Implementing Universal Health Care, promising or faux fax?
The advantage of being a graduate of the community engaged medical education allows me too appreciate that health is a by-product of its determinants. We were exposed and immersed to the social and harrowing realities of health.
The World Health Organization defines Universal Health Coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
The same is also related to the 3rd goal of the Sustainable Development Goals which is Good Health and Well-being.
Of course, these goals are lofty, ideal and needed. However, in a utopic world with an infinite or nearly infinite resources, the best healthcare delivery system without cost to its users would exist. I have my reservation on our provisions of the Universal Health Act in our country. I feel we are not ready. There is no clear roadmap or an attempt to disseminate information regarding it. What is made honestly clear is the money – the incremental increase of contributions for direct contributors of the Philhealth fund. Other than that, I know nothing more.
A review of RA 11223 otherwise known as the Universal Health Act revealed to me several things:
PhilHealth shall implement a comprehensive outpatient benefit, including outpatient drug benefit and emergency medical services in accordance with the recommendations of the Health Technology Assessment Council (HTAC) .
PhilHealth shall provide additional Program benefits for direct contributors.
The amount necessary to implement this Act shall be sourced from the following:
a. Total incremental sin tax collections;
b. Fifty percent (50%) of the National Government share from the income of the Philippine Amusement Gaming Corporation (PAGCOR);
c. Forty percent (40%) of the Charity Fund, net of Documentary Stamp Tax Payments, and mandatory contributions of the Philippine Charity Sweepstakes Office (PCSO);
d. Premium contributions of members;
e. Annual appropriations of the DOH included in the GAA
f. National Government subsidy to PhilHealth included in the GAA
- Within ten (10) years from the effectivity of this Act, only those who have been certified by the DOH and PRC to be capable of providing primary care will be eligible to be a primary care provider.
The above list are the issues I think Philhealth or the DOH or both should address in the soonest possible time. I feel there is no transparency from the end of Philhealth. For instance, how much contribution is collected in a quarterly or annual basis from the direct contributors and the billions that PCSO and the other sources of funds for the UHC. Very promising, right? Sounds delicious.
Dr. Dans was right, in my opinion. He commented regarding supply and demand. The demand from the Philhealth fund must be lower than the the available supply of funds. At at least 100 million Filipinos and spending 1,000 for outpatient care would require 100 billion pesos. This does not take into account the hospital expenses that a Filipino might make when admitted in a hospital.
One article pointed out that nearly half of Filipinos are unsure if they can pay for their hospitalization if they get sick, 40 percent of 1,350 respondents from various parts of the country expressed uncertainty on their capability of paying medical bills. It also revealed that 37 percent of respondents had to use their savings while 25 percent sought the help of their relatives to pay their medical bills. What this means, the objective of UHC is daunting. Financial hardship is really an elephant in the room and let’s just say, the Philhealth coverage is not enough to cover half of the medical bill.
And there’s also the failure of the Philhealth to give due benefits to its direct contributors. Equity is not synonymous to dole outs. Money is earned hard in our country. Think about the workers, the daily wage earners who contribute and your average drunkard, slacker, and addict. Each have the right to access to care, agreed and they must receive competent and compassionate care.
Lastly, it is 2022. The law was passed last February 2019. Granting the pandemic has stalled this act. A concrete phasing, format, plan and milestone. What again was set in stone was the collection of dues. Sending a wrong message, not of social justice but of, when you work hard, we will milk you harder of your money. Disappointing. Frustrating for the individual working 2 to 3 jobs just to make things meet.
We might not be ready for this. We might just end up worst that when we started.
A clear, strategic, year-on-year rollout chronology towards achieving the vision for UHC should be laid out in a transparent manner for all stakeholders namely healthcare providers, local government units, people. Reforms should start with generating clear demand for primary care through patient empowerment and incentive schemes for providers. Focusing on chronic diseases like hypertension, diabetes, dyslipidemia will have impacts on health financing and patient load in the tertiary or apex centers. This can drive the necessary motivation for the public sector to build capacity, and similarly attract the private sector to participate and coordinate.
By committing to a clear plan of action, the DOH and Philhealth can galvanize confidence amongst all stakeholders, public and private, local and national, and across government. Clarity of vision will be essential to deliver on the promise of UHC in the Philippines.
As for my future plans, I intend to be a primary care provider for adults. I believe as a general internist I could help more people. I believe the mechanisms for primary care providers are not yet set and clear. Until, there are clear guidelines, we are at a limbo for now. As a general internist, I hope to be able to manage common adult problems and refer to specialist if need arises.
Day 23 of #100DaysToOffload. Find out more about it here.
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