Telltale signs that health care in the Philippines is not universal

October 5, 2020

by Casey Salamanca

The House of Representatives deferred the Department of Health (DOH) budget until the agency submits documents pertaining to the Philippine Health Insurance Corporation (PhilHealth). PhilHealth is under fire for alleged corruption.

This gives more time to tackle Universal Health Care (UHC) that, with the government’s approach, banks on PhilHealth as its main mechanism. The Duterte administration wants UHC to be one its legacies where health services will supposedly be accessible to each and every Filipino. Yet PhilHealth is failing in its mandate to “ensure affordable, acceptable, available and accessible health care services for all citizens of the Philippines”.

The COVID-19 pandemic is seeing the Philippine health care system at perhaps its worst but there were problems even before COVID-19. There are many reasons to doubt the reliance on PhilHealth for UHC and ensuring “health care for all”.

First, PhilHealth membership is not resulting in more affordable health care. The portion of health expenses shouldered by households remains high under the Duterte administration. Filipino households still account for most of total health spending with out-of-pocket expenses at 53.7% in 2016, 53% in 2017, and 53.9% in 2018.

Philhealth claims that, in 2019, 83% of patients surveyed benefited from the No-Balance-Billing (NBB) policy. NBB means free services for those who avail of a hospital’s basic services and those within PhilHealth’s case packages. The survey however only covered patients hospitalized and, moreover, only those in basic or ward accommodations.

Despite the limited scope, 17% of patients surveyed still had to shell out money for medicine, medical supplies, and laboratory expenses. Reports also confirm that COVID cases are not covered by NBB.

Second, PhilHealth is a key component of privatizing and commodifying health in the country and hence a driver of more expensive health care. It is a financing scheme designed to encourage profit-seeking private investments in hospitals and health care. Yet private hospitals are three to four times more expensive than public hospitals.

Since PhilHealth’s creation in 1995, private hospital bed capacity has been growing faster than public hospital bed capacity. By 2012 there were more private than public hospital beds in the country. This is because the government has been using PhilHealth to support payments to expensive private hospitals amid cutbacks in the public hospital system.

Most PhilHealth payments go to private hands and profit-seeking health care providers. In 2019, 57% of the total amount of claims it paid went to private hospitals.

Third, PhilHealth is not really a social health insurance scheme and members still bear the burden of expensive health care. A real social health insurance has the State directly covering the cost of health care to make sure that indeed no one is left behind.

Yet the government dodges this responsibility with PhilHealth thriving mostly on direct contributions from members. In 2019, PhilHealth figures show that 53% of total premium contributions came from direct contributors and only 47% from government.

Even the government think-tank Philippine Institute for Development Studies (PIDS) recognizes that a private health insurance system, instead of social health insurance, limits who has access to PhilHealth funds.

Also, people can only avail of PhilHealth benefits when seeking medical attention in PhilHealth-accredited hospitals. Even DOH-accredited public healthcare institutions need to go through the time-consuming accreditation process of PhilHealth instead of being automatically accredited as part of the country’s public healthcare system.

Fourth, corruption makes PhilHealth worse. PhilHealth gets embroiled in corruption cases almost every year, according to the health worker group Health Alliance for Democracy (HEAD).

The Commission on Audit (COA) for instance estimated up to Php154 billion in public funds lost from 2013-2018 due to PhilHealth overpayment and fraudulent claims. In 2019, there were ghost dialysis claims implicating PhilHealth chair and DOH secretary Francisco Duque. Just this year, some Php45 billion worth of public funds were reportedly lost to corruption and anomalous Interim Reimbursement Mechanism (IRM) transactions.

PIDS explains that PhilHealth is prone to corruption because checks and balances such as joint congressional hearings participated in by the executive branch to monitor it never happened.

And, fifth, PhilHealth is a mere financing scheme disconnected from improving the country’s public health care system. So-called health financing reforms serve the government’s thrust of streamlining its stake in ensuring the people’s health. This makes health services even more elusive to the people.

A health care financing scheme should only be secondary to building a strong public health system with sufficient infrastructure and human resources for delivering genuinely affordable, if not free, health services. Even a reformed PhilHealth will not be enough to fulfill the urgent need for real UHC. The current grave public health crisis just makes this even clearer.

But the Philippine government, refusing to take responsibility for the health system, is at odds with the declared grand objectives of its own health law.

For example, the UHC program acknowledges the need for a national network of hospitals and health providers in coordination with local government units. Yet even the One Hospital Command set up by the government at the height of COVID-19 could only facilitate getting a patient on hospitals’ long queues for bed space. The problem boils down to there not being enough hospitals and health facilities to accommodate both COVID and non-COVID cases.

The UHC program also says that the country’s preventive health care systems and epidemiological surveillance should be strengthened. But these cannot happen with budget cuts in important health system areas.

The proposed 2021 budget for health is even lower than health spending this year from the 2020 national budget, Bayanihan 1, and Bayanihan 2 combined. Health advocates assert that the supposed increase in health human resources will only be temporary while allocations for the building of new health facilities and epidemiological surveillance shrink.

By hyping UHC, government pays lip service to the Filipino people’s right to health. The right to health pertains to a person’s overall well-being – not just the absence of illness but also freedom from hunger, poverty, joblessness, homelessness, violence. There should also be access to ample social and public services, and participation in development. The government has to play its vital role in ensuring all of these.