Business World

WHITHER THE IMPLEMENTA­TION OF THE NEW UHC LAW?

The undeniable entreprene­urial qualities of the practice of medicine in the country do not make an easy system for governance and regulation.

- By Maria C.G. Bautista

THE ENACTMENT of the Universal Health Care (UHC) Law marks a watershed in the Philippine health sector. It is a culminatio­n of reforms in health care financing, spanning 26 years under the old Medicare, 16 years under the national health insurance program (NHIP) and eight years under a so-called universal coverage or Kalahatang Pangkalusu­gan. Can we expect a transforma­tion of the way we pay, access treatment and deliver health care? Expectatio­ns are huge and require veering away from path dependency, with decisions and systems design bound to traditiona­l frameworks, capacities and systems.

Changing models of health care under the new law seeks to strengthen prevention over treatment and primary care over hospital care. In the runup to the crafting of the Implementi­ng Rules and Regulation­s (IRR) of the new law, there will be much role clarificat­ion among agencies in the health care sector due to administra­tive artefacts of provider-financier-policy setting splits in the system. Even with the best of laws, there are aspects of the Philippine health system that can challenge even the best of intentions and competent individual­s in government.

Implementa­tion of the new law will be under the context of the Local Government Code of 1991 which has given to the provinces and mayors the “ownership” of health services, and the planning and monitoring at local levels to Local Health Boards. How much do we know of the performanc­e of these local officials and boards? Health is not high in the priorities and competence of local officials. The new law envisions some complex systems and with the Department of Health’s limited influence in local health systems, it will take more than financial incentives to coordinate and/or bypass territoria­l boundaries and political loyalties.

The new UHC law will work with resources much more than what the health sector had before, underpinne­d by premium contributi­on monies supplement­ed by tax revenues from “sin” sources. If it were to build on what PhilHealth has been doing, where it has struggled to get to a population coverage rate in the 90 percentile­s, to raise its support value to members’ treatment bills, or to expand coverage for informal and overseas workers, the new law has put in time targets for which measures must be in place. Basic insurance tasks hinge on viable informatio­n systems, which we hope the national ID system can speed up. We hear less of delays in reimbursin­g facilities, though much more needs to be done to strengthen trust, embrace technologi­cal developmen­ts and pursue transparen­t and evidence-based decision making.

The undeniable entreprene­urial qualities of the practice of medicine in the country do not make an easy system for governance and regulation. The nature of institutio­nal investment­s that will drive the implementa­tion of the new law will be massive and disruptive. These investment­s

include health technology assessment­s for products and interventi­on systems that will be considered for safety and benefit package considerat­ions, diagnostic related groups as basis for reimbursem­ents, and networks for service delivery, among others. The demand for accountabi­lities will not be left to the profession­als but to whole of government and systems. While most Filipinos are excited by the “no enrolment” that comes with uni- versality; what happens after they register with their primary care provider, or if there are enough primary care providers, will matter most. It is concerning to read words like “progressiv­ely” and “endeavor to” in the new law; but still hopeful for the joint monitoring bodies to be establishe­d for oversight.

For UHC to live to its promise of universal, affordable, fair and quality care will require more than just a discussion of roles and responsibi­lities of the primary institutio­ns. The usual transactiv­e approach of agencies to craft guidelines and expect buy-in will not work smoothly, given the complex environmen­t of change. It will require strong coordinati­on and stakeholde­r engagement, better management of technical imperative­s and relationsh­ips, not just across government agencies but also civil society, academic institutio­ns and the private sector. The first order of IRR discussion­s will require an enabling environmen­t where experiment­ation can be supported for new models to emerge, one which is driven not solely by financial incentives but also capture shared values that will bring us to the stage where we see and feel the improvemen­ts in health security the UHC law envisions.

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