Get in first

The earlier you catch cancer, the better the chance of curing it. It’s the same with almost all other diseases. The sooner they’re caught, the higher the chance of cure. And the less the cost to cure.

Countries all over the world — Thailand, Brazil, Rwanda (now there’s a country we need to look at a bit more closely, as it seems well advanced in many things), Sri Lanka, Costa Rica, to mention but a few—are recognizing that spending on primary healthcare gives the best value for the dollar. As the Economist (8/24/17) points out: “Costa Rica spends far less than the global average on health, but has the highest life expectancy in the Americas after Canada and Chile, thanks to its impressive primary care.” It adds: “Primary health care is not flashy, but it works. It is the central nervous system of a country’s medical services — monitoring the general health of communities, treating chronic conditions and providing day-to-day relief. It can ensure that an infectious disease does not become an epidemic.”

A New York Times article, “In Health Care, Republicans Could Learn from Rwanda” (7/18/17), highlighted the improvements in that country’s healthcare system over the past decade: Its universal healthcare program now covers 90 percent of the population; Rwandans now see a doctor almost twice a year, compared with once every four years almost 20 years ago; citizens live 18 years longer compared to 10-15 years ago; more than 97 percent of Rwandan infants are vaccinated against diphtheria, tetanus, pertussis, hepatitis B, and other diseases; and almost all Rwandan adolescent girls are vaccinated against human papillomavirus, which causes cervical cancer.

According to the World Bank, the mortality rate among Rwandans aged 5 years and below dropped to 42 per 1,000 live births in 2015 (Philippines 28) from 152 in 1990; the mortality rate among infants declined to 31 per 1,000 live births (Philippines 22) from 93 during the same period. It spends about 2.9 percent of its GDP on health, compared to the Philippines’ 1.6 percent.

What should be done first is to promote healthy living, so you don’t need healthcare. Yet I don’t think this is part of the Department of Health’s agenda. It should be a major plank of the DOH platform, and Congress should provide enough funds to get the message across. The cost would be more than covered by the huge savings in later medical expenses.

After that, when you do get sick (as we all do) is where a nationwide primary healthcare service comes into play. Properly created, it could lower the national cost of healthcare and spread it to even the remotest barrios.

Clinics don’t need to be staffed by a doctor; it would be better if they are, but someone with basic training in a short course would be sufficient. A qualified nurse can certainly handle most of the cases. And this is the point: The clinic isn’t there to cure everything, but to weed out the common, and frequent, illnesses that take up much of a hospital’s time. The clinic acts as a filter weeding out the curable and referring the difficult to a hospital.

What is needed is an holistic approach to health. Focusing on just one aspect — for example, controlling medicine prices — is not the way to go. The forced lowering of prices in 2009 didn’t result in better statistics on health. It just gave the rich,

the ones who buy branded drugs, an unneeded break. The poor, who can’t afford medicine at any price, still relied on the government for free provision. The middle class bought generics at an even lower cost than the forced reduction of the cost of branded drugs.

These two actions would greatly relieve the pressure on the serious cases. Which is when hospitals come in. Serious cases should be fully paid for by PhilHealth, which should not have an upper limit on expenses reimbursed. Families shouldn’t have to sell the family home to keep Lolo alive.

E-mail: wallace_likeitis@wbf.ph. Read my previous columns: www.wallacebusinessforum.com.