Since the declaration of health as a fundamental human right is in the 1948 constitution of the World Health Organization (WHO), the members of the United Nations set, on Sept. 25, 2015, the goal of the achievement of universal healthcare (UHC) by the year 2030.
UHC means people receiving timely medical attention to save their lives or to maintain their good health without ruining them financially. It is about providing whole-person care for health needs throughout life, not just treating a set of specific diseases.
Primary healthcare is the most efficient and cost-effective way to achieve universal health coverage. It ensures people receive comprehensive care, ranging from promotion and prevention, to treatment, rehabilitation, and palliative care as close as feasible to people’s everyday environment. It addresses comprehensive and interrelated physical, mental, and social health and wellbeing.
UHC is not only about individual treatment services, but also includes population-based services such as public health campaigns, adding fluoride to water, controlling mosquito breeding grounds, and so on.
UHC, however, does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis. UHC was not conceived for advanced medical science, miracle drugs, open-heart surgeries, and organ transplants.
In his State of the Nation Address last year, the President mentioned the multi-specialty center being built in Pampanga which will specialize in cardiology, kidney, and cancer treatment. The estimated cost of the multi-specialty center is P10 billion. The President said in his address that similar centers will be built in other regions. That plan goes against the concept of UHC.
For UHC to achieve its goal, several factors must be in place. They are:
• A strong, efficient, well-run health system that meets priority health needs;
• A sufficient capacity of well-trained, motivated health workers to provide the services to meet patients’ needs;
• Access to essential medicines and technologies to diagnose and treat medical problems;
• Affordability — a system for financing health services to prevent people from falling into bankruptcy.
Quality healthcare makes UHC a large expense for governments. It is usually funded by general income taxes and/or payroll taxes. There are three models for financing UHC: single payer, social health or mandatory insurance, and national health insurance.
In a single-payer model, the government provides free healthcare paid for with revenue from income taxes. Healthcare facilities are government-owned, and healthcare providers are government employees. Every citizen gets the same quality of healthcare. The United Kingdom developed the single-payer system. Cuba has the same system. But whichever financing system is chosen, it will take some time to design and staff the organization that will administer the system.
The World Health Organization estimated that developing economies would take 15 years to put in place a strong, efficient, well-run, and sufficiently funded healthcare system. That is why it advised our legislators to target the achievement of UHC by 2030.
But many of our legislators rushed the enactment of a law instituting universal healthcare so that they could present UHC in the elections of 2019 as their gift to the Filipino people. Almost all of the members of the House of Representatives and Senators JV Ejercito, Sonny Angara, Nancy Binay, and Cynthia Villar were running for re-election.
On July 23, 2018, the 17th Congress passed Republic Act No. 11223, An Act Instituting Universal Health Care for All Filipinos, Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor. It is better known as the Universal Health Care Act. President Rodrigo Duterte signed the bill into law on Feb. 20, 2019, enabling members of Congress running for re-election to tell the electorate in their campaign sorties that they have made available quality healthcare at reasonable cost.
Section 2 of RA 11223 declares that it is the policy of the State to protect and promote the right to health of all Filipinos and instill health consciousness among them. Towards this end, the State shall adopt:
a.) An integrated and comprehensive approach to ensure that all Filipinos are health literate, provided with healthy living conditions, and protected from hazards and risks that could affect their health;
b.) A healthcare model that provides all Filipinos access to a comprehensive set of quality and cost-effective, promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardship;
c.) A people-oriented approach for the delivery of health services that is centered on people’s needs and well-being, and cognizant of the differences in culture, values, and beliefs.
Section 3 states that the Act seeks to:
a.) Progressively realize universal healthcare in the country through a systemic approach and clear delineation of roles of key agencies and stakeholders towards better performance in the health system; and,
b.) Ensure that all Filipinos are guaranteed equitable access to quality and affordable healthcare goods and services, and protected against financial risk.
The policy and objectives of RA 11223 are in line with the goals of UHC. But as to be expected of politicians, they are long on promises, but short on delivering the goods. RA 11223 was premature. The hard fact is that UHC cannot be achieved in the Philippines until 2030 or even beyond because the healthcare delivery system is acutely inadequate.
According to the Department of Health (DoH), as of 2022 there are 721 public hospitals. The number of hospital beds is a good indicator of health service availability. Per WHO recommendation, there should be 20 hospital beds per 10,000 population. Almost all regions have insufficient beds relative to their population. The insufficiency of public hospital beds is unspeakable.
The occupancy rate of DoH-managed hospitals is over 100%. That means there are more inpatients in the hospital than there are beds available. Some inpatients are made to lie on benches in waiting areas, others just have to be treated on visitor chairs. There are instances when two patients share a bed. Such instances occur during the dengue season, when many of those infected are children.
So, many patients are turned away. Poor folks denied admission just go home to their shack or hut, treat themselves with herbal remedies or consult the neighborhood arbolaryo (herbalist). Income earners seek medical attention in private hospitals. Most of these hospitals were established for profit. Their payment system is independent of the strict guidelines observed in government-owned hospitals.
As the physician-stockholder of private hospitals enjoys full discretion in using the hospital’s facilities, his practice is influenced by the incentives available to him. He may recommend more diagnostic tests, longer hospital confinements, and surgeries much more than necessary. For every procedure, for every service, the physician charges a fee. Depending on the doctor’s assessment of the patient’s capacity to pay, he may even order high-tech diagnostic tests the equipment for which he has right in his office. He prescribes the newest and therefore more expensive medicine, for which act he is rewarded by the manufacturer with a fully-paid-for vacation abroad disguised as attendance of a medical convention.
That is the reason why PhilHealth members pay out of pocket in spite of universal healthcare. According to a study conducted by a group of researchers from the Philippine Institute for Development Studies, PhilHealth pays an average of only 40% of total hospital cost. According to them, the elderly, women, rural, and poor Filipinos are more likely to spend more.
Republic Act No. 11223 law enrolled all Filipino citizens in the National Health Insurance Program administered by PhilHealth. In effect, the legislators who drafted the law chose the social health insurance model of financing UHC. Just as the Philippine healthcare system is unable to service UHC, PhilHealth is incapable of performing the enormous task suddenly thrust upon it — financing UFC, a task made more difficult by the enrollment of 38 million indigent Filipinos.
Based on the law that established it, PhilHealth is a hodgepodge of a healthcare provider/insurance company/ healthcare program administrator. Contrary to its formal name of Philippine Health Insurance Corp., it is definitely not:
• organizationally structured as an insurance company;
• managed by a team of people academically trained for and experienced in running an insurance company, particularly a health insurance company;
• fully staffed by health insurance adjusters (claims processors).
The Universal Health Care Act was poorly conceived and prematurely put into effect.
Oscar P. Lagman, Jr. is a retired corporate executive, business consultant, and management professor. He had extensive exposure to the healthcare field in each of those three capacities.
