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1 UNIVERSITY OF THE PHILIPPINES MANILA Taft Avenue, Manila / School of Health Sciences in Leyte, Aurora, So. Cotabato This article first appeared on MALAYA Business Insight (19 Sept. 2013) http://www.malaya.com.ph/business-news/opinion/universal-health-care-pipedream Universal Health Care: A Pipedream? By Alberto Romualdez, M.D. Wednesday, 18 September 2013 ‘Today, halfway through Aquino’s term, health reform advocates are just beginning to realize that attaining universal health care is a long and arduous process.’ “UNIVERSAL HEALTH CARE is the provision to every Filipino of the highest quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public.” This definition of universal health care was cobbled together by a diverse group of public health experts, economists, clinical specialists, health reform advocates, and health professionals during a workshop in early 2008. The workshop had been organized to review a paper on “The State of the Nation’s Health” to be presented at a panel discussion later in the year as part of the University of the Philippines’ Centennial Celebration. The paper had concluded that the Philippines’ most important health problem was health inequity or the great disparities in access to health care, resulting in significant differences in health status, between the rich minority and the poor majority of Filipinos. The workshop suggested that the definitive solution to this problem was “Universal Health Care”. Many participants had reservations about this suggestion and some even labeled it as a “pipedream”. 2 At that time, the National Health Accounts had reported that, for the year 2006, the country’s total health expenditure (THE) – the amount of money spent by all Filipinos on health goods and services – was around 200 billion pesos, an amount that initially appears to be staggering given the country’s status as a lower middle income nation. Nevertheless, some economists noted that this constituted only 13 percent of the national budget of 1.5 trillion pesos that had been proposed for the year 2009. Considering that the National Health Accounts had included payments for many useless and ineffective items (such as some cosmetics and beauty aids), members of the group concluded that it was not that unrealistic to hope that the entire health expenditure could be covered by an expanded government health budget. In other words, it is possible to envision a Philippine health system in which all health services (included under universal health care as defined) would be provided to all citizens free of charge at the point of service – i.e., individuals’ and families’ payments are prepaid either through taxes or national health insurance premiums For this purpose, a number of workshop participants organized an advocacy network that came to be known as the Universal Health Care (UHC) Study Group. This amorphous group would morph into a “think-tank” like operation that developed position papers on health for all the candidates of the 2010 presidential elections. Benigno S. Aquino III was among the candidates who listened to the group’s presentation. When he won the election, his new administration adopted universal health care as the main theme for the health sector during his six-year term. Eventually, the Department of Health translated the term into KP or Kalusugan Pangkalahatan – a slogan now used as the label for the entire health program of government both at national and local levels. Unfortunately, today, halfway through the P-Noy term, health reform advocates are just beginning to realize that attaining universal health care is a long and arduous process. Although theoretical political consensus on general objectives and thrusts appears within grasp, there are numerous obstacles to the detailed implementation of programs leading to true health equity. 3 2012 was a bumper year for universal health care legislation. Three major laws aiming to facilitate necessary health reforms were passed. The Reproductive Health and Responsible Parenthood Law was enacted to address the terrible inequities in achieving family health goals faced by the majority of poor Filipino women and children. Unfortunately, religious opposition remains formidable and implementation of the Law is tied up in a Supreme Court suit. A long overdue revision of the way the taxes for tobacco and alcohol consumption are collected was finally approved. Reports from the tax collection agencies show a marked improvement in revenues that will be allocated for the health sector in pursuit of universal health care. The health system however shows evidence of some deficiencies in the absorption and proper disbursements of these additional resources. The situation is likely to be worsened by the recently released “rationalization plan” for the Department of Health. The plan reveals a poor understanding of health needs by the finance and budget agencies of the national government by drastically reducing front-line capabilities across the board – not only for DOH but also for local governments. Finally, to bolster the administration’s thrust of providing better financial risk protection for poor and near poor Filipinos, Congress enacted a revision of the Philippine National Health Insurance Law. Together with Philhealth’s strong efforts to improve the enrollment of beneficiaries, implementation of the law will improve coverage of large segments of the population. However, despite nearly full coverage (70-85%) of the population, the fact is that Philhealth benefits account for only 10-12 % of total payments for health goods and services. Coupled with out of pocket payments of over 50% of total health expenditures, this indicates that quality health services available free of charge at point of service for all Filipinos remains a distant and elusive goal into the third year of Kalusugan Pangkalahatan. (Dr. Romualdez' email address is [email protected]) .

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