Of cataracts and health insurances

As former officials of the Department of Health grapple with allegations of gross misconduct with last year's P3 billion purchase of potentially damaging anti-dengue vaccines, focus has veered away from other equally important issues such as universal health care. With P103.6 billion to spend in 2018, is the DOH finally on track to provide comprehensive health services to every Filipino? Resurgent contributor Corazon Dee narrates her cataract-removal experience in the The Netherlands, where she's based, and dwells informatively on the health care programs of the Dutch government and that of her home country, the Philippines.

It’s a medical miracle. 

I can see clearly two hours after the surgery of my cataract and replacement of the lens of my right eye last November 13.  At home, I can vividly see the black numbers on our hanging calendar, the white tiles in the bathroom and other things that in so many years I had not clearly seen! From my window, I see the intensity of the colors of the jackets and coats worn by passers-by catching a ride to their destination via Metro Station Poortugaal, The Netherlands; the changing colors of the leaves on trees from green to yellow-gold to brown from our window; and most specially the beautiful sunrise with its brilliant colors specially during autumn and winter months. 

My cataract was first diagnosed on October 4, 2012. I was told that if it did not really bother me, an operation was not necessary. I had asked around after my check-up and was told that the operation would be done when the cataract has matured enough to necessitate a surgery to replace the lens. 

 Over the years, I had many different kinds of glasses to improve my sight.  I had distance glasses, computer glasses, reading glasses, bi-focal, multi focal, and unifocal.  The latest glasses I had before the surgery consisted of unifocal reading glasses and bifocal ones for distance and reading. Upon the prodding of my hubby, I relented to having my eyes checked again because I was complaining of blurry vision, sensitivity to light and glare, decreased night vision, halos around lights and right-side shadows on the letters of traffic signs. 

For cataract treatment in the Netherlands, one has to consult the medical general practitioner or huisart (family doctor) as a first step before seeing a specialist. I went last June after which he sent me to an optical clinic so I would know right away what was wrong with my eyes, i.e. what was causing the blurred vision and other complaints. After the use of state-of-the-art diagnostic machines, the optician said he would send the results to the GP, who would then decide if he would send me to an eye specialist. 

The procedure for cataract treatment can be tedious and lengthy. The huisart gave a referral letter to the Oogziekenhuis (eye hospital) last August. I received my letter of appointment for a check-up on August 16. When the time came, I went to  two waiting rooms and four private rooms; check-up of the eyes similar to the one in the optical clinic; check-up by the eye doctor explaining the procedures; check up by another medical doctor for the medicines I needed to take before and after the surgery including the anesthesia and the procedure for administering them during the surgery; a consultation to tell them the choice of who was to operate (a resident with a supervising consultant or the other way around, a consultant but with residents to observe the operation). Yet another session was a consultation regarding the choice as to the type of lens to be used: standard or multifocal. 

After every other medical staff saw my eyes, the final step was the appointment staff. I was told that I would be scheduled for a surgery on the first week of October and that I would receive a letter as to the exact date and time. I waited for the letter; it did not come.  I called a week before the first week of October, only to be told that my tentative schedule was changed to October 23 because the waiting time had lengthened from three to five months and that they would send a letter as to the exact date and time. Still, nothing came. I did not make a follow-up anymore since the appointment staff at the Cataract Department knew that I voluntarily made myself free and ready for the exact schedule on the first week of October.

Happily, a call came on November 8 asking me if I was ready for the operation on November 13, to which I responded positively. I received the letter on November 10.  

The Netherlands is one of the few countries in the world which has universal medical insurance coverage. That means all its citizens, permanent residents and temporary visitors are covered by medical insurance of varying coverage and costs.  All those mandatorily covered, except those who are 18 years old and below, are required to pay a certain amount depending on the insurance coverage one chooses.

Approximately, for the basic coverage, this is in the amount of almost Euro 100 or more or Philippine Peso 6,000 (conversion rate of Euro 1 to PhP 60) or more per person per month.  

According to Koenraadt, B. (2014), “this basic health insurance plan covers the most essential medical care, such as: visits and treatments from a general practitioner; medicine prescriptions; certain medical aids and healthcare programs; hospital care which includes emergency medical transport; hospital stays and the necessary hospital treatments performed by doctors, surgeons and other medical professionals; physiotherapy (only for some chronic conditions);  psychological/mental healthcare; dental care for children under the age of 18; midwifery; speech-language pathology; emergency medical care abroad (according to Dutch standards and tariffs).”

More information about the Netherlands’ medical insurance system is available at the website of Zorgverzekering Informatie Centrum (2017) and Government of the Netherlands (health insurance) available in English.  

This insurance system is envied by other countries including the United States; it inspired the legislation of Obamacare.  

The medical insurance coverage in the Netherlands has undergone changes compared to what it was in the 1990s and the bountiful years before then.  Old people say that the medical insurance coverage of the past was far superior or more comprehensive compared to what is available now, cheaper as well and without any own risk contribution. It used to be that even cosmetic surgeries were included in the package. 

Furthermore, those covered did not have to pay any extra amount or own risk to the monthly payments. One policy change in effect is the minimum own-risk amount one has to pay on a yearly basis for medical expenses before the insurance coverage covers one’s medical expenses. For my cataract operation, I did not have to pay any extra amount since I had already paid for my yearly own-risk amount prior to this operation. 

Cataract treatment in the Philippines is a totally different system compared to the practice here in the Netherlands. I was comparing notes with a friend from Davao City who underwent cataract operation two weeks ahead of mine. She was seen by the eye specialist doctor once and was scheduled for operation based on a mutually agreed date which was in a matter of a few days.  She was given three options for the lens with a price tag from the least expensive to the most expensive with corresponding features of the lens. Her being a senior citizen helped reduce the bill as she is covered by PhilHealth but she had to foot the bigger portion of the bill.

What happens when one does not have the money to pay for the choices? Does it mean that one will just have to seek alternative ways to alleviate the suffering of unclear vision? Borrow or ask money from others to pay for the surgery? This is a sad reality in the Philippines and in many other places around the world.

Meanwhile, in The Netherlands, I have an appointment for the physical checkup of my right eye three weeks after the surgery. The surgeon will then decide to proceed with the surgery of my left eye without me having to worry about the financial cost. Again, as with my right eye surgery, I only need to focus on getting well by following the meticulous personal and written instructions given by the eye hospital before, during and after surgery. I look forward to long years of enjoying the benefits of improved vision!

(Ms. Dee first came to The Netherlands in 1993 and has traveled in and out since then for leisure and academic purposes. With her revitalized eyesight, she now marvels, from her living room, at the burst of colors of a Dutch suburb called Poortugaal.)