Quo vadis, health?

(First of two parts)

Last week, the Pharmaceutical and Healthcare Association of the Philippines (PHAP)—composed of the country’s leading multinational drug and medical device companies—organized a whole-day health forum at the Asian Institute of Management.

Health Secretary Janette Garin and three of her predecessors—Doctors Esperanza Cabral, Enrique Ona and Manuel Dayrit—were among the resource persons. The forum would make a rich source of insights and inputs as President-elect Rodrigo Duterte, and whoever his chosen health secretary would be, frame his administration’s  health agenda for the next six years.

Although much gains have been achieved already in the last six years toward universal healthcare or Kalusugang Pangkalahatan, health inequity is still a pervasive problem that the next administration has to address.

Aquino health agenda

In the last six years, the Aquino Health Agenda (AHA) aimed to address the inequitable access to healthcare, wherein a good percentage of the population, particularly those residing in remote areas of the country, have nowhere to go for their health-care needs. The AHA’s objectives were indeed laudable—it sought to ensure that Filipinos, particularly the poor, are: 1) able to use quality health services at affordable cost; 2) cared for in modern health-care facilities, and 3) prevented from falling ill through promotive and preventive healthcare.

How did the AHA fare as President Aquino finishes his term? “After five years, the Aquino administration has a mixed bag of results to show for its efforts,” says Dr. Cabral.

On the plus side, PhilHealth coverage has reached 92 percent enrolment of the total population; and the support value of the insurance on the actual medical expense has improved to 56 percent. From one perspective, I believe these are indeed noteworthy accomplishments. However, Dr. Cabral suggests that health officials also look at it from a cost-effectiveness perspective. As they say, if we have limited resources, we must try to achieve the biggest bang for every peso spent.

Premiums of the poor

She explains: “The government allots billions of pesos (P36.7 billion in 2015) to pay the premiums of the poor but their utilization rate, though rising, is nowhere what it should be to make the expenditure worth it.”

She adds that at the moment, the well-to-do are the greatest users of the national health insurance program and the greatest claimants are the modern and expensive hospitals that they patronize. “In effect, the government is paying for the healthcare of the rich by subsidizing the health insurance premiums of the poor.”

PhilHealth coverage and improvement of health facilities must run in parallel; and Secretary Garin explained in her talk that the Department of Health’s Health Facilities Enhancement Program (HFEP) is making sure that all government health facilities are operational, and adequately equipped with the necessary manpower, instruments and supplies.

Gov’t health facilities

Despite the HFEP’s efforts, Dr. Cabral laments that most of our government health facilities are still in a state of disrepair, scantily supplied and poorly manned. In fairness though, it’s not really the fault of the current administration. This was brought about by years, probably decades of neglect of the government’s health infrastructures.

It really requires a strong political will and conviction to expand, and upgrade public health facilities to levels appropriate for the provision of necessary quality health services nationwide. The enhancement must not only be a one-time effort. Once enhanced, there must be an equally sustained effort that the quality of services offered by the health facility is maintained.

This requires that thorough planning, allocation, construction, outfitting and plugging the loopholes of various operational and other issues must be done so whatever money is allocated for this purpose is really well worth it.

“Over the past 10 or so years, more than P75 billion have been allocated to health facilities enhancement—for building, upgrading, equipping and supplying barangay health stations, rural health units, birthing clinics, district hospitals, provincial hospitals, regional medical centers, special hospitals, etc. This year, another P26 billion has been budgeted for the program. Many issues associated with these will need to be resolved before more good money is thrown after bad,” stresses Dr. Cabral.

Although primary- and secondary-level health facilities are important for the poor, they also need high-level health-care facilities should they develop more complicated medical conditions. Currently, these so-called specialty hospitals are concentrated in Metro Manila. With a new president from Mindanao, I’m sure he would not want our countrymen from far-flung areas to go all the way to Manila to avail of the services of these specialty medical centers.

With the excess funds we’re getting from the “sin taxes,” we should be able to afford to construct, equip and provide skilled manpower for heart, lung, kidney and other specialty centers in strategic areas in the Visayas and Mindanao.

Dr. Cabral laments though that currently, the prime beneficiaries of the specialty hospitals, which are clustered in Quezon City, are the affluent and the politically well-connected.

“At present, the specialized hospitals serve way more private than public patients,” she says. “We need to link public funding (whether from the budget or from public insurance) to quality services for the poor in these institutions.”

The medical director of one of these specialty medical centers told me once that much as they would love to cater mostly to the poor, they could not do so because of the scarce budget and resources allocated by the government. They have to fend for themselves to sustain their operations, and they derive the additional funds they need for their operations from the private or paying patients.

This is not an acceptable option, says Dr. Cabral. “A better option is (for the government) to fully fund these specialty hospitals to serve poor patients exclusively or almost exclusively.”