Private hospitals,

are these hospitals will go bankrupt,” he said.

UHC has an ambitious dream for free healthcare, from check-ups to accommodation. Ms. Consunji, Mr. Campomanes and Mr. Jimenez all agree the government is going in the right direction in wanting to increase access to healthcare.

But for them, timing is important for pursuing a big revolution such as UHC, as it would demand much from both the public and private sectors in terms of reshaping how healthcare works. Primarily, the law wants healthcare to be preventive rather than reactive by promoting primary care and assigning a primary care provider for every Filipino.

“Yung prevention na sinasabi ng UHC (The promotion of prevention that UHC wants is) very good. But I think there are a lot of things that need to be changed. The only challenge is the quickness of this, because this is a few (months). February they signed (the law), then October (they released the implementing rules and regulations). You can’t change a system in six months or even one year,” Ms. Consunji said.

Mr. Jimenez added: “We are telling them, ‘Do not implement it immediately. Talk to us.’ Because all the amendments that were supplied by us were not included in the IRR. So what will happen to the implementation if you do not follow our suggestions? You will fail, definitely.”

Jeremy Lim, co-director of Leadership Institute for Global Health Transformation at the National University of Singapore School of Public Health, said there a “political price to pay” for UHC to be sustainable.

Speaking at the Hospital CEO Forum on lessons on UHC implementation in Asia, he said it is “unfortunately the karma of any funding agency like PhilHealth to struggle.”

“The first rule of health economics is scarcity. There will always be much more demand than there will be supply. And that, unfortunately, is the reality moving forward. The financier will always have this challenge of how to balance. We see almost everyone has stumbled here and there,” he said.

He also said hospital CEOs will have to figure out a way to deal with cash flow challenges and pricing pressures as “these will not go away.”

“No matter the economic volatility… UHC implementation and sustainability, from a political point of view, will always remain. There is no country in the world other than America that has walked into UHC and wanted to walk out… Every other country has embraced UHC and said it is morally and nationally the right thing to do,” Mr. Lim added.

PhilHealth acknowledges it has to work to repay private hospitals for the years of receivables it has not distributed to claimants.

Speaking at the Hospital CEO Forum, PhilHealth Area Vice-President for South Luzon and NCR Gregorio C. Rulloda said the agency is committed to “craft settlement of our obligations to our partner hospitals.”

But PhilHealth President Ricardo C. Morales, in a briefing in October, noted it is a “cheap stunt” to threaten withdrawing from accreditation as it is “putting the public in a predicament which they don’t deserve.”

Despite the uncertainty about what will happen once UHC is in full effect, some private sector entities are positive about how it will change healthcare in the Philippines. For instance, Ayala Healthcare Holdings, Inc. (AC Health) has become more bullish on the industry because of UHC.

“I think it’s made us more excited to invest in the space… Anytime there’s an industry that has enabling regulatory frameworks… when you’re opening up an industry for more awareness and more utilization, it’s always good for private sector participants,” AC Health President and Chief Executive Officer Paolo Maximo F. Borromeo said in a Nov. 21 interview.

Operating as the health unit of Ayala Corp. with 70 FamilyDoc clinics and pharmaceutical operations, AC Health is looking to increase its investments moving forward in light of UHC.

“It’s an industry that is very exciting for us as a group. We think it has very big long-term potential. And so I think we’ll look to continue investing where we can help address gaps in the system,” Mr. Borromeo said.

But it doesn’t ignore the fact that beyond just money, there’s a need for a lot more beds and medical professionals for UHC to take effect. PhilHealth’s Mr. Morales agrees with this, thus the government’s decision to do a “gradual rollout” for UHC to cover 33 sites first by 2020.

Mr. Campomanes of St. Luke’s believes the government has to work closely with the private sector for an efficient implementation of UHC. “There are few hospital beds. Some cities and towns would have only a private hospital. So what happens then if someone gets sick? You need to admit,” he said.

Makati Med’s Ms. Consunji also said what the private hospitals can do is rationalize expenses to increase absorptive capacity for bad debts. “Decrease your costs because there’s no other way… Then maybe in the future, capital expenditure in terms of machinery. Maybe you’ll have to be more careful in buying,” she said.

But to give stakeholders a sense of “solidarity” in the midst of all the uncertainty, Mr. Lim said almost all countries that implemented UHC are struggling with it, and that is the normal thing to happen.

“The good news about UHC is there are no real experts. Everyone is struggling. There is a lot of solidarity, a lot of comfort in that the whole world is struggling with you. And we will continue to struggle until the end of time because UHC will never be finished,” he said.

“It is a journey, and it is important to appreciate that in this journey, the secret is not to not fall, but to fall forward. Because we will definitely fail in some areas, but we have to fail quickly, learn, and move forward in the right direction.”