LOW-EARNING Filipinos continue to shoulder the high cost of health care despite improvements in the benefits package covered by the government’s health program, a nongovernment organization said.
According to Jo-An L. Diosana, senior economist of Action for Economic Reforms (AER), expanding the coverage of the Philippine Health Insurance Corp. (PhilHealth), especially among the poor, was one of the objectives of Republic Act 10351, popularly known as the sin-tax law.
The Department of Finance hails RA 10351 as one of the landmark legislations under the administration of President Benigno S. Aquino III.
“The sin-tax law helps finance the universal health care [UHC] program of the government, simplified the current excise tax system on alcohol and tobacco products and fixed longstanding structural weaknesses, and addresses public health issues relating to alcohol and tobacco consumption,” a post on the DOF web site said.
However, a report from the Philippine National Health Accounts (PNHA) reveals that out-of-pocket spending accounted for 54.2 percent of total spending for health in 2016, compared to 55.7 percent in 2014, while the share of the government to total health expenditures increased to 34.2 percent in 2016, from 29.7 percent in 2014.
“Sadly, despite significant improvements in PhilHealth’s coverage and benefits, the high burden of financing for health still remains on the households” Diosana said.
Ambitious
Diosana describes the government’s UHC tack as “ambitious” and “yet in abeyance”, as several related bills remain pending at the Senate.
Those bills “should be able to improve access to quality health care, especially of the underserved citizens,” she explained. However, Diosana said this ambitious goal of UHC could only be reached “if sufficient and sustainable sources of funding are tapped.”
The AER and other health advocates believe the funding could come from taxes on so-called sin products—alcohol and tobacco. They are also pushing for the increase in the current sin-tax rates to sustain the financial requirements of the UHC.
The pending bills, to note, also eye the funds managed by the PhilHealth. This government agency is the natural recourse as PhilHealth implements the National Health Insurance Program (NHIP) as mandated by RA 7875.
The bills pending at the Upper House of Congress intend to make all Filipinos as PhilHealth members and expand the benefits that the members will enjoy. Specifically, the bills propose the inclusion of outpatient or primary care, such as consultations, medicines and laboratory tests, in the services that will be covered and paid for by the NHIP.
Gains
Lowering the costs of health care is good news for Filipinos like Marilyn Asidera, a resident of Baranggay Payatas, Quezon City.
Asidera said she has to spend P3,000 for medicines when her 10-year-old daughter undergoes medication for mild pneumonia.
“Although the medical clinic in Payatas provides free services, we have to spend for the medication and other related costs for a whole week, because my daughter’s case is considered outpatient,” she said in the vernacular.
Asked whether she is aware of the low-cost medication for pneumonia, Asidera told the BusinessMirror she is, but to qualify for the program, she has to wait for another week. That time is used to observe her child’s cough, including bringing phlegm samples to the clinic.
“I do not want to wait for my child’s cough to get worst as it will not only make her suffer longer than necessary but will also prevent me to report to my work.”
Asidera is an on-call household helper, while her husband works at a construction site.
Diosana said the expansion of benefits to outpatient care will greatly ease the financial burden of people like Asidera.
“We see how poor households sacrifice time and other basic necessities for the health care of family members,” she said. “The UHC bills hope to end that vicious cycle of the poor getting poorer due to their lack of access to the very basic health-care services.”
Outpatient
Earlier this year, a study group composed of local medical practitioners released a series of statements to persuade senators to strengthen the outpatient care in the country by including it in the UHC bills.
“It is high time we cared for our patients to protect their well-being instead of just delaying their trip to the grave, so to speak,” said Dr. Antonio Dans, head of the Philippine Primary Care Studies. The PPCS is a research group under the University of the Philippines system that is helping the Department of Health (DOH), local government units (LGUs), PhilHealth and Congress to prioritize the strengthening of primary care systems as one of the key elements of the UHC.
“We need reforms in our health-care delivery system that will focus on preventing ailments and promoting health aside from intervening when people are already sick,” Dans has said in one of the statements that the PPCS issued.
The physician added that “curative care is important but can be more exacting on the resources of the government and of patients and their families.”
“Primary care in its simplest definition is outpatient care,” the physician added. “This is where disease prevention takes place.”
The PPCS is pushing for primary care as the focus of PhilHealth benefits to realize the goal of universal health care.
“Many patients do not have access to hospital facilities but can still go to outpatient facilities near them. Most diseases need outpatient care and not hospitalization,” Dans further said. “And even most patients who have been treated in a hospital would need outpatient care when they are discharged.”
Access
According to Dr. Raffy Marfori, assistant program leader of the said study, the current health system in the country works for some, but not for all.
“That’s because a lot of Filipinos do not have access to health services despite the increase in the number of households getting covered by PhilHealth.”
“PhilHealth enrollment has reached up to 92 percent of the population and, in general, more people are now utilizing their health benefits when they are sick,” Marfori added. “But this improvement has been much slower and more difficult for poorer Filipinos.”
Studies conducted by the group show that, while only 33 percent of wealthier Filipinos were able to utilize their PhilHealth benefits in 2003, this improved to 88 percent in 2013. But in the same 10-year period, the utilization of PhilHealth benefits among the poorest segment went up from 18 percent to only 33 percent.
Marfori cited barriers that prevent people from actually claiming their health benefits, even with high-population coverage. These barriers include partial coverage of outpatient care, unavailable services near homes or workplaces, added costs to reach those services—such as transportation and absence from work—and a mismatch between the country’s health work force versus the country’s health needs.
“It takes many things to achieve universal health care, although the single most crucial piece of the puzzle is being able to strengthen primary care systems,” Marfori explained. She believes the UHC bills have the potential to address the problems “our health system is currently facing.”
“We [should aim] for a health-care system that reaches all Filipinos, connects all Filipinos to needed health services and limits barriers such as but not only cost, to achieve fairly distributed health outcomes for more people.”
Image credits: James Francis | Dreamstime.com