More than a basic human right guaranteed by the Constitution, health is a matter of priority here in the Philippines. Several efforts have been initiated by the government to strengthen the country’s health system, with the latest aiming to improve the access to health care services as well as to initially address remaining issues in the system.
According to the most recent report by the World Health Organization (WHO) through the Asia Pacific Observatory on Health Systems and Policies titled “The Philippines Health System Review,” such efforts can be traced as early as the 1990’s when the Philippines adopted decentralized health governance. Later on, the National Health Insurance Program more known as PhilHealth was introduced in 1995 “to provide financial risk protection for the Filipino people.” Since 2010, universal health coverage for every Filipino has been pursued, and it finally culminated in the signing of Republic Act No. 11223, or the Universal Health Care (UHC) Bill, earlier this year.
The report cited figures from 2016 which indicated that the country’s health sector has 1,224 hospitals, 2,587 city/rural health centers, and 20,216 village health stations. “Sixty-four percent of hospitals are Level 1 nondepartmental hospitals with an average capacity of 41 beds, and 10% are Level 3 medical centres and teaching hospitals, with an average capacity of 318 beds,” the report added. From 46% in 2003, the share of the private sector in total hospital beds increased to 53% in 2016.
In terms of human resources, meanwhile, there are 90,308 nurses, 40,775 doctors, 43,044 midwives, and 13,413 medical technologists as of 2017. Among these populations, most of the nurses, midwives, and medical technologists are in the public sector of the health care system.
The 2018 report also noted a consistent increase in total health expenditure (THE), but it pointed out inadequacy in the coverage provided by PhilHealth. “Financial protection is limited, resulting in a high level of household out-of-pocket (OOP) payment,” the report noted, adding that PhilHealth cannot yet be regarded as “a strategic purchaser of services.”
This was further impressed by the latest figures from the Philippine Statistics Authority (PSA). It indicated growth in the country’s THE in 2018 which amounted to P799.1 billion, up by 8.3% from 2017’s P737.8 billion. The PSA further noted that every Filipino spent P7,496 for health, up by 6.6%.
Among the financing schemes, household OOP stays as the highest with more than half (53.9%) of current health expenditures (CHE), amounting to P413.0 billion. Government schemes and compulsory contributory health financing schemes, meanwhile, totaled P260.6 billion or 34% of the CHE. Voluntary health care payment schemes had a 12.2% share with P93.3 billion.
In terms of how the health system performs, the report observed that albeit well-specified national objectives for health are set in place, “progress of local governments towards these targets remains highly uneven due to devolved health financing and service delivery.” Such inefficiencies pointed out by the report include limited number of health facilities relative to the growing population, overprovision of physicians, underprovision of care, and poor physician adherence to clinical practice guidelines.
Despite these observed lacks, the continued push for health reforms was nonetheless seen through Kalusugan Pangkalahatan (KP), a UHC policy initiated almost a decade ago. WHO noted that the Philippines attained success “in generating political and financial support to pursue KP and in legislating various policy proposals, most notably the Sin Tax Law and the Reproductive Health Law,” which were both passed in 2012. Through KP, PhilHealth coverage expanded to 92%; local health facilities were upgraded and constructed; and 23,800 health professionals were deployed while 51,594 community health teams were mobilized.
For WHO, nonetheless, more needs to be done. It found that “strong political support and wider fiscal space do not automatically impact on health system performance, as there is lack of institutional capacity to translate policy into effective programme implementation, monitoring and evaluation,” citing as examples “highly inequitable” access to health facilities and staff as well as inadequate funds for addressing critical health needs like the rise of noncommunicable diseases.
Furthermore, critical challenges remain to be faced by the health care system. These include health system inefficiencies and health inequities due to disorganized governance, fragmented health financing, and devolved and pluralistic service delivery.
Another challenge emphasized by the report is how to engage the private sector in delivering health care in the UHC context, saying this “requires strong regulatory capacity, not only by using command and control mechanisms but also by leveraging financing incentives.”
A big step
As the Philippine health care system encounters and addresses these challenges, the recently signed UHC Bill aims to make health services more accessible by automatically enrolling Filipinos into PhilHealth and expanding its coverage to include free medical consultations and laboratory tests.
Aside from ensuring full health care coverage to Filipinos, another intention of the UHC Bill is to reduce the high OOP expenditure for health. According to the accompanying results matrix of the Philippine Development Plan 2017-2022, OOP expenses are targeted to go down to less than 50% of the total health spending by 2022.
“Through this provision, we seek to protect people from the financial burden of paying out of their own pockets. It reduces the risk of people being pushed into poverty because it will help cushion the impact of having to use the family’s savings or of borrowing money to pay for health care services,” Senator Maria Lourdes Nancy S. Binay, a co-author of the bill, was quoted as saying in an explainer by WHO on its website.
The law also clarifies the once overlapping roles and responsibilities of various health agencies, which means patients do not have to go from one institution from another in order to get benefits.
“For instance, the Department of Health and local government units will be responsible for population-based interventions and health services (e.g., immunization programs and health promotion programs) while PhilHealth will be responsible for financing individual-based health services,” the Philippine Information Agency explained on this provision of the law. — Adrian Paul B. Conoza