Universal healthcare is zero balance billing

During his fourth State of the Nation Address on July 28, President Ferdinand Marcos, Jr. announced the implementation of the zero balance billing policy or what he calls the “Bayad Na Bill Mo” program (“Your bill has been paid” program).” According to Health Secretary Teodoro Herbosa, the program requires no additional documents or interviews, and all costs, including medicines and professional fees, are fully covered.

However, The “Bayad Na Bill Mo” program only applies to basic or ward accommodation in the 87 Department of Health (DoH) hospitals nationwide. A patient who opts to be transferred to a private room in a DoH hospital is not entitled to zero balance billing. Neither is a patient confined in the ward of a private hospital.

That is what universal healthcare is supposed to be: zero balance billing. To me, a clearer description of universal healthcare is “no medical billing program.” That is what universal healthcare is in the United Kingdom, and in many European countries. Healthcare is provided by government-owned hospitals and by doctors and other healthcare professionals employed by the government.

But as I had written here before, universal healthcare in the Philippines is still years away. That is because there are only about 27,019 beds in the 87 DoH hospitals. And that number includes beds in semi-private and private rooms, although they account for a fraction of the total.

Per World Health Organization (WHO) recommendation, there should be 20 hospital beds per 10,000 population. The country’s population in 2019 when universal healthcare was implemented was 110 million. That means there should have been 220,000 hospital beds in 2019. The DoH’s Philippine Health Facility Development Plan places the number of beds in 2020 at approximately 105,000, half of what the WHO says is the ideal ratio.

The WHO had advised our legislators to institute universal healthcare fully in 2030 when the country’s health delivery system — hospitals and primary care clinics — would be capable of servicing it. But the members of the 17th Congress, many of whom were running for re-election, rushed the enactment of a law adopting universal healthcare, RA 11223, so that they could present it in the elections of 2019 as their gift to the Filipino people.

The law mandated that all Filipino citizens be enrolled in the Philippine Health Insurance Corp., better known as PhilHealth. That was the monumental flaw of the law. PhilHealth is not a healthcare provider. It is a health financing agency. And it is not managed and staffed by health financing professionals. Ironically, Senator JV Ejercito, the principal author of the law, failed to be re-elected.

As the WHO feared, the country’s health system was far from being capable of servicing universal healthcare in 2019. The United Kingdom owns the hospitals and employs the healthcare workers that service all its citizens. While the Philippine government also owns hospitals and employs healthcare workers, their number falls way short of those required to provide the health services needed by the 110 million Filipinos.

The insufficiency of public hospital beds is unspeakable. In many parts of the country, farm workers, market vendors, food stall operators, tricycle/jeepney drivers, and retail store attendants who fall ill do not get the proper medical attention due mainly to the inaccessibility of a healthcare facility, not even a primary care clinic.

The problem with our universal healthcare or zero balance billing program is the acute shortage of beds in wards of DoH hospitals. The accompanying table shows the pathetic situation with regard to DoH managed hospitals.

A 108% occupancy rate means there are more inpatients in the hospital than there are beds available. That is in the National Capital Region or Metro Manila where there are several DoH-administered hospitals. In the Bicol, Central Visayas, Eastern Visayas, and Northern Mindanao regions, the occupancy rates are almost double. That means two inpatients share a bed or many inpatients are made to lie on benches in waiting areas, some are treated on visitors’ chairs.

While the President announced the zero balance billing policy will eventually be implemented in the four specialty hospitals — the National Kidney and Transplant Institute, the Philippine Heart Center, the Lung Center of the Philippines, and the Philippine Children’s Medical Center — and the Philippine General Hospital (PGH), which is administered and operated by the University of the Philippines (UP) as the training hospital for the students of its College of Medicine, it is high time the government provided the folks in the countryside healthcare by building more hospitals that provide a range of medical services, from basic to specialized, in underserved regions.

JV Ejercito, who was elected to the Senate again in 2022, recently called for the passage of a measure seeking to provide an additional P74.4-billion subsidy for PhilHealth in order to sustain the zero-balance billing program of the Universal Health Care (UHC) law. He just doesn’t get what universal healthcare means.

President Marcos did say that five DoH hospitals will soon be operational. He did not indicate where the five new hospitals are. Other than the University of the Philippines, two state universities with medical schools have their own teaching hospitals — the West Visayas State University and Bicol University. As in UP’s PGH, the zero balance billing policy should also be implemented in these two teaching hospitals in acutely underserved regions.

There are four other state universities offering a doctor of medicine program — Mariano Marcos State University, Cagayan State University, the University of Northern Philippines, and the Mindanao State University. They do not have their own dedicated teaching hospitals but have plans to build their own. The President should press for the erection of those hospitals so that they can be venues for the zero balance billing program or universal healthcare.

There are about 630 hospitals owned and administered by local government units. President Marcos should recommend or mandate the implementation of the zero balance billing program in these hospitals.

Last week the President said the program is “proceeding well.” At least 14,000 patients in two DoH hospitals have benefited so far from the program since its launch on May 14. Among the beneficiaries of the program was a 48-year-old who was admitted at the Eastern Visayas Medical Center after his lungs, diaphragm, and colon were punctured in a stabbing incident. His hospital bill, professional fees, and cost of medicines, and supplies reached P447,923.93, PhilHealth paid the bill. There was no balance because he stayed in the ward of the hospital.

What the total bill was for each of the 14,000 patients who benefited from the “Bayad Na Bill Mo” program should be the basis of PhilHealth’s packages of benefits for similar diagnoses and treatment of patients confined in private hospitals.

At present, PhilHealth’s packages of benefits are expanded without regard to inflation by the executive vice-president and chief operating officer, a lawyer. In January this year, PhilHealth implemented arbitrarily a 50% increase in case rates for nearly 9,000 medical and surgical cases, effectively doubling older rates that had been stagnant since 2014

Oscar P. Lagman, Jr. is a retired corporate executive, management professor, and business consultant. He had extensive exposure to the healthcare field in each of those three capacities.