In the June 8 episode of the TV talk show Headstart, host Karen Davila asked the newly appointed Secretary of Heath Dr. Ted Herbosa what his priority is in the short to medium term. Dr. Herbosa said, “I want healthcare access to all, quality healthcare for all people, especially those that are in the lower economic sector, those that cannot afford modern healthcare… which is embodied in the Universal Healthcare Act of 2019.” To achieve this goal, he wants to digitize and make the Department of Health (DoH) very efficient in delivering healthcare and to be able to monitor results quickly. He wants the department’s budget spent on the tools that the banking and the tourism sectors are already using as our healthcare system is still using pen and paper.
I do not know if the doctor is using the word “digitize” to mean “digitalize.” The two words are used interchangeably by many people, but they have different meanings. Digitizing means converting data into digital (bits and bytes) format. Digitalizing is transforming processes into advanced digital technology. I tend to think he means digitalizing as he makes reference to tri-party communication between doctor, pharmacy, and patient. Sec. Herbosa thinks digitizing the DoH will allow poor people in those areas to consult a doctor without having to walk two hours to see a doctor.
Whether it is digitizing or digitalizing the Department of Health, it will delay the full implementation of the universal healthcare (UHC) program by several more years than I had projected previously.
The June 9 issue of this paper had an article with the heading “Digitizing healthcare to require big IT skills push.” The article says that healthcare workers need to develop information and communications technology skills. That means training tens of thousands of healthcare workers — doctors, nurses, pharmacists, and medical technicians most of whom are still using pen and paper.
I know two doctors in Makati Medical Center with lucrative practices who are still using pen and paper. There must be hundreds of doctors of the pen-and-paper kind in government hospitals in Metro Manila and thousands more in the provinces. They need to be trained in digital technology even if only basic or primary healthcare is made accessible to all, including those in the lower economic sector and in the remote areas, as embodied in the UHC law.
Training hundreds of doctors will take time and will require a huge budget. If a huge chunk of the DoH budget is used for digitization, that would mean the deferment of the installation of the infrastructure required by UHC. If Dr. Herbosa really meant digitalization, that would require advanced training for more DoH personnel, more time, and a much bigger budget as more equipment needs to be acquired.
Dr. Herbosa forgot that unlike the user of banking services and the tourist, the poor patient in a remote area, who most likely struggles to put food on the table three times a day, has to have the gadget with which to consult a doctor. According to PhilHealth, there are 38 million enrollees who are indigents. That means about 38 million Filipinos who would still have no access to healthcare even if the DoH is digitized or digitalized because they do not have the gadget to consult a doctor with.
I have written in this space more than once that UHC is years away because the number of hospitals, doctors, nurses, and other healthcare professionals required to provide healthcare service to a population of over 100 million Filipinos is many times more than our present healthcare system has.
UHC is firmly based on the World Health Organization (WHO) constitution of 1948 declaring health a fundamental human right. Achieving UHC was one of the targets members of the United Nations set in 2015. On Sept. 25 that year, the resolution on Transforming Our World: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030.
UHC is meant for people whose lives can be saved or whose good health can be maintained if they receive timely medical attention without ruining them financially. Complications of the leading diseases in the Philippines like bronchitis, influenza, chicken pox, diarrhea, and respiratory tract infections can be prevented if the patient receives preventive, curative, rehabilitative, and palliative health services.
To achieve the goal of UHC, the country must have a strong, efficient, well-run health system that meets priority health needs, provides access to essential medicines and technologies to diagnose and treat medical problems, and a large corps of trained, motivated health workers to provide the services patients need. The WHO had advised our legislators to implement universal health care fully in 2030 when the country’s health delivery system would be capable of servicing it.
Per WHO recommendation, there should be 20 hospital beds per 10,000 people. Almost all regions have insufficient beds relative to their population except for the National Capital Region, Northern Mindanao, Southern Mindanao, and the Cordillera Autonomous Region. Among the 17 regions, the Autonomous Region for Muslim Mindanao (ARMM) has the lowest bed to population ratio (0.17 beds per 1,000 people), far lower than the national average.
According to the DoH, there are 721 public hospitals, 70 of which are managed by the Health department while the others are managed by LGUs and other National Government agencies. The 70 DoH-managed hospitals account for a total of 27,019 beds. The occupancy rate is over 100%.
In observance of the WHO declaration of healthcare for everyone, many countries launched UHC programs. But some of them rushed the enactment of a law on UHC. The Philippines was one of those countries. Our legislators rushed the bill on UHC so that they could present universal healthcare in the elections of 2019 as their gift to the Filipino people. Among the authors of the law were Senators JV Ejercito, Sonny Angara, Nancy Binay, and Cynthia Villar, who were all running for re-election. Ironically, JV Ejercito, the principal author of the law, failed to be re-elected.
President Rodrigo Duterte signed into law Republic Act No. 11223, An Act Instituting Universal Health Care for All Filipinos. When implemented effectively, the law will mean all Filipinos will get the healthcare they need, when they need it, without suffering financial hardship as a result. The law enrolled all Filipino citizens in the National Health Insurance Program to be administered by the Philippine Health Insurance Corp. or PhilHealth. That is more than 100 million Filipinos spread all over the archipelago — from Batanes in the north to Jolo in the South, from Samar in the East to Palawan in the West.
As the WHO feared, the country’s health system is far from being capable of servicing UHC. If Health Secretary Ted Herbosa spends a large portion of the DoH budget on digitizing the department, full implementation of the UHC program would have to happen well beyond 2030.
Oscar P. Lagman, Jr. is a retired executive, management professor, and business consultant. He had extensive exposure to the healthcare field in each of those three capacities.