AMONG the more than a dozen legislative priorities pitched by President Duterte in his third State of the Nation Address (Sona) on July 23 is one that—unlike the conditional cash transfers that still split public opinion, with many quarters claiming they encourage sloth—truly resonates among all sectors: an ambitious universal health-care system that is seen to end one of the most serious facets of poverty.
Heading into the weekend, civil society group Action for Economic Reforms (AER), which has supported the comprehensive tax-reform package, especially the higher sin tax rates to boost health funds, sought the swift passage of Universal Health Care (UHC) in the Senate. The AER gladly noted that the health-reform bill has gained “significant support from most of the members of the chamber.”
“The increasing support for UHC is a welcome development, and we laud Sen. JV Ejercito for spearheading the submission of the Committee on Health report to the plenary immediately after President Rodrigo Duterte announced the inclusion of UHC as among the urgent measures. This represents a landmark reform for the country, and passing the bill would help address many of the problems our health system is currently faced with,” said Jo-Ann Diosana, AER’s fiscal policy coordinator.
The Senate Committee on Health chairman, Ejercito, sponsored Senate Bill 1896, the substitute bill on UHC, with Sens. Nancy Binay, Leila de Lima, Cynthia Villar, Sonny Angara, Risa Hontiveros, Ralph Recto, Joel Villanueva and Sherwin Gatchalian as co-authors.
The one thing that stands out in the UHC bill is that, unlike the present regime where people can only turn to the Philippine Health Insurance Corp. (PhilHealth) packages, under UHC, “all essential outpatient services will be covered, including consultations, medicines, diagnostics and laboratory services,” Diosana noted.
“Moreover, having primary care as the anchor of the health system will ensure that all Filipinos will be cared for by a primary care provider, who will be ready to provide consultations free of charge. This would greatly reduce out-of-pocket spending, and prevent cases of Filipinos refusing to seek treatment for their ailments because they do not have enough money,” explained Diosana.
Surely the “out of pocket” spending she refers to is nothing to sneeze at. Beyond the abundance of anecdotal stories of families being wiped out by medical expenses when one or several household members fall ill, the data right there stares policy-makers in the face, and this is what must have swung decision-making in the higher levels of government. In his sponsorship speech for the substitute bill that consolidated those of his peers, Ejercito cited the Philippine Statistics Authority (PSA) finding that per capita health expenditure of every Filipino “rose by 8.7 percent in 2016.” This meant, he said, that every Filipino spent P6,345 for his/her health that year, up from the P5,840 in 2015. This is an additional expense of P505 for every Filipino, the senator added.
He then raised the question: how much of the expenses for safeguarding health are borne by the citizen? The answer, per PSA data, is more than half. Enough to gouge the average household’s income and not just wipe away savings but often even force families to give up some vital expenditures such as for schooling, or home repairs or even for the health maintenance of some members deemed less at risk of major ailments than a family member struck with catastrophic illness or requiring hospitalization.
According to PSA data, of the entire financing scheme for current health expenditures, the household out-of-pocket payment has the biggest percentage at 54.2 percent, or P342 billion. The government only accounted for 34.2 percent, or P216 billion, added Ejercito.
In pushing for having the UHC bill make the final hurdle through Congress, AER’s Diosana cited the case of 63-year-old Cesar Salvador, who suffered a stroke in 2015 that left him with slurred speech and a need for regular maintenance medicines. “However, despite being a member of PhilHealth, Cesar has not been able to regularly take his medicines because these are not covered by the health financing agency,” AER pointed out.
In an interview with Cesar’s wife, Carmelita Salvador, 53, the couple complained about the high cost of medicines and follow-up consultation with his doctor, taking away the budget intended for the food of their family on the table. Cesar was the only income earner and the family has depended on his salaries until he got sick, according to AER.
“PhilHealth does not help provide the medicines that he needs. Because we do not always have extra money to spare, we aren’t always able to buy the needed maintenance drugs,” AER quoted Carmelita saying in a mix of English and Filipino.
According to Carmelita, her husband had always been hypertensive, which increased his risk of having a stroke.
“Sometimes, his blood pressure reaches as high as 200-over-120. Our doctor said that his risk of having a stroke increases because of this. We hoped we have prevented it but consulting a doctor is expensive. And it’s difficult when you don’t have money because you are not given enough attention,” added Carmelita.
The proposed UHC bills, AER stressed, aim to address the ongoing issues of access to health care of Filipinos, particularly the poor. Backers of the legislation hope to achieve this by reforming PhilHealth and expanding its benefits coverage to more outpatient services, among others.
AER cited Exhibit No. 2: Maria Teresa Taidolom, 60, who got to enjoy her PhilHealth benefits when she was confined in the Tondo General Hospital after suffering from stroke two years ago. She is currently residing inside the Manila North Cemetery as she works as a caretaker of tombs inside the cemetery.
“I don’t have the means to pay for my PhilHealth but Congressman Yul Servo took care of it so it can cover the expenses of my confinement,” Taidolom told AER. However, sustaining her maintenance requirements is uncertain: “I have not paid for the monthly premium after I got out of the hospital so I am not sure if I can still avail myself of the PhilHealth benefits in case something happens to me.”
