It is a term that’s familiar to patients at public hospitals, including the most prestigious specialty public hospitals. For indigents and for those in the lower rungs of the middle class, this is perhaps the only way to pay for labs, medicines, confinement and procedures.

The so-called Malasakit Centers promised to “streamline” the procedures for getting medical assistance from the Department of Health, Department of Social Welfare and Development, Philhealth, Philippine Charity Sweepstakes Office, and other sources. There are many positive testimonials about it, and it has been credited for the electoral success of certain politicians.

I became quite familiar with the processes last year, when I had to undergo procedures at a specialty public hospital. I am absolutely grateful to fellow citizens and taxpayers. It is they, or we, who actually continue to fund the specialty public hospital, employ world-class public health workers and doctors, and make possible the procedures I needed to get. Let me explain.

GLs used to be actual letters, but the letters of the past have since been boiled down to a series of numbers attached to the name of the patient, a specific public hospital and a specific amount.

A GL (guarantee letter) number can be obtained from a senator or a congressman. Procedures for getting it vary from office to office. A letter of request or solicitation is often required. The closer one is to a ward leader, a district officer, or a staff member, the more certain one could get a GL — and fast. The amount also varies. Sometimes, a few thousands to more than a hundred thousand.

Some offices of senators or congressmen would just give the GL number via text or email, but many would put the GL number in a letter featuring huge photos or names of the senator or congressman. In many areas, there are big community events, where lawmakers or senior staff would hand out these GL letters represented as “medical assistance” from the congressman or senator.

The GL number is then submitted to the specific hospital’s charity department or Malasakit Center, which in turn converts it into a “service order” containing information like name of the patient, the source fund (DOH allotment), the specific reference to the senator or the district or partylist of the congressman.

The information in the service orders is perhaps the ultimate reminder that the financial assistance did not actually come from the pockets of our dear legislators, but direct from the taxpayers ­ from the budgets of the DOH and DSWD under such program names as Medical Assistance to Indigent and Financially Incapacitated Patients (MAIFIP) and Assistance to Individuals in Crisis Situation (AICS).

When obtaining medicines or lab work, or at the end of confinement or for procedures, the bills would be charged against the amount in the GL or GLs, benefits from Philhealth, and discounts for seniors and persons with disabilities. Up to 50 percent of the GL amount could go to professional fees of doctors.

For some, this process looks “managable,” but for full-time minimum-wage workers, seniors, PWDs and survivors of devastating illnesses, the process could feel tragic, humiliating, and demeaning. There are waiting lines and queues at each step of availing any of these forms of “medical assistance” from offices of lawmakers, to the social service departments of hospitals. In some hospitals, queueing starts as early as 4 a.m., although transaction windows open only at 8 a.m.

According to the DOH, the 2025 budget for MAIFIP is ₱41.16-billion. This money is with the DOH, and it is the lawmakers who decide as to who gets the GLs and how much. Without a GL from a lawmaker, a patient won’t be able to unlock the MAIFIP for his or her benefit.

The government’s “zero balance billing” and the free checkup and medicines program called Yakap are steps in the right direction, especially for the poor and workingclass, as well as the middle class. We could only pray that our people would be able to “make do” with only 721 public hospitals and 70 DOH-managed hospitals nationwide now and in the future.

With health being important to individuals, families, and communities, how the state dispenses publicly-funded medical assistance and how adequate our public health system is are issues that demand our attention. A lot needs to be done to guarantee health services for all.