PhilHealth unequipped for universal health care

The World Health Organization (WHO) constitution of 1948 declared health a fundamental human right. In 2015, the United Nations adopted a resolution urging developing economies to institute universal health care (UHC) by 2030.

In February 2018, our legislators presented a universal health care bill to President Duterte for his signature. On Feb. 20, 2019, he signed it into law: Republic Act No. 11223, or An Act Instituting Universal Health Care for All Filipinos.

UHC means that citizens of the country can use the preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while ensuring that the use of these services will not ruin them financially.

For universal health care to achieve its goal, several factors must be in place, including: a strong, efficient, well-run health system that meets priority health needs; a system for financing health services to prevent people from falling into bankruptcy; access to essential medicines and technologies; and a sufficient number of well-trained, motivated health workers to provide the services.

Quality health care makes UHC a large expense for governments. It is usually funded by general income taxes and/or payroll taxes. In the United Kingdom and Cuba, government-owned hospitals and government-employed professionals provide health care for free.

In the Philippines, every employee and his employer contribute to a fund administered by Philippine Health Insurance Corp. (PhilHealth). It pays for the care of the sick, including those who cannot afford medical care. According to PhilHealth, 21 million enrollees are indigents.

WHO recommends 20 hospital beds per 10,000 population. Based on Department of Health (DOH) data, all regions have insufficient beds relative to the population except for Metro Manila.

Public and private hospitals are classified by their service capability. The capability of Level 1 hospitals is comparable only to infirmaries. They account for 56 percent of the total number of hospitals. While Levels 1 and 2 hospitals are relatively well-distributed nationwide, hospitals with higher service capabilities are highly concentrated in Metro Manila and Central Luzon.

That means most hospitals in remote provinces cannot perform major surgeries or provide intensive care. To comply with the mandate of RA 11223, a patient needing such services in an area where there is no hospital capable of providing them will have to obtain them in a private Level 3 facility. But PhilHealth pays only a fraction of the hospital bill and of the doctor’s fee.

A patient on whom open heart surgery is performed will have to pay a large sum out of his own pocket, forcing him into financial ruin, a situation RA 11223 is supposed to prevent from happening.

RA 11223 automatically enrolled all Filipino citizens in PhilHealth. That is 109 million Filipinos spread all over the archipelago, from Batanes to Sulu. But PhilHealth is not configured to run a complex and far-flung operation. It does not have the personnel required by a health insurance company with 109 million enrollees, the majority of whom are vulnerable to diseases due to their harsh circumstances. It does not have the specialists that are key to the viability of the organization: a formally trained actuary, a doctor-leader with exposure to hospital administration, and an experienced investment manager.

WHO had advised our legislators to implement universal health care fully in 2030 when the country’s health delivery system would be capable of servicing UHC. It looks like the principal authors of RA 11223 rushed the enactment of the bill into law so that they may present UHC in the elections of 2019 as their gift to the Filipino people. Among the authors were Senators JV Ejercito, Sonny Angara, Nancy Binay and Cynthia Villar, who were all running for reelection. They must have said, “Bahala na si Batman.”

Their cavalier attitude placed PhilHealth in a precarious situation, prompting the beleaguered former PhilHealth president to say that not even Superman could cope with the task. But now brought in to fix the mess is a Dick Tracy.

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Oscar P. Lagman Jr. was at one time or another country manager for a multinational health insurance company, adjunct professor in the Master in Hospital Administration program of a university, and head of Healthcare Consulting at a large consulting firm. He was also a member of the USAID-sponsored team that set up the universal health care program of the Province of Bukidnon.