Universal health care beyond PhilHealth

The country has a historic opportunity these days to transform its health system — from one that is inequitable, narrow and fragmented to one that is based on human rights, where no one is left behind, and is comprehensive and integrative in content, scope and approach.

That chance has come in the form of passing a good universal health care law and getting it right.

Sen. JV Ejercito has filed Senate Bill No. 1896, known as the Universal Health Care (UHC) bill. While the pending bill has many laudable provisions, there is still room for improvement, and civil society and people’s organizations are working with various actors — notably the Department of Health, other legislators, media, academic and research institutions, etc.—toward passing a UHC bill that will: 1) prioritize public health interests over corporate interests and trade influences; 2) protect Filipinos against natural and human-induced crises; and 3) effectively address inequity, impoverishment and discrimination in the country’s health system.

This is achievable if, first, a strong rights-based health system is set up, one that aims to protect the people’s right to the highest attainable standard of health possible. That involves improved healthy living, working and schooling conditions, and where all Filipinos have equitable access, without discrimination, to sufficient quantity and quality health care, whether promotive, preventive, curative, rehabilitative or palliative.

At present, PhilHealth only pays mostly for curative and some secondary preventive health services, such as diagnostic and laboratory services. While one of the aims of the pending UHC bill is to further expand enrollment and coverage, health service delivery is only part and parcel of the entire health system. The other part of the equation is the need to improve the conditions where people grow, live and work, as these also significantly affect people’s health.

As such, the second thing the bill can do is to push for a system-wide transformation of the health system into one that is comprehensive but integrative, empowering and needs-based. Under this setup, the health sector will be required to collaborate with other disciplines beyond the medical sector and agencies. The UHC bill can provide for a “whole-of-system, whole-of-government, and whole-of-society” approach in managing the health of the population by integrating health in all government policies—education, agriculture, housing, environment, labor, trade and foreign policy.

A recent example of economics (cost) taking precedence over the people’s health was when the Department of Energy ordered the sale of “dirtier” but cheaper diesel fuel. Health Secretary Francisco Duque rightfully questioned this move, since the DOH was not consulted about it despite the fact that the people’s health was at stake. This incident underscores the need to institutionalize a health impact assessment of all government policies, plans and projects.

The UHC bill should promote healthy living, and working and schooling conditions that are realized progressively. A UHC bill that basically focuses on PhilHealth may mean, as many have

observed, “may coverage ka nga, pero wala ka namang care (you may be covered, but you don’t have care).” This holds especially true for the poor, who may be covered but don’t have access to health care workers and facilities.

A good UHC bill should ensure that quality health personnel and facilities are available and affordable to all. Filipinos deserve a health system that genuinely “cares” for all citizens, and that includes caring for the health workers, too.

This is the ideal UHC measure being pushed for by the Health Cluster-Alternative Budget Initiative of Social Watch Philippines, a network of more than 70 progressive civil society and people’s organizations advocating for systems reforms in health.

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Ma. Victoria R. Raquiza is coconvenor of Social Watch Philippines and a professor at the University of the Philippines National College of Public Administration and Governance.