countrymen may not be aware that under the Pesionado Act of 1903
during the turn of the 20th century, Filipino nurses started studying and working in the United
States. Act number 854 of the Philippine Commission and passed by the United States
congress. It is a scholarship program for the Filipinos (Rodis 2013).
The opportunities for migrant workers did not stop after the scholarship program was
established. Rampant nursing shortages struck the world during the 1970’s. Developed
countries like the United States offered higher compensation and benefits thus allowing
nurses to have better opportunities. Who can say no to an offer that can elevate your family’s
economic status? So more Filipino nurses grabbed the opportunity and worked abroad. An
advantage of our people is that we can speak better English than most Asian countries. We
have the right skills and attitude for the job making those nurses at that time a perfect
replacement workforce.
Twenty percent of the Filipino immigrants in California are all registered nurses
(Rodis 2013). It is highly unlikely that Filipinos would just remain a mere worker that’s why
it is not surprising to know that they have established their own national organization: the
Philippine Nurses Association in America.
Our economy was down and less jobs were available during the 1950’s pushing the
government to encourage skilled workers and professionals to work in other countries.
Somehow, the government has to find ways to support its people even though it meant
sending them off to other lands to work. Their main objective is to allow the Filipino workers
to obtain advanced training then return home and improve the quality of service in the
Philippines. The main objective is ideal and should benefit the nurses, their families, the
government and their countrymen.
1. Skilled migration and mass migration
There is no uniform definition of “skills.” In many countries “skills” are defined in
terms of occupational skills and/or educational attainment levels. Similarly, there is no single
methodology for skill needs analysis(International Labor Organization 2020)
The most basic definition of mass migration is the movement of large numbers of people
from one geographical area to another.
 2. Who are the skilled workers? Brain drain and brain movement
Workers with advanced technical, academic, and interpersonal skills, usually
includes problem-solving, leadership, teamwork, systems improvement, etc. 
Brain drain is the loss suffered by a region as a result of the emigration of a (highly)
qualified person, while brain gain is when a country benefits as a consequence
of immigration of a highly qualified person (Shubhaangi Srivastava 2020).
3. The macro dimension of skilled labor migration. Significance for the
receiving country.
4. Demographic characteristics
a. Gender
b. Age
c. Civil Status
d. Length of stay
e. Reasons for choice
f. Returning home
According to the World Health Organization, nurses’ migration is not solely because
they are underpaid but because of other factors too. Poor facilities, corruption, cronyism,
unsubstantial benefits for the nurses and their families and inefficient management can result
for them to choose to serve foreign countries (Michael Clemens 2013).
Migration is determined by the motivation and decisions of an individual (Connell J,
Buchan J 2011).
A variety of reasons for migrating have been reported. The focus groups revealed the
following perceived push and pull factors for migrating (O’Brien P, Gostin 2011).
The worldwide pandemic is an eye opener for everyone, from the top level to the
regular Filipino citizens regarding the impact of nurses' migration to work in other countries.
We were left with a handful that cannot fully sustain the need of frontliners due to
Corona virus plague. The new nurses who are practicing for only a few years were the ones
left while the tenured and more experienced ones have left the country. We are not
undermining the capacity and skills of new nurses but in times of an emergency like what the
world is experiencing, we need tenured nurses who have been in the industry long enough to
still maintain their cool amidst the medical nightmare.

At country level, this will require implementing policy bundles with two inter-related
objectives:
1. To improve retention of domestically trained nurses
2. Ensure adequate domestic training capacity.

