Prevention is better than cure, says DoH

THE Department of Health (DoH) is moving toward people-centered primary care from a curative care-focused system, according to a medical expert.

“Universal health care (UHC) is founded in primary care, which addresses more than 80% of people’s common health needs throughout their lives,” said Christian Edward L. Nuevo, chief health program officer of the DoH Disease Prevention and Control Bureau, at a Jan. 18 event by Liveable Cities Lab, an innovation-sharing platform. “UHC is all about the environments individuals are situated in.”

People-centered primary care, Mr. Nuevo told the webinar, is defined as the matching of every Filipino family to a primary care provider. The primary care provider determines if family members need to receive services in a hospital, or if they can be helped at the primary care level.

Primary care, according to the World Health Organization (WHO), covers an individual’s physical, mental and social well-being. In addition, it is “a whole-of-society approach that includes health promotion, disease prevention, treatment, rehabilitation, and palliative care.”

Added Mr. Nuevo: “Why primary care?… It is fair and equitable, and provides people with access to essential health services in their communities.”

According to the WHO, social determinants of health — such as the circumstances in which people are born, grow up, live, work, and age, and the systems put in place to deal with illness — account for between 30–55% of health outcomes, as shown by numerous studies.

Mr. Nuevo enumerated six enablers for people-centered primary care: improving health literacy; defragmenting the local health system; expanding primary care facilities; strengthening the competencies of primary care workers; standardizing who does what; aligning incentives, benefits, and financing; and ensuring the interoperability of data within networks.

FINANCING MECHANISM
It is impossible to finance UHC through the Philippine Health Insurance Corp. (PhilHealth), according to Dr. Ernesto O. Domingo, a national scientist of the Philippines, liver cancer specialist, and professor emeritus at the University of the Philippines College of Medicine.

“It must be based on tax money, and that’s what the law says,” Dr. Domingo said at the Liveable Cities Lab event. “The money will come from taxes [such as the] sin tax, be incorporated into a global fund, and entrusted to [local governments] for them to budget in the coming year.”

Although out-of-pocket expenditure has declined from 2014 to 2020, the Philippine Statistics Authority in 2020 reported that household out-of-pocket payments amounted to P379.7 billion, or 47.9% of the country’s current health expenditure.

Dr. Domingo said an efficient system will result in considerable savings, pointing out that an executive checkup worth P100,000 is not necessarily better than one worth P10,000.

“If the healthcare provider is careful and knows what he is doing, then he doesn’t have to have so many examinations to diagnose a disease… Why order a chest X-ray for someone who has the sniffles?” he added in the vernacular.

Tightening the screws by requiring requests that have to be justified, Dr. Domingo said, will generate a lot of savings in the healthcare system.

Republic Act 11223, or the Universal Health Care Law, was signed into law by President Rodrigo R. Duterte on Feb. 20, 2019. It redirects healthcare towards a preventive care-focused system, and guarantees equitable access to affordable and quality health services. — Patricia B. Mirasol