Yellow Pad

The Universal Health Care (UHC) bill is at its final stages. After a couple of preparatory meetings during the Congress break last October, the Bicameral Conference Committee is officially meeting tomorrow to reconcile the differences of the Senate and the House versions. At this rate, we can expect that the UHC bill will be signed into law before the year ends.
While we’re almost there, a few remaining challenges cannot be overlooked as these could either make or break the entire health care reform. The main obstacle is none other than Senator Ralph Recto who is at it again, six years after his infamous Recto-Morris act. (In 2012, health advocates slammed Senator Recto for adopting the tobacco tax proposal of Philip Morris-Fortune Tobacco; hence, the label Recto-Morris.)
In Senate Bill 1896 (SB 1896), the Senate-approved UHC bill, Senator Recto negotiated to take away one key word in the definition of terms — “gatekeeper.” Prior to Senator Recto’s intervention, the term service delivery network “refers to a group of primary to tertiary care providers, [whether public or private,] with the primary care provider acting as the gatekeeper and coordinator of care within the network.” The final SB 1896 renamed service delivery network to “health care provider network” and defined it as “a group of primary to tertiary care providers, whether public or private, offering people-centered and comprehensive care in an integrated and coordinated manner with the primary care provider acting as the coordinator of health care within the network.”
The gatekeeping function of the primary care provider is one of the important things that is missing in our current health care system. The lack of a gatekeeper in a complex system of health providers has led to many Filipinos getting lost in the health care system, patients being overtreated and burdened by high out-of-pocket expense, overcrowded hospitals, and overworked specialists.
Thus, gatekeeping of the primary care provider is crucial in ensuring that patients see specialists only for conditions that could not be managed at the primary care level and are referred to an appropriate specialist, when necessary. Without gatekeeping, the primary care provider will not also be an effective coordinator of care and navigator in the health care system.
Contrary to the principles of a social health insurance wherein the well-off subsidizes the poor, Senator Recto also intends to give more PhilHealth benefits to those who can pay more. Under the section “Entitlement to Benefits” of the approved SB 1896, he inserted this provision: “PhilHealth shall provide additional NHIP [National Health Insurance Program] benefits for direct contributors, where applicable.” Direct contributors “refer to those who have the capacity to pay premiums, who may be gainfully employed with an employer-employee relationship, self-earning, professional practitioners, or migrant workers.”
While Senator Recto’s main motivation is to encourage businessmen, doctors, lawyers, and other professionals, who are part of the informal sector, to voluntarily pay for their PhilHealth premiums by giving them additional benefits, the two-tiered benefit scheme will also exacerbate health inequity in the country. The poor and vulnerable indirect contributors will continue to be treated as “charity patients.” In other words, Senator Recto’s provision goes against the very essence of Universal Health Care and creates more problems than solutions.
Also, if the real intention is to encourage members of the informal sector to pay, administrative reforms in PhilHealth, such as strengthening its coordination with other agencies like the Social Security System, Home Development Mutual Fund, Bureau of Internal Revenue, and Professional Regulation Commission, etc., can be undertaken without jeopardizing the objectives of our social health insurance.
To add insult to injury, Senator Recto also introduced a section legislating the currently regressive PhilHealth premium schedule, which caps the premium contribution of those earning above P40,000 a month at an amount equal to the contribution of those earning exactly P40,000. On the other hand, those who are earning below P40,000 pay a PhilHealth premium that is proportional to their income. His reason — so that richer Filipinos will have freed up resources to pay for private health maintenance organizations (HMOs).
This is obviously contrary to the long-standing proposal of removing the ceiling so that those who have more can contribute more to the social health insurance. Worse, the Senator wants this regressive premium schedule legislated so that PhilHealth will no longer have the mandate to adjust the premium ceiling as provided for in the current National Health Insurance Act.
Once these emerging issues on the UHC bill are already settled and assuming our legislators will be able to fight for the best provisions that will secure the objectives of UHC, the next major hurdle will be on funding. The Department of Health (DoH) estimates that, in the first year alone, an additional P164 billion will be needed to fully implement UHC. So far, only P17 billion can be pooled from PAGCOR and PCSO, which leaves us with a deficit of P147 billion — an amount almost equal to the current budget of the DoH.
Recently, Senate President Sotto was quoted as saying that the UHC bill can be implemented even if the 17th Congress will not be able to pass the pending bills on increasing the excise taxes on tobacco and alcohol.
Meanwhile, the scheduled fuel excise tax increase in 2019 under the TRAIN law has already been suspended. If implemented for a whole year, this will result in a net loss of P26 billion. The approval of the pending general tax amnesty proposal is estimated to just offset the loss due to the suspension of the fuel excise. Aside from the general tax amnesty, only the tobacco and alcohol excise tax bills, and package 2 of TRAIN are pending in Congress — the latter is estimated to be revenue-neutral.
Now where will we get funding for UHC?
Jo-Ann Latuja-Diosana is a trustee of Action for Economic Reforms.