Health is wealth

When the pilot of that jet plane miscalculated and ditched the plane in the water off the plush Balesin island resort, a Cabinet member was criticized for being on that flight. Observers say he should have been in Bohol where earthquake victims are still crying for help.

Poor Health Secretary Enrique Ona! After the harrowing experience of a plane crash, he has to explain why he is vacationing in luxury while health facilities in Bohol are still on emergency mode, some even operating out in the open air.

Actually, I wouldn’t begrudge Sec. Ona a weekend away from work. The change of scenery, specially one as pleasant as Balesin, should do wonders in recharging this seemingly tireless public servant.

As long as he had been at the quake sites and knows what the challenges are, the Health Secretary does not have to station himself there until things clear up. A good manager with good subordinates should always have the confidence that operations will run smoothly even if he is not on the site.

Indeed, the Health Secretary is one of the more productive cabinet members. He has done a lot over the past three years to improve the health delivery system of government.

P-Noy, in his recent talk before foreign correspondents, noted that they have been able to upgrade the facilities of government hospitals, such as the Lung Center of the Philippines, the Philippine Heart Center, and the Philippine Children’s Medical Center.

We also have to give credit to P-Noy because he has supported health care delivery from Day One by increasing its budget from P24.65 billion in 2010 to P50 billion this year and P81 billion next year. That’s how to invest on our human capital.

I have written in previous columns about how P-Noy is working to make universal health care available to all Filipinos. That’s no easy task, even in the United States, as President Obama will tell you. 

Universal health care is also the focus of Dr. Ona. He has always said it is his mission to ensure that access to adequate health care “is available to what we call the q1 segment, the poorest 20 percent of the population who earns P3,500 to P4,000 per family per month.”

In this regard, he pointed out the expansion in PhilHealth enrollment. The Universal Health Care Program is anchored on three areas: (a) financial risk protection through expansion in enrollment and benefit delivery of the National Health Insurance Program; (2) improved access to quality hospitals and health care facilities; and (3) attainment of health–related Millennium Development Goals.

Government will increase spending in PhilHealth premiums from the current P12.4 billion to P34 billion to cover some 10.2 million families. Enrolled population has gone up from 57 million in 2010 to about 80 million this year.

Poor families in poor municipalities are now covered by the national government even without the counterpart funding of the premium by the local government unit. A recent forum of the Philippine Institute for Development Studies or PIDS, a government economic think tank, highlighted this progress in the provision of universal health care.

The Health Secretary said in that PIDS forum on “Sustainable and Inclusive Health Market Innovations: Challenges and Opportunities for the Philippines”, that universal health care is part of the Aquino administration’s Kalusugan Pangkalahatan initiative.

Sec. Ona admitted that because of the uneven enrollment of the “near poor”, only around 70 percent of families are able to access hospitals.

To address inequity in health service delivery, the DoH has deployed human health resources to “geographically disadvantaged areas” that often do not have doctors, Dr. Ona explained. Around 21,400 nurses have been deployed across poor areas of the Philippines.

“I’d like to say that the rural health care units are the backbone of our primary health care system. We estimate to have birthing facilities at around 70 percent of rural health units by next year, from 57.79 percent in 2010,” Dr. Ona bared. The budget of the Health Facility Enhancement Program that seeks to upgrade rural health units has also significantly increased, he added.

Improving the health care delivery system is one way of making our recent impressive economic growth more inclusive. The old saying that health is wealth can be starkly seen in the Philippine setting… it explains why so many Filpinos are poor. People in poor health can’t contribute to national growth.

“Moreover, rising population growth, Aniceto Orbeta, a PIDS economist pointed out, continues to put pressures on existing resources. This is why the role of market innovation in addressing inequality specifically in finding new technology will help us deliver health care better.

“Health market innovations are critical in improving the supply-side response to the large-scale demand for adequate health financing and service delivery,” Orbeta said.

But as we have experienced through the years, providing health care to poor Filipinos had been problematic. Like in the current debate in America over Obamacare, the huge costs involved have daunted past governments.

The PIDS forum however, highlighted some local success stories. Some LGU leaders have been boldly testing some business models that can now serve as good examples of health market innovation for the rest of the country.

Often cited as models in health delivery innovations is Leyte province in efficiently financing its hospitals and a government-owned medical center in Davao in maximizing resources and improving its facilities.  

Carlos Jericho Petilla, the former Leyte governor who is now energy secretary, was able to improve the province’s health care delivery by giving incentives to doctors and health workers, maximizing collections from the state-owned Philippine Health Insurance Corp. or PhilHealth, and raising revenues by charging fees to patients who are willing to pay.

Petilla said his province’s hospital incentive scheme provided for maintenance and other operating expenses, capital outlay, and employees’ share. This way, hospitals retained money to improve facilities and through PhilHealth, government doctors earned decent incomes.

PIDS noted that the plantilla was filled up and government hospitals reduced the need to hire private doctors as consultants. “The bottomline is that sustainable programs depend on medical practitioners,” Sec. Petilla said.

Another strategy was to partner with Mother Bles Birthing Clinics founded by a religious sister to improve maternal care. This exerted a positive effect on underutilized rural health units, which “declogged” the hospitals of normal deliveries.

The solution, as Dr. Ona explained to me some months ago, lies in allowing patients to maximize PhilHealth benefits by linking hospitals to an electronic database that eliminated the need for membership cards. Local governments should focus on the supply-side of health care delivery, and let PhilHealth take over the demand side, Petilla argued.

The Davao experience was also explained to me in a meeting I had with Sec. Ona. As PIDS reported it, Dr. Leopoldo Vega, chief of the Southern Philippines Medical Center (SPMC), a training hospital under the Department of Health, credited improving process flows for their ability to maximize PhilHealth benefits.

A dramatic improvement in PhilHealth reimbursements allowed SPMC to increase PhilHealth admissions. This also allowed the hospital to improve its facilities and embark on public-private partnership arrangements such as the consignment of modern hospital equipment.

Alex Raoul Villano, assistant secretary-general of the League of Provinces of the Philippines, told the PIDS forum that the presentations of Petilla and Vega employed working business models. “Hospitals should be economic enterprises without sacrificing social responsibility,” he said.

Health Undersecretary Madeleine Valera, who was also a discussant, noted that these innovations worked to attain the best care at a lower cost, but pointed out that these ultimately depended on PhilHealth resources. “Innovation can really distinguish between a true leader and a follower,” she said.

I think Sec. Ona deserves a weekend away from work. It is just too bad that the one time he chose to recharge, his plane had to crash.

Two words

P-Noy was reported to have had a private meeting with some of his increasingly disappointed supporters from the professional and business sector… the Makati Business Club types.

After hearing out their litany of complaints about PPP, DOTC, DAP, etc, P-Noy cleared his throat and said. I only have two words for you: President Binay.

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter @boochanco