By Paolo Romero
President Aquino signed on Wednesday a law granting health insurance for Filipinos funded through proceeds from sin taxes.
Bacolod City Rep. Anthony Golez, one of the principal authors, said yesterday Republic Act 10606, the Universal Health Care Act, will ensure that all Filipinos, especially the poorest of the poor, will get health insurance coverage from the Philippine Health Insurance Corp. (PhilHealth).
“I firmly believe in the benefits that this law will bring to Filipinos and in achieving universal health care for Filipinos,” he said.
“I am glad that President Noynoy finally signed it into law, and I am mighty glad and proud to have been part of the legislative process in crafting one of the more important pieces of legislation at this point in time in our country’s history.”
The law is a consolidation of over 50 bills from the House of Representatives and the Senate to amend RA 7875 of 1995 creating the PhilHealth, Golez said.
It mandates a national health insurance program (NHIP) as the means for the healthy to help pay for the care of the sick and for those who can afford medical care to subsidize those who cannot.
It shall be compulsory in all provinces, cities and municipalities, notwithstanding the existing health insurance programs of local government units.
The 1987 Philippine Constitution affirms the right to health of all Filipinos and directs the State to protect this right.
Despite the efforts of both the government and private sector to apply the advances of scientific medicine and modern public health methods, health status indicators have been slow in improvement and have lagged behind our ASEAN neighbors.
Within the country, there are glaring disparities in health status among regions and income groups.
This disparity in health status results from the inequities in society in general and, within the health system, from the inequity in access to health services.
This inequity in access results from a health system characterized by:
inappropriate governance within the health system, an antiquated and inadequate health information system, ineffective regulation of health goods and services, fragmentation of health service delivery, a dysfunctional health workforce, and unfair, unjust and inadequate health care financing.
The Philippines must implement Universal Health Care to address the inequities in the health system. Universal Health Care is defined as the provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed and appropriately used by an informed and empowered public. Universal Health Care will ensure health as a right to ALL Filipinos regardless of ability to pay.
To implement Universal Health Care, radical reforms are needed in the six building blocks of the health system, namely: focused and directed governance based on a policy of equity, a dynamic health information system useable for health policy formulation, regulation of health care, integrated and rational health service delivery, an adequate production of well motivated human health resources, and an adequate and equitable health financing.
The Department of Health serves as the government’s overall policy formulation and implementation agency in health. The DOH must assert its leading role within the health sector and develop the cooperation of other sectors of society to implement Universal Health Care.
The most glaring governance problem to achieve Universal Health Care is the lack of an encompassing policy of health service provision that explicitly addresses the issues of health inequity and its social implications.
The firmly entrenched top-down approach stifles attempts at introducing participatory processes in health decision-making and policy formulation through the Primary Health Care Approach.
The DOH in consultation with the other sectors of society must articulate a clear and explicit national policy of health service provision that directly addresses the issue of inequity. An executive order addressed to all government agencies that defines health equity as equal and just access to health care will provide the basis for the implementation of Universal Health Care.
Participatory processes must be effectively implemented for decision making and policy formulation along the lines of the Primary Health Care approach.
Existing mechanisms must be strengthened and new ones installed for the effective and meaningful participation of families, communities, professional groups and other relevant groups in the management and operation of health programs, facilities and activities.
Health Information Systems
Information systems are crucial for decision-making and policy formulation. However, the health information systems in the Philippines are rudimentary and ministerial – the data are gathered and recorded as a matter of duty, and not for their usefulness to the health care system.
Higher offices are deprived of timely information which could be crucial to effective and dynamic national policies. The lack of effective leadership and direction for the implementation of health information standards has caused stagnation in the improvement of the data gathering system.
To address this burgeoning problem, the Department of Health must take the lead in the creation of a framework of health information system, taking its cue from the rapidly expanding field of e-Health.
This is defined by the World Health Organization as a cost-effective and secure use of information and communication technologies in support of health and health attendance fields, including health care services, health surveillance, health literature, health education, knowledge and research.
The Health Information System of the Philippines must reflect a multi-user and multi-perspective design. It should be able to provide support for the decision-making process by deconstructing what decisions need to be made, the knowledge that is required to support these decisions, and the information and data components.
Services should be documented at the point of care – relevant patient information will eventually form the building blocks of the national health information database.
Regulation of health stems from the government’s responsibility to ensure that the people, especially the underprivileged, have adequate and equitable access to health products, facilities and services.
