Philippine’s Universal Health Care: Political gimmick?

The World Health Organization (WHO) defines universal health coverage (UHC) as “ensuring that everyone, everywhere can access essential quality health services without facing financial hardship.”

This, basically, underpins the dogma for the Philippines’ version of universal health care coverage, now a proposed law that has passed the last stages of legislative action, and is now awaiting the signature of President Duterte.

UHC is something that no sane politician will dare oppose, not just because health is foremost a human right, and safeguarding everyone’s physical and mental health is just, fair, and consistent with principles of right conduct and distributive justice, but it is also close to the heart of millions of Filipinos.

Translating the UHC’s canon into practical, down-to-earth terms, however, is different for each country that subscribes to it. Because of the substantial resources needed to attain ideal health care for all, governments have to define limits or boundaries based on their means, specifically state resources.

We’ve seen how many developed countries have argued about the cost of UHC for their citizens, and even with the sophistication and budgets of their health care systems, there is no perfect total coverage. Canada, which takes pride in having one of the best UHC systems in the world, for example, does not cover dental care in its package.

Deglamorizing the country’s UHC

To be able to deliver quality health services to all 105 million Filipinos when the law is passed and implemented, the Department of Health (DOH) and lawmakers estimate that P257 billion will be needed on the first year of implementation and another P280 billion in the second year.

This roughly translates to P2,448 per person on the first year, and P2,667 on the second year assuming the population stays at 105 million. With the cost of medicines and doctor’s fees, you and I know that this amount will not go far.

This gives you a glimpse of just how limited the Philippines’ UHC coverage would be after you deglamorize it of the political rhetoric. Don’t blame our lawmakers because they’re just trying to earn the most brownie points with elections coming up in May.

We certainly hope that the law, when it’s fully implemented, will not disappoint those whose appetites have been wetted. The cost of maintenance medicines for those with hypertension, for example, is definitely so much more than what the state can afford to dole out.

True health care

One of the tenets that social development has imprinted on me is the importance of helping people to help themselves – and this should extend to health. The true essence of health care for me is teaching people how to lead a healthy life without medicines and hospitalization.

Among the top health concerns of Filipinos today are lifestyle related. Ischemic heart disease, which is the number one killer in recent years, is attributable to excessive smoking and drinking, and intake of sugars and fats that lead to high cholesterol levels. Stress is also a cause.

Other lifestyle-related ailments that are in the country’s top 10 killers list are cerebrovascular diseases, hypertension, diabetes, and respiratory tuberculosis. Some are caused by excesses, while others are a reflection of poor diets, both of which can be mitigated.

Current health care practice in the Philippines is still more skewed to prescriptive care, which means relying on drug intake to control diseases, rather than on preventive health, which in contrast emphasizes balancing nutritional requirements of the body to avoid degenerative ailments.

This is why healthcare in the Philippines – and in many other countries – is synonymous to a thriving drug industry earning billions of pesos from the sale of simple multivitamin supplements to powerful expensive drugs.

Reduced role for public health system

The proposed law promoting UHC in the Philippines emphasizes on hospital care through a health card, which will be managed by the new Philippine Health Security Corp. (PHSC), renamed from the Philippine Health Insurance Corp. (PhilHealth).

One of the more distinct roles of the PHSC will be creating supplementary coverage by health maintenance organizations (HMOs) and private health insurance, as well as providing network-based licensing, contracting, and accreditation of facilities.

Criticism over the increasing role of private health delivery services over public facilities under the proposed UHC law has been muted, but the unmistakable glee in the welcoming tone of companies that offer generic drugs, medical check-ups, diagnostic tests, and laboratory services is discomforting.

Shouldn’t taxpayers’ money go instead to strengthening public hospitals and clinics, which are really at the frontline of public health servicing? Shouldn’t barangay health centers be the first beneficiaries of health taxes to improve their capability to serve the poor?

There is a need for more trained community health workers at the grassroots level who will provide person-to-person care, as well as act as a bridge with remote doctors and facilitate the use of modern diagnostic technologies.

Still an unhealthy nation

Already, the DOH is saying that sin taxes have to be increased three-fold to fill up what would be a budgetary deficit to implementing UHC during the first two years. Over taxing tobacco and alcohol drinks has risks, but more importantly, will not be able to answer for a potentially higher cost of future UHC delivery.

Once again, more emphasis must be paid to preventing diseases and promoting a healthy lifestyle. Otherwise, we may find ourselves trapped in the spiraling cycle of higher medicine bills, but really facing the grim reality of still high death rates from life-threatening diseases.

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