It’s time for universal healthcare

Over the past several Department of Health administrations, incremental gains have been achieved toward improving our healthcare system. Quasi Romualdez’s Health Sector Reform Agenda (1999), Francisco Duque’s “FOURmula One for Health” (2005), Ike Ona’s Kalusugan Pangkalahatan (2010): These programs were essentially iterations of the core goal to strengthen the building blocks of healthcare such as health financing, good governance and service delivery.

In recent years, these gains have accelerated. Thanks to the Sin Tax Law (2012), revenue for health has greatly increased, and so has the budget for DOH (the coming year, I hope, will be no different, amid reports to the contrary). The revised PhilHealth law (2013), moreover, has greatly expanded the scope and range of benefits.

Nonetheless, deep problems remain. Although PhilHealth coverage is now nominally at 93 percent, utilization is low, and many Filipinos remain unable (or unwilling) to access health services due to other factors such as transport costs, distance and mistrust. Moreover, even with PhilHealth coverage, they remain at risk of impoverishment with “catastrophic illnesses” like cancer—especially with the understandable recourse to private healthcare.

Meanwhile, the shortage of health professionals and their skewed distribution to the private sector have led to overwork and long queues in government hospitals. While patient frustrations are understandable, “doctor-shaming”—Mon Tulfo’s uncalled-for tantrums come to mind—only adds to the hazards health workers face, even as they try to cope with limited resources by “triaging” or prioritizing those who need care the most.

In terms of governance, devolution was seen as a way for LGUs to govern based on their needs. However, this has led to mixed results. While there are some notable examples of a responsive health system like Valenzuela City, healthcare—from hiring of personnel to procurement of medicines—is often held hostage by local politics.

The Universal Health Care (UHC) bills (SB 1896 and HB 7875) try to fix these problems by addressing them in a systematic way. First and foremost, the bills include the revolutionary provision that all Filipinos should have access to quality healthcare and automatic inclusion in PhilHealth by virtue of citizenship.

The bills also rightfully put primary care at the heart of health service delivery by emphasizing the provision of essential health services. In a bid to reconcile the pros and cons of devolution, SB 1896 calls for province- and city-wide health systems, as well as “service delivery networks” to strengthen the referral system.

Crucially, the bill clarifies the roles of various agencies. For instance the DOH will be responsible for population interventions (e.g., immunization programs), while PhilHealth will be responsible for financing individual care (e.g., outpatient and inpatient care).

One question raised about UHC is whether we can afford it. With sufficient political will to pool existing resources (e.g., funds from DOH, PCSO, Pagcor) and to expand the Sin Tax Law (I hope Senators Angara and Recto will support this initiative), the answer is yes. UHC’s attention to preventive and promotive care can also reduce expenditures: Simply put, it’s cheaper to promote healthy diets and exercise than spend for dialysis.

Of course, UHC is not a panacea for all our health problems. Fiscal management on the part of PhilHealth, regulation on the part of the DOH and FDA, the exact role of the private sector, and much-overlooked cultural determinants of health remain areas of concern. Despite provisions for “return of service” and competitive compensation packages, the dearth of human resources is something that only more accessible medical education, greater empowerment of nurses and midwives, and regularization of contractual health workers can ultimately solve.

Even so, the bills lay down a framework and a mandate to respond to these challenges. With the potential of a UHC law to transform our healthcare system, there is every reason for our lawmakers, government, medical communities and all concerned Filipinos to work toward its swift passage.

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