Getting UHC to work

Last week I talked about establishing a culture of health. Behind that must be a healthcare system that works.

“Walang mga limitasyon. Kung ikaw ay may sakit at walang pambayad, kami na ang sasagot sa gastos mo (No Limits. You’re sick, you can’t afford it, we’ll pay).” That’s what this government promised. Will it accomplish it?

Government health services must be completely free. This can be done if we continue to increase public spending on health. The funds are available, a historic budget of P172 billion this year, and growing from sin taxes. Free or near-free treatment for the poor is essential with no upper limits. The concept of financial support up to a certain level is wrong. It’s when expenses are highest that support is most necessary. A working national health system must be the goal.

Universal health care is not just about curing Filipinos when they are sick, it is also about keeping them from being sick. Current national health programs are generally about what the government can do for you when you are ill in the hospital. The government should focus more on keeping Filipinos healthy and, as much as possible, away from needing to be hospitalized.

Eating a balanced diet (less rice and pork, please) and a bit of exercise can keep the doctor at bay. There’s a need to shift to outpatient focus (clinics, etc.) so hospitals can be freed up to concentrate on the serious cases. The focus on preventive health care would also free up more finances for the government to pay for the poorest of the poor.

Filipinos should be able to have regular check-ups, see a doctor annually, get the appropriate medicines they need to keep their conditions from getting worse, etc.—not once in their lives, which is what the poorest of the poor is doing, and generally as that life ends. PhilHealth should allot additional funding to support this focus on prevention and primary care. It should expand coverage of service to include diagnostics and medicines for outpatient care (e.g. maintenance drugs that keep you from having a heart attack). Right now, this type of health care service is barely covered in PhilHealth.

We already have the cheap drugs (seven out of 10 Filipinos have turned to generic drugs, which are at least 50 percent cheaper than their branded counterparts). So controlling prices is not necessary. Just ensure that prices are comparable (not equal) to similar countries, taking into account price-affecting differences. And if drugs are bought in volume and then distributed to the country’s health centers, costs can be greatly reduced. If PhilHealth worked with the drug companies, this could be achieved with no need to force prices down as is being proposed now.

Most of the more common illnesses are preventable by providing a cleaner environment and pushing for healthier lifestyles. For most Filipinos, especially the poorest and those living in the rural areas, the only health care facility they know is the rural health clinic, if there is one, and their next-door neighbor who has a little bit of medical knowledge (“hilot”). There is a need to bring health care public service closer to them by upgrading rural health facilities at the barangay level, as well as providing better training to health workers.

Getting local government units (LGUs) more involved would help improve access. But the roles between national and local governments need to be better clarified. They also need to be working together, not separately as they do now. LGUs need to be helped to become more active partners as they are mandated to do. A number of cities have successfully done this, but too many haven’t. Lack of how-to is a major reason, as is sourcing of funds, or the misuse of those funds.

The Philippine National Drug Formulary list, which contains what drugs hospitals/clinics in the country are allowed to prescribe, is not updated in a timely manner. The Food and Drug Administration has been dragging its feet on this matter. It is important that life-saving medicines, vaccines, and technologies are made available promptly to those who need them.

Spending on health is the government’s investment in the country’s economic future. A sick or sickly Filipino puts emotional and financial pressure on their families and government finances. This a losing situation for everybody. Let’s keep Filipinos healthy.

[Email: wallace_likeitis@wbf.ph]