The Philippines lies at the threshold of universal health care. By learning from the successes and failures of the last 50 years, capitalizing on its growing economy and its vibrant millennial generation, the Philippines must seize the opportunity to truly transform its health system and ensure the health of all its citizens.
The health profile of the country reflects rapid socioeconomic development and modern lifestyles which have impacted its urban centers but have left behind a large proportion of the population still immersed in poverty in underdeveloped agricultural, upland and coastal areas as well as in poor and crowded informal settlements in the cities.
In its quest to achieve universal health care as mandated by the new UHC law (RA 11223), the Philippines must ensure that all levels of its health delivery system work effectively, efficiently, and seamlessly with each other everywhere in the country. Here are four specific challenges.
First, the Philippines must improve the quality of services at all levels of its health system. This improvement is particularly demanded at the primary care level (health centers and clinics) which is often bypassed by Filipino patients in favor of hospitals. For example, government health centers need an upgrade in facilities, staffing, and equipment to be able to provide customer-friendly services to many who depend on them in cities as well as in municipalities throughout the country. People often bypass these centers which have a reputation of being unreliable (e.g. no doctor in the house) and go to hospitals where there are long cues and so much congestion. In most cases, patients’ needs can be attended to at primary care facilities if these facilities functioned properly.
Secondly, the Philippines must ensure equitable access and inclusiveness of health services. For the poorest of the poor who already have been identified in the NHTS-PR (National Household Targeting System for Poverty Reduction) and are considered members of PhilHealth, adequate education about their entitlements as well as guidance on the utilization of health services must be guaranteed. The same goes for those in GIDAs (Geographically Remote and Rural Areas) where physical remoteness is a formidable barrier to accessing health care. Serving vulnerable populations like persons with disabilities and indigenous peoples will require innovative approaches to fulfill their special needs.
Therefore, strengthening the capacity of local governments not only as health service providers but also as enablers for development will be strategic. Twenty-seven years after the public health services were devolved, exemplars for excellent public health governance have emerged from among the young generation of mayors and governors who have improved health outcomes in their political jurisdictions through better leadership and innovative approaches.
Thirdly, the Philippines must address its rising out-of-pocket expenditures (OOP). Rising OOP alongside rising SHI (Social Health Insurance) coverage is a pattern shown by LMICs (low- and middle-income countries) whose OOP expenditures average 52% of THE (Total Health Expenditure). It is said that with sustained economic growth, robust government expenditure on health, and adept handling of risk pools, OOP expenditures can fall in what has been called the “health financing transition.” Developed countries underwent this transition as they became more affluent and addressed the social determinants of health.
But achieving the health financing transition is not automatic nor inevitable. Reducing OOP in the Philippines will require a multitude of interventions including: effective prevention of illness and mortality at the primary level; the expansion of PhilHealth benefits prioritizing effective interventions and preventive services; the maintenance of government health expenditure on health at the WHO-recommended level of 5%; the mobilization of additional financial resources for health; and the consolidation of health resources in one national strategic purchaser able to demand better quality and lower costs of health commodities and services.
Finally, the Philippines must find ways to synergize the activities of its public and private sectors. Unity in the pursuit of UHC is paramount and societal norms for genuine service have to be upheld. Can government contract out preventive and curative health care provision of provinces or municipalities to private providers at costs that are non-inflationary but still profitable to the private provider? Can government and private sector devise new models of care in GIDA areas? Can the cogent use of e-health technology open new horizons for innovation?
(Article was excerpted and slightly revised from: Manuel M. Dayrit et al. Chapter 11. The Philippines in Legido-Quigley H, Asgari-Jirhandeh N, editors. Resilient and people-centred health systems: Progress, challenges and future directions in Asia. New Delhi: World Health Organization Regional Office for South-East Asia; 2018).
Manuel M. Dayrit, MD, MSc, is Dean, Ateneo School of Medicine and Public Health.