Some of the requirements include:

1. Assessing and improving nurse workforce
2. Continuous professional development
3. Improving nurse retention in the organization
4. Implementing policies to enable the nursing workforce contribution to be
recognized
 "Nurses are the backbone of any health system. Today, many nurses find themselves
on the frontline in the battle against Covid-19," said Dr Tedros Adhanom Ghebreyesus, WHO
Director General,April 2020.
Year 2020 is the year of the Nurse and the Midwife. Yet, 2020 is also the year of a
global pandemic that killed a lot of people and created nationwide panic.
Clearly, there is a global shortage for nurses. Though this has caused a negative effect
in taking care of the sick and sustaining the health of the origin country, the remittances
received in their home country has helped improve and sustain its economy.
Most of the nurses who work abroad go home to be with their families. They make
sure that their families are in good shape and conditions. Others will bring their family abroad
to give them better opportunities. We cannot judge the nurses who choose that path.
Now our main mission here is finding ways to utilize the Philippine Health Insurance
(PhilHealth). Upon reviewing the past and current policies for the covered bill per patient,
doctor's professional fee is generally covered but not the nurses who stay and take care of the
patients at longer hours. Comparison can be destructive but at this point may prove to be
beneficial. The fair utilization of the healthcare insurance can be a vital point to address the
shortage of nurses in the Philippines.
News about billions being corrupted by the CEO of Philhealth drove the news left and
right. He has resigned but no additional news were made to ensure that the money taken will
be returned. It was blown like nothing happened. Every Filipino has given contribution to
PhilHealth. It doesn’t feel right that one person is using the money collected and the citizens
cannot do anything about it. It is about time that the existing policies would be revised and
match to the current scenario we have in this world. And if we do it right, then maybe we can
change the situation our nurses are experiencing in this country through the policy
innovations for PhilHealth.

Push Factors- WHAT FACTORS MAKE YOU LEAVE

 Economic
Is the salary substantial?
Is the overtime and hazard pay enough
Is there health insurance coverage efficient?
 Job related
Overworked and underpaid
Stressful work environment
Slow to no promotion
 Socio-political and economic environment
Pull Factors
Corruption present in affiliated health organizations
Limited opportunities for employment
Unstable socio political and economic areas

Pull Factors- WHAT FACTORS MAKE YOU STAY

 Economic
Salary is substantial
Better benefits included
Incentives and recognition awarded
  Job related
More options for the shifting schedule
Opportunities to study and continue professional growth
Promotions are within reach
Nurse to patient ratio is non-stressful
 Personal/family related
 Socio-political and economic environment

THEORETICAL FRAMEWORK
The push-pull hypothesis has been broadly utilized in explaining work migration
around the world. This emphasizes the interaction between sending- and receiving
components/factors that oversee the migration process. Push factor components regularly
incorporate dissatisfying conditions (e.g. political insecurity, overwhelming tax collection)
within the sending places that motivate individuals to work. In contrast, the pull components
are favorable conditions (e.g. less contaminated environment, wellbeing care framework) in
receiving countries that encourage the migration process.
In entirety, utilizing one hypothesis isn't adequate to assist us illustrate the affiliations
between migration and cognitive work.
An individual’s migration status comprises of a few correlated key components. It
includes geographic designs/patterns, age at migration/length of stay, and reasons for
migrating. A major trend in relocation in the world nowadays is that individuals tend to move
from less developed areas to more developed places (urban regions, high-income nations) for
more working and education opportunities and higher salary.
Migration acts as a means of rebalancing the availability of the workforce. Present
day migration can be economic or non-economic. However, most of our professionals like
the nurses are classified under the economic migration because their main purpose of going
abroad is to earn more money for themselves or their families. The redistribution of
manpower permits a redistribution of wealth, market potentiality and consumption.
Globalization has given a lot of countries to survive during difficult times within their
country. It also corrected certain deficiency that can affect their socio-economic status.
The push-pull theory can dig deeper and identify what factors trigger a nurse to leave
the local area and work abroad. Whereas for some, what kept them from working abroad and
decided to stay working here as nurses in the Philippines. Eventually, identifying those
factors can help us make recommendations to help our healthcare forces in their struggles.
Validating the known factors can make this research viable to be considered in making new
policies that can resolve massive work migration of our nurses.
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