The Philippine government has treated health as a commodity, subjected it to a market-driven system, unprotected and unregulated
Approaching election season, the Aquino administration brandishes the accomplishment of universal health care as a legacy that would be continued by Liberal Party candidates. Yet, what the Aquino presidency does not mention is how his administration eroded the concept of right to health and how this has been grossly violated under its watch. This, as the world anticipates the 50th anniversary of the signing of the Covenant on Economic, Social and Cultural Rights next year.
The right to health was enshrined in the International Covenant on Economic, Social and Cultural Rights (ICESCR) in December 1996 and came into force in 1976. In this agreement, State parties recognized steps to be taken to achieve the full realization of the right to health. The right to health contains freedoms and entitlements and among those identified as needing key and immediate attention was maternal and child health.
Exclusionary, not universal
President Aquino has been claiming the increase of PhilHealth members as his biggest accomplishment in health. According to his last SONA, PhilHealth, the administration’s main health program, has reached 89.4 million beneficiaries covered in 2015 or eligible to avail of benefits. According to Aquino, the increase in coverage was mainly because of the 14.7 million indigent families that the national government sponsored in 2014 from only 5.2 million families covered in 2013.
But according to latest National Demographic and Health Survey, around four out of 10 families have no health insurance whatsoever. This lack of health insurance, whether from the government or from private sources, is worse in the urban areas and in ARMM, Central Visayas, National Capital Region and MIMAROPA.
PhilHealth also registers a low utilization rate of only 6% as of June 2015 and 11% in the full year of 2014. Low utilization rate in social health insurance is supposed to be a bad indicator in terms of access of insured population to health services. Social health insurance by design is supposed to encourage the people’s health seeking behaviors.
It also does not shield the poorest of the poor from additional payments for treatment, which is supposed to be the rationale behind the no balance billing (NBB) scheme. From January to June 2015, 52% of number of claims paid to sponsored beneficiaries are still not enrolled in the NBB, which means that these poor beneficiaries were still made to co-pay on fee for service basis for medical services, medicine inside the hospital, laboratory, professional fee or procedures.
According to the 2013 National Demographic and Health Survey (NDHS), of those who were confined in a public hospital or clinic in the past year, 92% of the average cost of medicines/services from outside pharmacy or laboratory and 65% of total hospital bills were paid from salary/loan/sale of property, while only 5% and 37%, respectively, were paid by PhilHealth. The total amount paid for by the patient (hospital bills and medicines/services purchased outside) is equivalent to 27 days of wages (according to minimum wage in the National Capital Region). It is even higher for those confined in a private facility, with total expenses equivalent to 68 days of wages.
This corroborates the result of the latest Philippine National Health Accounts wherein Filipinos still pay for some 68% of their personal health care needs out-of-pocket.
This, as the government allowed PhilHealth to increase insurance premium by 100% since 2014 supposedly because of its increased benefits to members and beneficiaries. However, according to the Commission on Audit, PhilHealth failed to reimburse Php250.2 million worth of member’s claims in 2012. The COA also revealed that PhilHealth officials received excessive and unauthorized bonuses and allowances amounting to Php1.5 billion in 2012 and Php1.25 billion in 2013.
Anti-women In this age of advanced technology, there are more mothers dying in childbirth than before. In the General Comment Number 14 (Right to Health) of the United Nations Office for the High Commissioner on Human Rights, Article 12.2 was explicit in articulating the right to maternal, child and reproductive health. Yet, the country’s maternal rates worsened from 209 in 1990 to 221 at present. This was significantly higher than the maternal mortality ratio of 162 in 2009, or an increase of 37 percent.
Under Aquino, mothers were forced to give birth in health facilities even if (a) there were no facilities, (b) the facilities are very far or (c) they don’t have money to pay for medical services. To comply with and give teeth to the ‘no home birthing policy’, LGUs have passed ordinances to ban home birthing in their constituencies. These ordinances usually contain penalty clauses such as monetary penalties, threats of imprisonment to the birthing attendant or to the father of the child, or denial of registration of birth. At present, there is no accounting of LGUs which have passed their version of this policy. In a study done by IBON in various urban and rural communities, the LGUs and their respective health offices are implementing the policy even without parallel ordinances.
The cost of giving birth in hospitals and birthing facilities under the management of LGUs is prohibitive. According to a study done by IBON in Eastern Samar, Iloilo, Capiz, Nueva Ecija, Oriental Mindoro, Negros Occidental and Pasig City, the cost of using a facility in the Rural Health Units range from Php1,000-Php3,000. Mothers try to save up for facility-based delivery, but the little amount that they save goes to emergency households expenses and is usually depleted at the time of delivery. According to the NDHS, around four out of 10 women did not deliver in a health facility because it “cost too much”.
In a survey done by IBON in communities in these provinces, four out of 10 mothers gave birth at home, in a tricycle, in kuligligs (farm hand tractor) and other means of transportation. According to the IBON survey, nearly four out of 10 women cited transportation-related reasons for not giving birth in a health facility. In Eastern Samar, pregnant mothers have to be carried across rivers in big baskets to be able to give birth in a health facility or they are forced to rent a space in the urban center for a month to be near the health facility.
The right to health includes respect of the culture of individuals, minorities, people’s and communities, sensitive to gender and life-cycle requirement, respects confidentiality and improve the health status of those concerned. It should also be non-discriminatory. However, government policies have been increasingly disrespectful and discriminatory to the poor and the indigenous population. In Oriental Mindoro, the traditional Mangyan birthing practices are violated in hospital birthing. But many of the Mangyan, especially those who are under the CCT Program, are now afraid of giving birth in their homes for fear of getting delisted. Worse, in going to the hospital, they already endured the discrimination from taking the public transportation, having to travel for up to seven hours and not being attended to immediately.
The poor sections of the population are the one who suffer the worst health outcomes. The poorest 20% of the population have the highest neonatal mortality rates (19%), post neonatal mortality rates (17%), infant mortality (36%), child mortality (17%) and under-five mortality (52%). Yet, the Aquino government has pushed for the corporatization of government health facilities and public-private partnerships (PPP), which pools public resources for private gain.
The Aquino government awarded a PPP project to Megawide Corporation to build and operate the Philippine Orthopedic Center, which would displace around 595 indigent inpatients and 450-500 daily poor outpatients. While Megawide terminated the contract for the slowness of the government in granting the land where the new POC will be built, the Aquino government is intent in pushing for the project. Likewise, the Dr. Jose Fabella Memorial Hospital, a 700-bed tertiary hospital specializing in maternal and newborn care, will be closed down. The hospital will be transferred to a new building that will be part of the PPP project Tri-Medical Complex. The proposed building for Fabella will only have a capacity of 400 patients, further marginalizing poor mothers giving birth.
The Philippine government has been careful not to call its health framework privatization. Nonetheless, it is guided by the principles of corporatization, revenue-generation, rationalization, user fees, devolution and reduced public spending for health. The Philippine government has treated health as a commodity, subjected it to a market-driven system, unprotected and unregulated. This profit orientation means that curative care has been stressed over primary and preventive care. Such framework has raised the health costs, reduced people’s access and made health service inappropriate for common diseases.