Universal health care

Another important new law recently signed by President Duterte is the Universal Health Care (UHC) Act. The law’s intention is to guarantee equitable access to quality and affordable healthcare services for all Filipinos.

The World Health Organization points out that “universal health coverage is fundamental to ensuring social protection for health. The poorest populations often face the highest health risks and need more health services. A key element of financing for universal health coverage is sharing resources to spread the financial risks of illhealth across the population.”

On top of my mind is the health care system in Canada. A friend of mine had a heart attack in a park in Vancouver and within minutes there was an ambulance on the scene. He was given emergency care and eventually a heart bypass. When all was over, he told me his total bill was all of $8.

I have heard that the Scandinavian countries have a similar universal health care system. The United Kingdom has the National Health Service that works well, but I am told there are long waits for non-emergency cases.

There had been attempts to introduce some kind of universal health care in the United States, but it had been politically contentious. Many Americans suffer inadequate health care or have to pay quite a bit to get the health care they need.

Universal health care had been a long- sought dream for us in the Philippines. When I was covering the Senate many years back, I remember how then Sen. Freddie Webb sponsored the bill that created the PhilHealth.

I am trying very hard to see how our new UHC law improves on PhilHealth. The laudable intentions are the same. But even if the new law listed down potential sources of funding, the real test is actually being able to get all the needed money to carry out the intentions of the new law.

The new law is said to create a national health insurance program and expand PhilHealth coverage to include free medical consultations and laboratory tests. It also designates PhilHealth as the national purchaser for health goods and services for individuals, such as medicines. This is where the fun begins.

The thing is, our health care system is essentially urban oriented, mainly hospital based and private sector driven with a pay-as-you go business model. The government is supposed to cover the very big gaps in the system --- the larger portion of the population who cannot afford the cost of getting treatment.

But even in government facilities like PGH, the Heart Center and public hospitals across the country, the cost of treatment goes beyond the capacity of government to provide. The patient’s family must spend for some medicines and if some complicated procedures like a heart bypass is required, not every needy patient can get it.

There is the PCSO giving financial assistance often at the behest of some politician. Senators and congressmen earmark portions of their pork barrel funds to hospitals like PGH so patients with their endorsement can get treatment.

The UHC law is supposed to make the poor less dependent on political patronage. I am curious to see how this works in actual operation.

The new law is supposed to cover cost of consultations and makes PhilHealth the national purchaser of health goods and services. That should enable it to establish standards in service delivery and professional fees to be charged for particular services or procedures.

If the new system becomes a national purchaser of drugs, it can drive down the cost of medicines through bulk purchases.

One national purchaser is good for the consumer of medical services. But it goes against the current business model to which the health industry is used to.

Even now, doctors are not too happy with the private HMO system and many do not accept patients who want to pay through an HMO. Many doctors and hospitals also complain about how long it takes for PhilHealth to settle claims.

I am rooting for this new law to succeed. We have long suffered a basic conflict of interest situation wherein doctors who own hospitals can potentially make more money by prolonging patient confinement, ordering expensive tests, and doing complicated procedures without the benefit of second opinions.

In the US, HMOs and medical insurance providers provide a check on prescribed procedures and disallow those that expert second opinion deems unnecessary. Doctors hate this oversight which they consider an affront on their professional competence.

I cannot see how this new UHC law can make things different for us any time soon. Attitudes of stakeholders in the health care industry must change. And the key result area we should look at is how well the government can fund this very ambitious program.

According to PhilHealth, they need some P22 billion to implement the UHC law in its initial year. The General Appropriations Act will provide about P18 billion and P217 billion from premium collections.

Yes, there will be mandatory payroll deductions for UHC. Management and labor may not like this, specially with higher SSS contributions also approved. Many will prefer the HMO coverage they already have, but the law is apparently putting this new payroll deduction on top of that.

The new law is also looking at funds from the Philippine Amusement and Gaming Corp. (PAGCOR) and Philippine Charity Sweepstakes Office (PCSO).

They are talking of raising tobacco and alcohol taxes and use the generated funds for UHC. But they can only raise sin taxes so much without causing large scale smuggling and product avoidance that will reduce even current collections.

The positive thing is that we have taken the first step towards universal health care. It will be difficult to implement. But in the end, realizing this dream means no Filipino should suffer or die because he is too poor to afford medical attention.

Boo Chanco’s e-mail address is bchanco@gmail.com. Follow him on Twitter@boochanco