by Cristina Morabe and Josh Protacio (UPCM Class 2023)
The Medical Students for Student Responsibility–IPPNW Philippines (MSSR-IPPNW) and Pangkalusugang Lingkod Bayan (PLB) held a talk on R.A. 11223, or the Universal Health Care Law (UHC law), last Friday, March 29, 2019 at Calderon Hall, UP College of Medicine.
Dr. Beverly Loraine Ho, Special Assistant for the Universal Health Coverage to the DOH Secretary, spoke on behalf of the Department of Health, explaining the core principles of the Universal Health Care (UHC) Act. She discussed at length about how the law aims to have complete nationwide healthcare coverage, as well as maximize health care through having predictable expenditure and benchmarking coverage costs through health technology assessment.
She began by clarifying the meaning of the Universal Health Care Act, saying that its “universality” means that it encapsulates all Filipinos.
“Universal health care means that everyone wins,” she declared.
However, Dr. Ho emphasized that the UHC Act does not promote a “libre lahat” (“everything is free“) mindset. Rather, it gives emphasis on the basic services that should be made available for the people, coursed through a stronger primary health care system. This entails that every Filipino family should have access to a primary health care team that ensures that they are given the appropriate services and facilities. Furthermore, Filipinos families should also be protected from financial risk by establishing the predictability of health spending, the job fulfilled by PhilHealth. Having said that, she also remarked that there are limits to what the government can pay for.
“There are benefits, but there are rules that accompany the benefits,” she says. “Again, it’s not all about ‘libre ang lahat’. [The services provided] have to be within what is prescribed by the primary health care physician. If the patient wants their own doctor, a private room with TV and WiFi, then they will need to pay for what is extra. Their PhilHealth will only cover the basic services.
“When they [do pay], they need to know about it upfront. Hindi yung magugulat sila at the end of their hospital stay.” This statement falls under one of the core thrusts of the UHC, which is that patients are able to receive effective care without financial hardship.
In discussing the financing aspect of the UHC, Dr. Ho then clarified the different roles of various stakeholders in health care. Local government units (LGUs) and the Department of Health were identified to be purchasers of population-based services, while PhilHealth finances the individual-based services. However, Dr. Ho also clarified that LGUs have a dual role, as it can also act as a provider of health services.
Additionally, Dr. Ho mentioned that the UHC recognizes the concern that in the Philippines, physicians are not on payroll and do not have a stable, predictable income, thus affecting the cost of healthcare.
“The most variable cost of healthcare services is the professional fee,” she says. “We are one of the few countries where our physicians are not on a payroll. Many of you probably did not know that once you graduate and start your medical practice, you are actually considered entrepreneurs. You have to set up your own clinic, your own business permit, etc. And it’s not the doctor’s fault. It’s the system that allows them to do it, because they have to fend for themselves.”
Another thrust of the UHC emphasized by Dr. Ho is health promotion and prevention. This means that the UHC should be applicable not only for when people are sick, but as well as in times of good health.
“We always say that the UHC is not just about the health service delivery part,” Dr. Ho explained. “We talk about UHC wherein Filipinos have healthy living, working, and schooling conditions.”
She added that the UHC also recognizes the importance of education in pushing for better health practices. She mentioned that it provides for a revision in school curricula to include concepts that will equip the next generation of Filipinos to “know how to choose to be healthy.”
Dr. Ho was followed by Dr. Joshua San Pedro, a physician-anthropologist and the Health Education, Training, and Services Officer of the Council for Health and Development. The first half of his talk was primarily about the different changes and additions that the UHC law will provide. This includes strengthening of local primary healthcare through formalized trainings and better interplay between public and private sources of primary care.
His talk touched upon changes in the membership classification of PhilHealth (now being renamed as the National Health Insurance Corporation) where there will now be two types of members: direct members, which include those who pay premiums or are SSS/GSIS pensioners; and indirect members, which are government-subsidized like those in the 4Ps and PWDs. He also discussed the eventual formation of an independent body for Health Technology Assessment, which will work with DOST to ensure the quality of the healthcare tools and equipment that will be employed in our healthcare system.
The second half of his talk focused on the gaps of the current health system. Currently, more people receive healthcare from the private sector due to the predominance and availability of private healthcare providers. Conglomerates, which are expanding their businesses to the primary healthcare sector, have been buying more hospitals in the country and expanding their networks which further promote for-profit healthcare.
Dr. San Pedro presented a case study in health system failure and PhilHealth misutilization. In the study, it was shown that people in Dumagat communities have numerous cases of preventable diseases like measles because they cannot be reached by local health units for vaccination. And if the indigenous people in these communities want PhilHealth coverage, they have to submit paperwork including birth certificates which some of them do not have. With the current system as it is, these people, who still need to purchase their own medicine before being reimbursed by PhilHealth, are forced to approach local politicians.
Dr. San Pedro ended his talk by stating that the healthcare system is largely inefficient and broken and these gaps may not be answered by the Universal Health Care Act because law is about having universal healthcare coverage instead of providing free and comprehensive healthcare.
After Dr. San Pedro’s talk, a short open forum was held. One of the notable points raised in the forum was from the College of Medicine’s own Dr. Delen Dela Paz. In her statement, Dr. Dela Paz said that the equity component of the UHC law does not reflect the essence of the Alma-Ata declaration which is that health is a fundamental human right. She stated that the we must not make laws that are only palliative to our situation but rather focus on changing the system that is causing our current situation.
In response to Dr. Dela Paz, Dr. Ho has stated that she cannot defend the legislation for she has her own opinions about it, but in her view it is the Department of Health’s job to maximize the UHC law and implement it. She also raised a challenge to the audience to study on how make bolder reform in the health sector because the most difficult component of reform is the transition from our current state to what is ideal.
“I agree that this cannot be completely changed just by policy, but by a meaningful social mobilization,” she says. “But until you have enough critical mass to actually think that way, to actually populate the bureaucracy, it’s going to be difficult. And that’s why the challenge is for us to not all be on the same side. So that someone can always challenge the system, otherwise we’re all assimilated into the same way of thinking. Just be very conscious na nakikinig ka.”
The entire forum can be viewed at MSSR-IPPNW’s Facebook page facebook.com/MSSRIPPNW. A Twitter thread of the event can also be found at MSSR-IPPNW’s Twitter account @mssrippnw.