Commentary: Spend wisely for Universal Health Care
“Staying healthy and avoiding illness” is still the top personal concern among the majority of Filipinos, according to the year-end survey conducted by Pulse Asia (2019).
Actually, it is not having a certain disease or acquiring an injury that worries the public but the burden that it can bring due to the high cost of healthcare in the country. For many of us, being sick can merely spell the difference between a comfortable life and a sheer financial ruin.
This urgent concern of Filipinos hopes to be addressed by the Universal Health Care (UHC) Act which was approved early last year and expected to take-off its implementation this year.
The law, in general, seeks to protect the citizens by providing the necessary health services (promotion, prevention, treatment, rehabilitation and palliation) without giving them undue financial hardships. It also aims to address the limitations of the current health system by addressing the different gaps in health service delivery, financing, regulation and governance.
In order to provide the needed services and address the gaps in the current health system, it will entail sectoral reforms that need thorough planning and management, political will and, most especially, the provision of adequate resources.
Under the General Appropriations Act for 2020, the Department of Health will receive a total amount of P100.56 billion.
As an attached agency, the Philippine Health Insurance Corporation (PhilHealth) was allocated a budget of P71.35 billion. Both agencies have increased allocations, as compared to their previous year, mainly to support the existing health programs and jump-start the implementation of the much-awaited UHC Act.
As additional support, PhilHealth will also increase the premium payments that will be collected to direct contributors until 2025. The premium rate this year was increased by 3% and will be adjusted to increments of 0.5% every year until it reaches the 5% limit in 2025.
Given the minimum amount of P300 monthly contribution and the number of direct contributors which is around 16 million Filipinos (2018) under the formal economy. A quick calculation, tells us that another P4.8 billion is expected to receive by the corporation monthly.
Likewise, the Philippine Amusement and Gaming Corporation and Philippine Charity Sweepstakes Office, will further provide additional financial support in the implementation of UHC Act. That is 50% of PAGCOR’s contribution to the National Treasury every year and 40% from the PCSO’s charity fund, which according to its general manager is around P3 billion for this year.
The total sin tax collections will also provide additional funding for the UHC programs. This could increase further once the bicameral approved bill regarding its amendments will be signed into law.
According to the bill, 60% of the total revenues from the excise tax on alcohol, heated tobacco, and vapor products will be allocated on the implementation of UHC.
Now that funding has been secured for 2020, the next question is what could be expected from the government in terms of the UHC implementation?
According to DOH, the most reasonable and cost-effective approach to ensure the delivery of quality services in the health systems is to roll out UHC “nationwide (in scope) but progressive in approach”.
Last year, the DOH had identified 33 priority integration sites: 13 in Luzon, 10 in Mindanao, 8 in Visayas and 2 in the National Capital Region, which will be considered pilot areas for the integration of local provider networks into provincial/city health systems.
However, it is not yet clear how the DOH will distribute its resources to these sites, without disrupting the health services in the non-priority areas.
Also expected this year is the institutionalization of “health technology assessment” (HTA). Health technology includes pharmaceuticals, devices, procedures and organizational systems used in health care.
HTA is considered as a fair and transparent mechanism to guide funding allocations and coverage decisions in support of UHC. It is an important tool in deciding who should be getting which intervention and at what cost.
A group of health experts, termed as HTA Council (HTAC), was formed by the DOH early last year to facilitate provisions of financing and/or coverage recommendations to be financed, oversee and coordinate the HTA processes and review and assess existing benefit packages.
The HTAC is primarily expected to conduct assessments in accordance with the principles and procedures that will ensure that its process is transparent, conducted with reasonable promptness, and results of deliberations are made public.
Recently, the names of the council members, including those who are part of its subcommittees, has been released recently by the DOH. Moreover, the DOH is also expected to expand the current Drug Price Reference Index that will be implemented in DOH-owned health facilities.
A draft DOH order, that provides mechanisms in setting the allowable mark-ups, enforcement, and monitoring on essential medicines, is currently on the pipeline and will be expected to be finalized within the current year.
Meanwhile, for innovative, patented and single-sourced drugs, medical devices, and supplies that will be procured in the said facilities, the DOH is expected to create a Price Negotiation Board in accordance with existing procurement laws of the country.
Lastly, the guidelines for the creation of the Special Health Fund (SHF) are also anticipated this year by the province/city-wide health systems.
The purpose of this funding is for local government units to pool and manage resources that are intended for either population or individual-based health services; capital investments; operating costs; and remunerations and/or incentives of health workers.
However, the guidelines that will specify the allocation and utilization of SHF is still in the finalization stage. Given these expectations, the leadership of these agencies should be wise enough to properly spend the resources in line with the objectives of UHC.
The efficiency and transparency in the implementation of the law will assure continuous support from stakeholders until the guarantee of equitable access to quality and affordable health care are realized. This is the clamor of every Filipino.
Alvin Manalansan is a health fellow at think thank Stratbase ADR Institute.
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