According to Diosana, this is a common predicament among the poor who are not recipients of the Pantawid Pamilyang Pilipino Program (4P) and are thus not getting government subsidy for the PhilHealth premium.
How to fund it?
THE UHC as endorsed by Ejercito et al. appears to be a blessing, indeed, to millions of Filipinos impoverished by their health requirements, or at risk of not being able to fend for themselves should they fall ill. However, ambitious as it is, it requires a major, sustainable source of funding.
In her earlier sponsorship speech, one of those who backed the UHC, Hontiveros pointed to the provision on the pooling of the health assistance funds of different government agencies as a means to fund UHC. Additionally, Ejercito proposed to include his Senate Bill 1605 proposing to increase the excise tax rates on tobacco products as one of the funding sources. This will be part of the next-round tax reforms now being pushed in Congress.
“Without the proper funding, the Filipino people will struggle to reap the benefits that UHC should bring. We therefore agree that pooling of the funds from the Philippine Charity Sweepstakes Office (PCSO) and the Philippine Gaming and Amusement Corp., and passing Senator Ejercito’s bill on tobacco tax are necessary in order to ensure that we have the sufficient budget,” added Diosana.
In endorsing the Report of the Committee on Health and Demography on the Universal Healthcare Bill, Ejercito had said the goal is to have a system that is “efficient, adequate and affordable.”
The committee, Ejercito reported, conducted five hearings and a series of consultations and technical working group sessions before coming out with the present version of our proposed UHC bill. “The committee strived to reach the major cities in Northern and Southern Luzon, the Visayas and Mindanao,” he added.
“We reached the cities of Cebu, Davao and Legazpi, Albay, and the municipality of Lingayen in Pangasinan to learn from our people of their true needs. We had a productive series of consultations because when we returned to Manila, we brought back valuable insights from our people, as well as personal experience that proved helpful in crafting the committee’s final version of the bill,” said Ejercito.
The senator noted that, besides empowering households with enough funding for health, the UHC bill takes a hard look at the state of government hospitals: mostly congested, in disrepair or poorly ventilated.
He cited a Department of Helath (DOH) report that 42,000 beds are needed to attain the ideal ratio of one bed to 800 population (1:800). The required budget to do this is P228 billion.
The current bed-to-population ratio is at 1:1,121, and only Metro Manila and Region 10 or Northern Mindanao region have reached the minimum standard. The disparity between regions is most appalling: Metro Manila has a ratio of 1:591, and the ARMM languishes with a 1:4,200 bed-to-population ratio.
Ejercito said his committee’s visits to state hospitals around the country opened his eyes to the urgency of pushing the UHC bill as soon as possible.
Thus, the bill, he noted, also seeks to address other raging health-care issues:
• ensuring equal access to quality and affordable health goods and services for every Filipino;
• reviewing the mandates of relevant agencies like PhilHealth, DOH, and the local government units—both to avoid overlaps or, conversely, the fragmentation of the health-care system.
Moreover, each Filipino is automatically covered or included in a National Health Insurance Program as a direct or indirect contributor. The service coverage has been expanded, and the preventive and promotive aspects of health care boosted.
Under the UHC bill, a National Health Workforce Support System is championed to strengthen the publicly owned or -led service delivery networks and resolve shortages in the health work force, such as through better compensation and more plantilla positions.
The measure mandates the establishment of service delivery networks or SDNs—a mechanism that allows a contracted SDN comprising public or private or a public-private mixed enterprise to deliver services. This improves the gatekeeping in the disposition of cases, to prevent the undue swelling of cases in tertiary hospitals that could be handled in polyclinics or health centers.
A Health Technology Assessment (HTA) mechanism will improve policy making by constantly reviewing programs, regulations and systems.
With this in place, tragic episodes such as the Dengvaxia fiasco, where hundreds of thousands of schoolchildren were needlessly exposed to a serious dengue strain, will be avoided. An HTA Council or unit will be formed with experts who can validate and develop policies and recommend such to the DOH and PhilHealth.
For the funding aspect, the bill gives PhilHealth the responsibility to preside over a pool of funds meant for health provision or assistance from various government agencies. This pool comprises contributions and subsidies, as well as appropriations that the government has set aside for health operations, and other sources like the health assistance funds of the PCSO and the Pagcor, medical assistance programs of DOH, administrative fines, donations and grants-in-aid, among others.
Ejercito committed, meanwhile, to “personally push” for the measure to raise the excise tax on tobacco products as a health and revenue measure. Under Senate Bill 1605 that he authored, the excise tax will rise to P90 per pack and will be adjusted by 9 percent each year thereafter.
With this, Ejercito is confident enough funds can be generated to provide for the ambitious requirements of the UHC.
Indeed, the UHC may seem a tall order, but to people like Teresa Taidolom and Cesar Salvador, it may well be the one important lifeline they need, not just to climb out of poverty, but enjoy a healthy life.
Image credits: Action For Economic Reforms