PhilHealth and a better normal

Our chronic problems with PhilHealth and its predecessor Medicare reflect a deeper malaise: our refusal, in the Philippines, to build a public health care system that responds effectively to the needs of people, regardless of their paying capacity.

This happened because we insisted on blindly following the US model of health care, which has been an abject failure. While Western Europe and many other countries around the globe put up national health services with tax-based financial benefits so everyone had access to care, we followed the Americans with patients left to pay out of their own pockets, or through expensive insurance.

Attempts to put up tax-based government health care were opposed, in the US and in the Philippines, as “socialistic.” The US eventually put up Medicare and we followed with our Philippine Medical Care Commission (also known as, surprise, surprise, Medicare) in 1971, then PhilHealth in 1995, both systems depending on premiums, as with insurance, collected from individuals, with costs climbing all the time.

When a Universal Health Care law was passed last year, government immediately imposed an increase in the premiums to be paid by overseas workers. Rather than having a fixed amount, the new system prescribed the premium as a percentage of wages. Filipinos in Hong Kong were particularly vocal in their protest because before this new requirement, an OFW would pay P2,400 (HK$366) a year. The new premium was pegged at 3 percent of wages, and for a domestic helper earning the minimum salary, the premium would now be HK$1,667 a year, five times the previous amount.

You can imagine how our Filipino workers in Hong Kong felt reading about the plunder of PhilHealth’s funds.

Think back, too, to more recent PhilHealth scandals like the ghost patients in dialysis centers, and the victimizing of senior citizens in urban poor communities, recruited for cataract surgeries that were not needed.

The “mafia” deals have eroded PhilHealth’s funds, with predictions that there won’t be funds left in a year, this happening during the COVID-19 pandemic where a severe case can run hospital bills up to the millions. PhilHealth is supposed to provide P750,000 for a severe case.

But all this is not surprising because the Philippines just doesn’t look at health care as a right. Nor do we look at it as an investment: A healthy citizenry moves a nation forward. The United Kingdom, western European countries, Canada,

and a few other countries around the globe established strong state health care systems, and universal coverage, right after World War II. Although reeling from the war, their leaders saw the need to invest in health, establishing a public health care system whose services were, to borrow from the British National Health Service, “comprehensive, universal and free at the point of delivery — a health service based on clinical need, not ability to pay.”

In the Philippines, we look at public health — represented by the Department of Health — as inferior health care for the poor, so it’s not surprising we have such a dismal record handling public health problems, from smoking and bad nutrition to diseases like dengue and heart disease (yes, that’s public health, too). When COVID-19 broke out, our health department abdicated its duties and left them to the military and politicians.

Worse, PhilHealth and Medicare were seen as milking cows for bureaucrats, in collusion with unscrupulous doctors and hospitals.

COVID-19 was a wake-up call. The lack of universal health care, the lack of other social safety nets like unemployment insurance, made us so much more vulnerable to the pandemic’s adverse effects.

We need a better normal with our social services. We need a public health system—one that covers the preventive, curative, rehabilitative, promotive aspects of health care—supported by well-managed funds, and which will draw committed and competent health professionals to serve.

mtan@inquirer.com.ph