Universal Health Care law will not solve chronic health care problems in the Philippines
The government must go beyond health insurance program and strive to achieve the people’s aspiration for a free, comprehensive and progressive health care system.
The Philippine health department has recently declared a national dengue alert amid the surge in reported cases of the mosquito-borne illness in various regions in the country. From Jan. 1 to June 29 this year, 106,630 dengue cases have been officially reported nationwide—an 85-percent increase from the 57,564 cases reported over the same period in 2018.i
This came as the country is still grappling with a nationwide measles outbreak, which was described as one of the worst measles outbreak in the world. Between January 1 and May 11, 34,950 measles cases including 477 deaths were officially reported.ii
Despite the urgency of the situation, President Rodrigo Duterte in his State of the Nation Address (SONA) last July 22 never mentioned anything about the government’s plan to address the worsening health situation in the country. Curiously, there was no mention of the Universal Health Care (UHC) law that he signed last February, which he said will surely make a positive impact in the lives of our people. iii
WHO-backed health care law
The World Health Organization (WHO) even ecstatically described the President’s signing of the law as a new dawn for Philippine health care:
It is a time for celebration in the Philippines. President Rodrigo Duterte has just signed a Universal Health Care (UHC) Bill into law (Republic Act No. 11223) that automatically enrolls all Filipino citizens in the National Health Insurance Program and prescribes complementary reforms in the health system.iv
WHO even took pride in the crucial role it played throughout the process of developing and refining the bill, and during legislative deliberations.
WHO's global drive for UHC came at an opportune time to advocate and inform the consultation and drafting process of the Bill in the Senate during the second half of 2017. By that time the Bill had already passed the House of Representatives. To get it passed through the upper house, the Bill needed technical refinement to ensure that it was comprehensive, practical and feasible, and would eventually achieve universal health coverage.v
UHC vs right to health
Advocates of the right to health, however, have maintained their stand against the law asserting that contrary to its name, there is nothing universal about it. They argue that UHC will mean more commercialized and privatized health care under the neoliberal framework of development.
“In the era of neoliberal globalization, the UHC is another deceptive program to commercialize and privatize health care. UHC is masquerading as "social health insurance" but in reality, it is a health market innovation ... UHC is nothing more than additional raking of profits for big businesses and government bureaucrats, this time using pooled membership contributions of workers and government subsidy for the poor," said the People’s Health Movement (PHM)–Philippines in its statement.
Main feature of UHC
On its website, the DOH enumerates what can be expected from the passage of the UHC law:
Among the significant reforms that will be implemented over time because of the UHC Act are the automatic enrollment of all Filipinos to PhilHealth, designating PhilHealth as the national purchaser for health goods and services, improvement of health facilities, especially in underserved areas, responding to the gap in health workers, strategic engagement of the private sector, and creating and expanding new functions in the Department of Health (DOH) to improve delivery of health services.
It adds ... the law ensures that every Filipino, including overseas Filipino workers, are eligible for preventive, promotive, curative, rehabilitative, and palliative care upon automatic enrollment to the government’s health insurance program.vi
Philippine Health Insurance Corporation or Philhealth is a government-owned corporation created to ensure sustainable national health insurance for all Filipinos.
It cannot be overemphasized here how health reforms being promised by the UHC are entirely dependent on an insurance scheme, which is Philhealth, having been designated as the national purchaser for health goods and services.
Under UHC, the government is seen as the major purchaser of health services and not their provider, which is contrary to its role as a duty-bearer.
Various social movements have long raised caution about the potential consequences of establishing UHC as government’s primary solution to problems besetting the health care system. Viva Salud, in its journal states:
Mainstream research on UHC focuses on health financing by the State but generally limits its role to that of ‘purchaser’ of health services, pushing aside its previously key provider role...at the same time, civil society organizations have warned that the UHC prescription has come to be dominated by the use of insurance schemes that weakens public health systems, by leaving the door open for the privatization health care delivery.vii
Around the globe, neoliberal reforms have led to dramatic changes in health care systems as governments are forced to abandon its duty of fulfilling the people’s right to health all in the name of the free market. Private sector, like insurance, has been given priority while public health care continues to be set aside, and national health budget slashed.
“UHC is being implemented in countries where the state itself is committed to neoliberal policies and renege on its responsibility to provide health care to its people, and the Philippines is no exception. said PHM-Philippines.
Quoting from T. Mladenov, authors Dikaos Sakellariou and Elena Rotarou stated that, “one important element of neoliberalism is the retrenchment of the welfare dimension of the state, which is seen as an impediment to the optimal functioning of the markets”. This retrenchment can be translated into fewer, more expensive, less controlled, and of lower quality healthcare services. Furthermore, this process of reducing the welfare state moves responsibility for taking care of people from the state to the free market, leading to wide disparities in the level and quality of care people receive.viii
UHC not a solution
In a pre-SONA forum, the Council for Health and Development, together with other right to health groups, asserted that UHC is not the solution for the lingering health problems in the Philippines, especially the lack of public health services.
“The UHC Law has promised insurance coverage for all Filipinos but it does not guarantee access to health care. Under the UHC Law, billions of health funds are given to Philhealth while the budget for public hospitals and direct health services is decreased. This will result in more expensive hospitalization fees, consequently, making access to quality health care more difficult for sick Filipinos,
In 2018, the budget for Maintenance and Other Operating Expenses (MOOE), the budget for medicines, medical supplies and other operational expenses of 66 DOH hospitals was cut by P1.5 billion. This led to a 200% to 300% increase in laboratory fees that poor patients had to pay for in some government hospitals. This 2019, the MOOE budget allotment of these hospitals was further reduced by P353 million,” the health groups said in a statement.
Philhealth has recently come under fire due to corruption scandals. A newspaper investigative report exposed irregularities in Philhealth including, among others, payment for ghost dialysis treatments and overpayments to private medical institutions.ix
Right to health advocates assert that for health care to be truly universal, the government must go beyond health insurance program and strive to achieve the people’s aspiration for a free, comprehensive and progressive health care system. Government funds which came from people’s money should be allocated directly to strengthen the public health care system.
vii Universal Access to Health Care (pdf), Third World Health Aid
viii The effects of neoliberal policies on access to healthcare for people with disabilities, Dikaios Sakellariou, Elena S. Rotarou, Int J Equity Health. 2017; 16: 199. Published online 2017 Nov 15. doi: 10.1186/s12939-017-0699-3