Beyond the UHC law

The late Dr. Quasi Romualdez, former health secretary and convener of UP Manila’s Universal Health Care Study Group, would have been proud of the moment the UHC law was signed. During the 2010 elections, presidential candidates like P-Noy committed to UHC, but it would take nearly another decade of advocacy and legislative work to see such a law passed. Credit belongs to everyone whose efforts led to this moment, including lawmakers like Sen. JV Ejercito, the Department of Health under Secretary Francisco Duque III, and even the Duterte administration — which, for all my objections to its overall governance, has been quite open to health reform.

But Romualdez, ever the pragmatist, would also have been the first to recognize the fact that the UHC law is just the end of the beginning. It is certainly a milestone; a bold declaration that health is a right of all Filipinos—and, crucially, that policies should undergo “health technology assessment,” a step that would have averted the Dengvaxia controversy.

Even so, much work needs to be done if we are to go beyond universal coverage and make “health for all Filipinos” a reality.

In the first place, there is the all-important question of health financing; the feasibility of UHC has always been contingent on raising tobacco taxes, specifically to no less than P60 per pack of cigarettes. I urge members of both houses of Congress — including Sen. Sonny Angara who promised to act on this measure after the elections — to support a tobacco excise tax rate increase, as it will greatly benefit Filipinos not just from the revenue raised but from the smoking-related deaths prevented.

Moreover, given that out-of-pocket expenditure has remained unacceptably high, we should also approach health financing from the perspective of ordinary Filipinos. Philippine Health Insurance Corp. coverage notwithstanding, the fact that people have to spend time and money to go to health care facilities is also part of the financial burden of health, and so are informal payments like giving an expected “tip” to the ambulance driver.

Although some pharmaceutical companies have significantly lowered their prices and some medicines are actually free in health centers, many others remain prohibitively expensive. And what of the unnecessary, unregulated, unethically marketed supplements that many Filipinos buy?

Secondly, there is the equally important conundrum of human resources. In a study with Dr. Tony Dans and Philippine General Hospital colleagues, we found that health workers in tertiary hospitals note dramatic improvements in patient care since the implementation of the sin tax law, but they themselves feel overworked and underpaid. Outside the cities, understaffing is much worse, with some municipalities lacking not just doctors but also nurses, dentists, medical technologists and midwives.

Beyond measures like the doctors to the barrios and nurse deployment programs, we need more regular — and regularized — health workers. And, as professor Clarissa David and colleagues found out in a recent study, we need to dramatically scale up our schools of medicine, dentistry and allied professions. Ultimately, we also have to radically rethink the curriculum and the roles of each profession, reorienting them to primary care and the demands of the future.

Rightfully, the UHC law acknowledges the failures of “devolution,” which has put too much power in the hands of local government unit executives. In my fieldwork around the country, I have seen how  mayors use health as a political tool — for instance, by insisting that they dispense medicines from their own offices instead of the health centers so they’ll get the credit for them. The UHC calls for (re)organization of health services at the provincial level, but the success of this measure will depend on rigorous but practicable implementing rules and regulations, strict auditing and a health systems perspective at the level of the provinces.

These and many other hurdles notwithstanding, the UHC law is a positive step toward health for all Filipinos. “It is a beautiful law,” as Dr. Ernesto Domingo, National Scientist and Quasi’s coconvener at the UHC Study Group told me. “Now we have to work for its implementation.”

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