YEAR-END REPORT Health-care system, 1998

The delivery of health care is the largest ticket item on any government’s budget and the NMI is no exception. As demands for more health care delivery expands by leaps and bounds, the local health care system finds itself in a bind when austerity measures came into effect this year. It meant more for less.

Although the Department of Health and Environmental Services is one of three most important government agencies, it too suffered budgetary cuts when the administration imposed a 13.4 across the board reduction in departmental fund allocations.

The department’s budget was reduced from $41 million in fiscal year 1998 to $33.9 million for the current fiscal year. The money contraction included severe cuts in medical supplies from $3.5 million in FY ’98 to $982,000 although there’s $2 million in Imprest Fund for emergency medication. It means the department must temporarily come up with creative means to ensure that medical supplies are ordered on a timely basis. Villagomez assures that he’s working out with the department of finance and the office of management and budget to set this matter in order.

Against the tide of less money to work with this fiscal year, Health Secretary Joseph K. Villagomez must still deal with an increase in ambulatory, catastrophic and long-term illnesses of a growing population, including turning the facility that now houses the Division of Public Health into medical wards. This would eventually happen in the next year.

Maintaining a strong health standard

The health department had to wrestle with maintaining a strong health standard throughout the health care system.

There was a shortage of qualified nurses and it must deal with the hard question of whose interest comes first, nurses by foregoing the professional nurses’ license test or a standard that ensures quality delivery of health care. The so-called NCLEX (National Council Licensure Examination) test is the means to determine whether nurses — locals and foreign hire alike — know their profession.

It’s a critical group next to doctors who should be able to call, i.e., the misplacement of decimal points in medicine ordered for patients. It makes a difference and it hinges on life or death. A qualified nurse should be able to detect these errors and bring it to the attention of attending physicians.

Albeit difficult, it decided to stay with the NCLEX test for it is an instrument to ensure that the local hospital is equipped with qualified nurses. For those who passed their tests, they are retained and given their dues, accordingly. For those who flunk, they either (if a foreign nurse) take the test for the second time and pass it or must return home eventually. For locals, it meant a demotion to nurse’s assistant.

But even with this standard in place, the local hospital must still resolve current and future nurses’ shortage. It now relies on a nurse’s program at the Northern Marianas College for future qualified nurses. It is a continuing concern. But even against the odds, it held its ground to maintain quality health care standard in the NMI.

Rise Lifestyle and Communicable Diseases

For the first time in our developmental history, there’s a substantial increase in non-communicable diseases like diabetes. The NMI’s ration when mirrored against the national average is alarmingly high. Today, we have more than 2,000 diabetics throughout these isles. Comparatively, it is the single disease, other than heart diseases, that has gained attention in that every year there’s added 200 more diabetics.

It means, that there must more locals who may be afflicted by this disease but are unaware that they have it. They only discover that they are diabetics when they come into the Commonwealth Health Center for another reason, i.e., treatment for a bad flu or other less significant illnesses. It is a major local affliction that may have more diabetics or borderline cases awaiting discovery and subsequent treatment.

The department is committed to campaigning for stronger health habits for the indigenous population. Diabetes is a lifestyle disease which emerged over the last three decades from a shift in local diet — fish and complex carbohydrates to meat, sweets and the modern drink — soda pops. It is further aggravated by eating fatty and salty food that abound in local diets like fritada and the constant use of more than necessary salt in food preparation.

So what’s most alarming about diabetes? It speeds up other ailments that one may have, i.e., heart, kidney and other diseases especially when more better but not necessarily good healthy food is eaten by diabetics. Careless in dietary regimen or failure to follow medication prescribed by a doctor leads to long term complications, i.e., lack of blood circulation in the lower section of the body that may lead to infection, thus requiring amputation when a the infected area turns into gangrene. What is even more alarming for medical professionals is the rate of deterioration that is found in locals who have diabetes.

The health secretary is grateful that there was established a Diabetes Center, but it came a bit short of the goal in that it lacked funding for its eventual establishment. He now looks towards the National Diabetes Advisory Council for assistance to fund the local diabetes center.

The department also had to scramble over the last year to impose the controversial health screening test when it found, through the Center for Disease Control in Atlanta, that there’s a high rate of communicable diseases here, i.e., tuberculosis and sexually transmitted diseases (AIDS, syphilis and gonorrhea). The increase in
STDs and tuberculosis was triggered by foreign workers who come from places where these diseases abound.

The cost of medical referral is within its budgetary limit. In fact, it has decreased with the participation of private health providers and health insurers (government and private) who defray the cost of their patients when referred to off island medical centers on Guam, Honolulu, Manila and San Diego.

Looking Ahead

Health Secretary Villagomez envisions untangling certain laws that inhibit the daily operations of the local hospital. For instance, current statutes permits CHC to bill for medical services, but collection goes to the general fund for subsequent appropriation and disposition.

Over the last year, CHC collected some $10 million from employers who have failed to pay services rendered their employees for over a period of time. It is money the health care system can appropriately dispose to meet budgetary shortage so imposed by cuts under the administration’s austerity program.

Said Villagomez: “When the health care system eventually turns into a public corporation, we should be able to hire qualified professionals, deal with our fiduciary responsibilities in health care delivery and hopefully turn the current situation into a more self-sustaining operation. It should enable us to stand on our own two feet”.