Awaiting health care for all

The Philippines is a step closer to enacting a Universal Health Care (UHC) law that will guarantee all Filipinos equitable access to quality and affordable health goods and services. This, after the Senate recently passed its own version of the bill, following similar action by the House of Representatives. The two versions now await reconciliation by a bicameral committee before President Duterte can sign it into law.

Both measures have the same core feature: Regardless of one’s health condition or economic status, all Filipinos—now estimated to number 103 million—will be placed under the National Health Insurance Program, allowing them to avail themselves of basic health services or medical procedures.

The Senate’s version states that the bill seeks to establish a “health care model that provides every Filipino access to a comprehensive set of cost-effective and quality promotive, preventive, curative, rehabilitative and palliative health services without causing financial hardships, and prioritizing the needs of the population who cannot afford such services.”

While PhilHealth claims to have achieved 93-percent coverage of the total population, that means 7 percent, or about 7 million, are still not covered by health insurance, a number equivalent to the entire population of Hong Kong. Worth noting, too, is that a third, or 33 percent, of the 96 million PhilHealth beneficiaries in 2017 (51 percent are members and 49 percent are dependents) were classified as indigents.

Through the UHC measure, PhilHealth’s coverage will be expanded to include free consultation fees, laboratory tests and diagnostic services. In other words, services such as regular checkups, X-rays and cancer risk screenings will be provided free, at no cost to citizens.

By making health care within reach of every Filipino, proponents hope it will change the mindset among many of consulting a doctor only when their condition has become serious or life-threatening. That is obviously because many can’t afford even the most basic health care. “Bawal magkasakit,” as the popular tagline of a multivitamin commercial said, reflecting the difficulty among the poor to prioritize health care over their daily survival, much less to access a professional health practitioner in their lifetime.

A UHC law will undoubtedly bring relief and succor to the most marginalized Filipinos. However, it also comes with a steep price tag, prompting some quarters to question whether the government has the capability to sustain such an expensive and ambitious undertaking.

The Private Hospitals Association of the Philippines Inc., for one, has raised concerns that this might only worsen PhilHealth’s mounting debts to private hospitals, and could even result in the closure of some of these facilities. For the first year of its implementation alone, UHC is estimated to cost between P60 billion and P80 billion, on top of the annual budget of the Department of Health (DOH). There are allegations of corruption within the health system that the law also needs to address.

Appropriations for the program are to be taken from the collection of sin taxes and the national government’s share in the income of the Philippine Amusement and Gaming Corp. and the Philippine Charity Sweepstakes Office, as well as from premium-contributions. By next year, the minimum contribution of PhilHealth members is also projected to increase to P300 a month from the current P200.

This week, the DOH asked the President to certify as urgent Senate Bill No. 1605, which seeks to raise tobacco taxes up to P90 from P32.50 per pack, in order to fund the UHC law. The upgraded sin tax, if approved, will generate about P45 billion annually in revenues.

Despite the financial challenges ahead, the UHC bill deserves to be enacted into law with the same speed accorded other less important measures. Section 15, Article II of the 1987 Constitution guarantees UHC as a fundamental human right: “The State shall protect and promote the right to health of the people and instill health consciousness among them.” The United Nations also advocates universal health care for all its members by 2030. At present, only 58 out of 195 countries have UHC (even the United States lacks one).

Universal health care maywell end up the defining landmark legislation of Mr. Duterte’s administration, one that brings the full weight of state commitment and resources to the fundamental task of caring for the wellbeing of all Filipinos without exception. The country eagerly awaits his signature on the bicameral committee’s final bill.