Back again
I’ve been in sick bay in the past couple of weeks, so that may be why there was a bit of a focus on social issues. Memories of 20 years of epilepsy triggered the conversation on marijuana. I’d like to take the subject of health a bit wider this week. We have a resurrected health secretary in Francisco Duque. He’d been there before, during Gloria Arroyo’s presidency, and done a good job, so he’s not a neophyte.
This time he has something different: lots of money due to the sin tax. (Given the huge success of that tax, one has to wonder why it was so difficult to get through Congress, and why getting the very sensible tax reform package through is now encountering obstacles.)
In 2016 the Department of Health was granted P123 billion, expanded by P69 billion from sin tax revenues. The additional funds from people sinning were used to augment the budgets of PhilHealth, the Millennium Development Goals program, the deployment of human resources for health, and the Health Facilities Enhancement Program, among other health initiatives. However, the DOH’s 2016 annual report noted that the budget wasn’t all spent; only 87 percent of the allocation was fully utilized. While the budget for the salaries of DOH employees was almost fully spent (98 percent), the utilization of the budget for capital outlay, which covers equipment and infrastructure, was wanting at only 74 percent. And spending for capital outlay is crucial in improving health facilities nationwide.
Duque has a unique opportunity to make 2018 a revolutionary health year. I don’t think anyone would dispute that rural hospitals are in appalling shape and generally inadequately staffed. I had a reasonably serious accident two years ago, and all the emergency room of the provincial hospital had was a blood pressure unit and a bottle of oxygen. The few staff members there might not have had the credentials and expertise of Manila’s hospitals, but they were excellent, caring, reassuring (you get pretty shook up after an accident), and competent at what they had to do. They were a dedicated team, but too few.
It’s replicated nationwide. So, rebuilding, reequipping, and adding more staff can take a substantial chunk of the budget. Some privatization, if only of operations and maintenance, might be considered.
But all the money shouldn’t be spent on hospitals. There are three other areas I’d concentrate on. PhilHealth has done quite well handling what I’d call the mid-tier illnesses, covering hospital costs, laboratory tests, and other diagnostic procedures. But there’s a limit on assistance. The seriously ill and long-term patients find there’s a cap depending on illness: P210,000 for acute lymphocytic leukemia for children; P100,000 for early-stage breast cancer; and P600,000 for end-stage renal disease eligible for kidney transplant, for instance. The allocation is insufficient. Families end up mortgaging, even selling, the family house. There should be no limit, or a very high one. Adequate health insurance is needed to prevent middle-class families from becoming impoverished.
The second area is at the other end. Far too many patients go to outpatient clinics IN hospitals, diverting doctor and nurse time away from the seriously ill. We need hundreds of clinics, including family planning clinics.
I’m delighted to see the sprouting of private-sector clinics in malls. I hope the mall owners are giving them a good deal in their endeavor to keep us healthy. But now we need government-run ones where services are free for those who can’t afford.
The third area is medicines, which I covered in my column of July 6. If the government buys in huge volumes, it can get large discounts. The companies can supply and still make a profit. If they are forced (if the bill of Rep. Ferjenel Biron is approved) to reduce their price on consumer levels of purchase, they’ll lose money. Companies can’t operate at a loss, so they’ll have to withdraw the products from the market. If they’re forced to supply, they’ll leave the market entirely. So, if the government buys, it can then supply free to indigents and those who can’t afford.
These three things done would revolutionize the health system.
A fully functional DOH is now a real possibility. It’s in Duque’s hands.
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