Of booster shots and astringents

Several years ago, we wrote in this column that our public health system was in a serious state of disrepair. We likened it to a patient fighting for his life in the intensive care unit (ICU). And at that time, it seemed like there was nothing much to hope for.

That was the height of the exodus of doctors and healthcare professionals in search of greener pastures abroad. Doctors here were taking up nursing and migrating abroad to work as nurses. Many hospitals particularly in the provinces were both ill-equipped and undermanned, if not totally unmanned.

PhilHealth didn’t play that much of a significant role in bridging the healthcare gap between the haves and have nots.  The privilege one could get from PhilHealth could only cover less than a fifth of one’s hospital bills even with the doctors’ fees waived.

So the average worker avoided being hospitalized even if there were strong indications to be confined because they still could not afford the remainder of the bill outside of what PhilHealth shouldered. Ironically, even those who could afford didn’t bother to use it because of the hassles members experienced when availing of the privileges.

When P-Noy declared in his inaugural speech a little more than two years ago that universal healthcare was one of the cornerstones of his administration’s agenda, the optimism that it would be realized was far from enthusiastic. This was quite ironic in a democratic society wherein the right to good health is a fundamental right mandated in the constitution.

It was logical that to achieve universal healthcare, PhilHealth, the country’s  insurance system, was supposed to be major vehicle, but not a few doubted that it could really achieve a 100-percent coverage—not simply targeting that every Filipino would carry a PhilHealth card—but that it could really provide a meaningful health insurance coverage, especially for the marginalized sectors of our society.

Challenges

In a matter of two years, I must say that PhilHealth has changed the dim outlook our healthcare status had previously. There are still challenges like delayed processing of claims and inadequate coverage, but overall, PhilHealth has improved its services and meaningfulness to the average Filipino. So, we encourage all PhilHealth members to be aware of the additional and new benefits they’re entitled to, and claim them when they get hospitalized.

One particularly useful benefit members can now avail of is the case-rate payment scheme, which packages benefits for common illnesses like a “pakyaw” system such that all services are already included in the package. Benefits enjoyed by members are much bigger for some medical and surgical problems included in the new payment scheme. And because there’s no need to make itemized computations, it has significantly reduced the processing time of claims from two to three months to only around two weeks. So even the hospitals and healthcare providers are happy. The payments may be a little less than the previous fee-for-service scheme, but at least, they get the payments more quickly.

We’re still a distance from achieving universal healthcare or what Health Secretary Ike Ona prefers to call as kalusugang pangkalahatan, but we see a good direction toward expanding PhilHealth membership and coverage to all Filipinos belonging to the lowest quartile of society. The National Household Targeting System for Poverty Reduction (NHTS-PR) of the Department of Social Welfare and Development (DSWD) is identifying nationwide the poorest of the poor who will be provided with free health insurance coverage.

The “no balance billing policy” or NBB ensures that those who can’t afford the out-of-pocket expenditures when hospitalized can still be provided with quality healthcare without bias. Getting hospitalized specially for emergency medical problems can be financially draining; and the case-rate scheme and NBB offer some sort of a financial risk protection.

60% of medical bill

For a healthcare insurance to be meaningful, it must cover at least 60 percent of the medical bill, so the out-of-pocket expense from the individual families will be much less than what they have to shell out now. We hope the PhilHealth can provide at least this much financial coverage for all members.

By my estimate, for cases not included in the case-rate scheme, PhilHealth covers for 30 to 40 percent of the hospital bill, excluding the professional fees. This is a big improvement from the coverage a few years ago, but still not good enough for those who have no choice but to relegate health to the background when it’s placed side by side with other basic needs like food and shelter.

There’s still much to be desired with our health insurance coverage. Obviously, to achieve its idealistic goals, PhilHealth needs more funds. The government also needs more funds so it can repair dilapidated government hospitals and equip them decently so they could provide life-saving services to patients brought to them. It needs more funds so government doctors and nurses don’t have to quit their jobs and leave hospitals and other healthcare facilities unmanned in search of a better pay.

Hopefully, when the sin tax bill finally gets enacted to become a law, the additional revenues the government can get from it will be able to give PhilHealth and the government the booster shot in the arm it badly needs. Deriving funds from vices such as smoking and excessive alcohol intake may somehow leave a bad taste in the mouth, but until such time the government could comfortably afford to allocate at least 5 percent of its GNP for healthcare, achieving universal healthcare can be an effective astringent to take away the bad taste.