Universal health care: An unkept promise?

As the Philippines continues its journey toward achieving universal health care (UHC), established through legislation in 2019, it is crucial to assess the effectiveness of this initiative in addressing long-standing health inequities afflicting our population. While UHC presents an ambitious vision for a reformed health-care system, the reality of its implementation reveals persistent shortcomings that demand urgent attention.

Recent discussions, such as the Health Equity webinar organized by the University of the Philippines College of Public Health and the Zuellig Family Foundation (ZFF), highlighted some progress, but also underscored significant gaps in executing UHC principles. Though there’s progress in creating an integrated province-wide health system, questions linger on whether these structural changes yield tangible benefits to Filipinos when it comes to health-care access and delivery.

The UHC law aims to unify a fragmented health system beset by inequitable funding and inadequate primary care services. However, the effectiveness of these initiatives is put into question when we consider the troubling statistics on primary care facilities (PCFs). As of December 2023, only 42 percent of PCFs in the country has received accreditation to deliver essential services. The number is far from the 5,500 functional PCFs needed to adequately serve our population of over 110 million. The exceedingly low accreditation rate suggests that the government is far from meeting its target, leaving a vast number of Filipinos without reliable access to primary care services such as medical consultation, health risk screening, diagnostic services, and medicines.

Moreover, the recent announcement that Philippine Health Insurance Corp. (PhilHealth) is obliged to return P89.9 billion to the national treasury raises serious concerns about the allocation of health resources in our country. This amount represents unutilized funds that could have been directed toward critical health programs, particularly primary care. With the pressing need for financial investment in health-care infrastructure and human resources, returning such a substantial sum contradicts the UHC’s goal to ensure accessible and quality health care for all. Instead of enhancing health-care delivery, this decision amplifies fears that fiscal policies prioritize budgetary constraints over the health needs of Filipinos.

In a country where so many still lack basic health services, the inability of PhilHealth to effectively deploy its resources is not just discouraging; it is a glaring indictment of the current system. The experiences shared by the ZFF’s partner areas illustrate an alarming trend: Although some local government units (LGUs) have made commendable advances, such as achieving high accreditation rates, these efforts are not uniform across the board. The inconsistency in LGU performance indicates a lack of strategic cohesion, and underscores the necessity of a decisive push from the national government—the Department of Health (DOH) and PhilHealth—to provide adequate support, guidance, and resources to meet UHC objectives.

Furthermore, relying only on local leadership to drive the UHC agenda poses inherent risks, particularly in regions where local governance structures may need more capability or commitment to prioritize health care sufficiently. While the involvement of local leaders has been noted as a positive factor in areas like Pangasinan, this isolated success should not overshadow systemic issues that persist in many other regions. The DOH and PhilHealth must engage proactively with all stakeholders—not just a selected few—to develop a cohesive nationwide strategy that ensures equitable health service delivery.

As we evaluate the road ahead for UHC in the country, it is evident that merely establishing policies and frameworks is insufficient. The government must prioritize investments in health infrastructure and workforce capabilities, while streamlining health data systems to facilitate better planning and decision-making.

In conclusion, while UHC presents a promising framework for comprehensive health-care reform, its current implementation reveals critical weaknesses that must be addressed promptly. The return of PhilHealth’s P89.9 billion to the treasury signifies not just a failure of resource allocation, but a disappointment for millions struggling to access primary care. The urgency to bridge these gaps cannot be overstated; the health of millions of Filipinos hangs in the balance. Without decisive actions and a commitment toward truly realizing the goals of UHC, we risk perpetuating a system that fails to serve its most vulnerable citizens effectively. The call for accountability, transparency, and concerted efforts from all levels of government is clear: We must ensure that UHC does not remain a mere aspiration, but will evolve into a transformative reality for every Filipino.

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Dr. Anthony Rosendo “Tonyboy” Faraon is deputy executive director of Zuellig Family Foundation and chair of the Philippine Society of Public Health Physicians.