Have we opened a Pandora’s box with UHC?

Budgetary constraints, readiness, and progressive realization are anxiety-inducing words that mark the forthcoming implementation of the Universal Health Care (UHC) program covered by a law signed early this year, and whose implementing rules and regulations had just recently been passed.

With an estimated budgetary requirement of P1.5 trillion over five years until 2024, the promised “no billing” or free hospitalization right of every Filipino will likely not happen during the first years of UHC because there is not enough money that can be set aside by the government.

A progressive or partial rollout was not exactly how lawmakers and state health officials pictured the program’s scope and implementation when deliberations for the passage of the law were taking place last year.

PhilHealth, the government agency that will implement the UHC program, and the Department of Health (DOH) are now saying that there will only be pilot runs next year, specifically in 33 chosen areas (28 provinces and five cities) because of budgetary and capacity constraints.

Even on a pilot-run basis, PhilHealth and DOH are saying that the P166.5-billion budget allocation given to them next year will be short by about P64 billion after both agencies forwarded a P257-billion budget bill to implement UHC. (The remaining amount will come from PhilHealth premium contributions, the Philippine Amusement Gaming Corporation, and the Philippine Charity Sweepstakes Office.)

The budget shortfall is expected to increase further in the coming years since the DOH estimates that widening the UHC coverage to more provinces and cities will require incremental cost increases of 10 to 15 percent a year.

Exacerbating cost effect

The budgetary constraints will surely exacerbate PhilHealth’s and DOH’s human resource capabilities to deliver health services under the UHC program. For PhilHealth alone, UHC could mean a doubling of monthly clients, which would necessitate more personnel to process claims.

Considering how inept the bureaucracy is at processing the creation of new positions, it would be too much to expect that PhilHealth will have the adequate number of employees to handle the upcoming surge in reimbursement entitlements.

PhilHealth is also looking at expanding the number of its offices to be able to serve more Filipinos who will seek compensation, and this again means an appropriation of more funds.

Of course, the bigger burden will be on the DOH and all the local public health units that will need more health care workers and professionals to deliver health services. As it currently stands, by world health standards, the Philippines has far too few doctors, nurses and midwives in public health facilities who will attend to the needs of a fast-growing population.

An increase in operating cost will not only come from having to hire more people; the UHC law mandates the regularization of all health care workers and health professionals, as well as competitive salaries and remuneration, especially in priority areas.

Most recently, the Supreme Court ruled that nurses should receive the appropriate higher salary as stipulated by the Philippine Nursing Act of 2002, which should double what most are receiving to approximately P30,000 a month.

But more than all of the above, the underlying principle of universal health, which means free basic health services for 108 million Filipinos, represents a sizeable expense for a developing economy like the Philippines that continues to struggle to raise funds for its operations every year.

Corruption and inefficiencies

While the World Health Organization and similar international agencies have lauded the Philippines’ initiative to institutionalize free health care for all its citizens, it also recognizes that the most basic program on UHC would entail massive financial resources.

The success of UHC is not only limited to the availability of funds, but also on an efficiently functioning health system where health care workers and professionals have proper training to tend to the sick, there are enough safeguards against corruption, inventory systems and supply chains function well, and electricity and clean water supplies are reliable.

The recent scandal involving PhilHealth where billions of pesos were reportedly channeled to fake treatments, overpaid charges of hospitals and clinics, and padded claims has not yet been fully resolved, and here we are now entrusting more money to the agency.

The DOH too is no stranger to corruption stories, the most recent being the anti-dengue Dengvaxia vaccine that had to be recalled because of reported deaths among those administered with the controversial drug.

More importantly, as many health professionals point out, there is a breakdown within the DOH in ensuring the delivery of public health safety. There is now a resurgence of malaria and measles; and after decades of having eradicated polio, new cases have cropped up.

Boomerang

The UHC law raises expectations of Filipinos, especially those who can ill-afford to pay for medical expenses and basic health services. It is something that has definitely contributed to raising President Duterte’s popularity rating, but in the long run, may be a Damocles sword that could shred the public’s trust in him even before his term ends.

Unless properly implemented and assured of sustainable funding, the UHC program may boomerang badly on the current administration, much like opening a Pandora’s box of more problems that may be too much, too hot to handle.

Passing new taxes to ensure more funds to support the UHC program is a first step, but demanding for and ensuring a better bureaucracy that will oversee and implement the country’s public health program would be crucial in upholding the public’s trust – and seeing through the program’s success.

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