Why the Philippines needs Universal Health Care

Dr. Ernesto Domingo, National Scientist, Ramon Magsaysay Awardee

Posted at Oct 05 2019 06:44 AM

The President of the Republic of the Philippines signed on February 20, 2019 Republic Act (RA) 11223 entitled, An Act Instituting Universal Health Care (UHC), which provides the legal basis by which the provision of Section 15 of the Philippine Constitution can be implemented. The law under Section 2 states, “It is the policy of the state to protect and promote the right to health of all Filipinos.”

The question is: why is a law necessary to implement a very noble, non-controversial principle? Part of the answer is given by the authoritative commission on health, called Lancet Commission (LC) which in 2010 stated that “Health systems left to their own devices do not gravitate naturally towards the goals of health for all through primary care as articulated in the Declaration of Alma Ata.

"Three worrisome trends in health systems are: a) disproportionate focus on specialists, tertiary care often referred to as hospital centrism; b) fragmentation as a result of vertical programs; and,
c) pervasive commercialization.”

These trends, plus the practice of treating health care and services as commodities that should be purchased when there is a need for them, inevitably lead to the most pervasive problem in health, which is inequity. The LC noted the glaring gaps and inequities in health, both within and between countries, underscoring the collective failure to share the dramatic health advances equitably.
 
Nowhere is this more true than in the Philippines. For example, 60% of those who die pass away without any health professional attendance. The poor are way below in every measure of health compared to the well-to-do and rich. The prevalence of catastrophic illnesses among the poor is way above the internationally accepted norm.

In more than 100 countries that faced the same problem in health as the Philippines, the one common remedy is the institution of a UHC as the dominant health care system. In our part of the world, the Philippines is among the last, if not the last, to adopt UHC.

The global purpose of the health care system, according to the LC, is to assure universal coverage of high quality, comprehensive services that are essential to advancing opportunities for health equity within and between countries. UHC, by long experience, is the system that best assures the attainment of this purpose.

In the Philippines, UHC is meant to provide every Filipino 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. The overarching philosophy is that health is a right and provision of health services is based on needs and not on an individual capacity to pay.

For the average Mang Juan and Aling Juana, a more understandable definition of UHC is process-oriented, thus:

"Kapag kayo ay nagkaroon ng kapansanan sa inyong kalusugan at ito ay hindi naman 'emergency', mayroon kayong facilidad na pupuntahan na ipinaalam na sa inyo sa simula pa. Dito kayo ay bibigyan ng kaukulang serbisyo at lalapatan ng kinakailangang lunas na kalugod-lugod sa inyo. Matapos ang mga ito kayo po ay hinde magbabayad ng anuman ngunit ito po ay hindi 'charity' dahil ito po ay binbayaran ng inyong kapwa pilipino sa pamamagitan ng inyong pamahalaan. Kapag 'emergency' naman ang inyong kalagayan kayo ay maaring pumunta sa pinaka malapit na pagamutan at ganon din po ang patakaran. Kung kailangan ninyo ang mataas na antas ng pagkalinga mayroon pong bahalang tumulong sa inyo hangang makamtam ninyo ang kailangan ninyo."

UHC is not an easy system to implement except that, to paraphrase Winston Churchill in favoring a democracy over other forms of government, there is no other health system that can ensure equitable access to health care and services.

Presently, under the leadership of the Department of Health, the necessary implementing rules and regulations or IRR to implement RA 11223 is being crafted. The widest consultations of all stakeholders are being undertaken on five (5) key areas namely: Financing, Service Delivery, Local Health Systems, Regulation, and Governance and Accountability. Pilot implementation areas are going to be launched to identify key problems and provide the needed solutions.

UHC should be viewed as a work in progress because health problems will surely change over time. Grounded on the principle of EQUITY, UHC will and should be able to remedy future health problems.

Disclaimer: The views in this blog are those of the blogger and do not necessarily reflect the views of ABS-CBN Corp.