A regulatory system aims to provide a set of methods to influence behavior of both providers, specially the private sector, and protect the buyers from their own inability to judge quality.
Regulation must improve access, advance moral principles and counteract monopoly.
The Philippine health regulatory authority struggles with the problems of scarce resources, inadequate staff and capability, inefficient use of available technology, and lack of progressive technological development.
Health policies and regulations are inadequately enforced, because of the lack of manpower, technical capacity, funding, organization, as well as the problem of legal constraints. As a result, health facilities are not only substandard and dilapidated, but uncoordinated and fragmented, if not absent.
Initiatives must be taken to address these problems. An integrative framework for the harmonization of the different regulations of the health care system is necessary.
Coordination and capacity-building must be at the forefront of these reforms. The various stakeholders, such as the LGUs and the private sector, must also be directly involved as well. Education and other participatory processes will be central in engaging the different stakeholders of health.
Health services can be characterized by the dichotomy of public and private hospitals and the fragmentation at the local level. The former traces its roots back to the American colonial model, whereas the latter stems from the enactment of the Local Government Code of 1991.
Primary care is devolved to municipalities and barangays, and there is a palpable absence of a unified, cohesive and logically organized referral system. These problems are further compounded by the lack of quality assurance of these health institutions.
Health services can be improved through the implementation of the following reforms:
1.Strengthening Primary Care – through the development of the “Essential Health Package” (EHP) that center on problems identified in the community. The EHP should not limit services and goals, but instead serve as starting points of a comprehensive primary health care program. Pilot EHPs can be implemented in several disadvantaged provinces.
2.A multidisciplinary primary care team approach that is linked to a referral system. The primary care team will serve as the gatekeeper between the patients and the hospitals.
3.Reinstituting the District Health System through political and financial support – the subcontracting of a capitation based Global Health Budget to provide essential health services can be used to reinvigorate the district health system.
4.Integrating all referral hospital services, whether public or private to align with the visions of Universal Health Care.
The DOH must take the lead in removing the structural barriers to the integration of our national health systems.
Health Human Resources
The health care system of the country suffers from the paradox of lacking health care professionals, especially in economically depressed regions, while at the same time enjoying an oversupply of the said professionals.
Most doctors and nurses are concentrated in the private sector, while the supply of midwives, who provide the basic health care needs for the poor, is inadequate to meet the demands of the rural and barangay health centers.
These problems can be traced back to three factors: unregulated market forces, quotas determined by capacity rather than sustainability, and absence of emphasis on public service and common good.
These factors combine to produce the phenomenon of migration to other
countries and overcrowding in a highly competitive job market.
Reforms in HHR production must be anchored on fundamental changes in the recruitment, education, training and deployment of health care professionals.
These must be guided by the overall objective of providing competent,
well-motivated, transformative and committed professionals in a system of universal health care. These must be based on a country’s demands of health care instead of market forces.
These reforms will be anchored on regulations. A commission headed by the DOH and including members from the CHED, PRC, PHIC, LGUs, DOLE, DEC, etc, can spearhead the efforts in promulgating policies regarding the standards and regulations in the production, practice and deployment of health professionals.
The Philippines faces the same health financing issues of the region: chronic underfunding, inequitable sourcing of funding (low public spending leading to high out-of-pocket spending), efficiency issues in terms of allocation of limited financial resources and payment mechanisms leading to higher health care costs.
Added issues are the fragmentation and overlap of the health financing institutions and by the lack of an articulated national health policy based on equity and health as a right as basis for health financing policy formulation.
To rectify the situation, the stakeholders in Universal Health Care must craft a unified Health Financing Policy based on equity and health as a human and constitutional right.
Total Health expenditure (THE) must be increased to the WHO recommended level of 5% of GDP. Government and Philhealth share must be increased such that Out of Pocket payments are eventually reduced to 20% of THE.
Funding for health care must be allocated to the more cost effective public health interventions and primary care services, while maintaining the quality of tertiary level health services.
Philhealth’s move towards Case Mix payments, true capitation and global budgeting should be further developed for financing both primary and tertiary care services.
Achieving the goal of UHC also demands that government address the social determinants of health beyond the health system.
Increasing poverty should be addressed by a comprehensive national
socio-economic development that includes asset reforms, agricultural
modernization and national industrialization. Universal Health Care will address issues of inequity of access. National socio-economic development will create the living conditions for a healthy population.
Only with a clear program for national socio-economic development, will Universal Health Care succeed in making our people healthy.