Healthcare for all in the Philippines – but is there a catch?

Photo: Rody Duterte/Facebook

President Duterte has signed into law the Universal Healthcare Bill. It should benefit Filipino citizens, but will it provide sufficient care and are there any drawbacks?

By John Pennington

Filipino President Rodrigo Duterte has signed the Universal Healthcare Bill (UHB) into law. He keeps an election promise. All Filipinos have access to the medical care they need. In theory, everyone benefits.

“As long as you are a Filipino, you are covered…under the Universal Health Care law, every Filipino is covered by PhilHealth. That is what is historic in this law,” proclaimed Deputy House Majority Leader Ron Salo.

The bill expands PhilHealth to ensure all Filipinos have access to healthcare

The new law guarantees that all Filipinos have access to affordable healthcare. The challenge in recent years has been getting informal workers enrolled in PhilHealth. The UHB is, therefore, a significant expansion of PhilHealth. Anybody who was not previously enrolled can now benefit.

Restructuring the structure of the program will allow everyone in the nation to come under the PhilHealth coverage. There are just two categories, one for those that are able to pay premiums (those with employment) and one for those unable to pay premiums, including the unemployed and the elderly. In these cases, the government will sponsor their coverage. People in both groups receive the same basic benefits. Those paying higher premiums will be eligible for more benefits.

The UHB aims to addresses problems in the healthcare industry

PhilHealth, and before that, Medicare, established basic healthcare for most Filipinos. However, the majority were still meeting the costs of treatment and medicine themselves.

In the Philippines, the doctor to patient ratio is 1:33,000, which is significantly higher than the global average of 1:6,600. There is just one hospital bed for every 1,121 Filipinos, although this figure varies from 591 in Manila to 4,200 in Mindanao. The Philippines’ healthcare system also suffers because vast numbers of medical staff leave the country to work elsewhere.

In an attempt to address these problems, the UHB will also award grants to medical students and mandate that newly-qualified medics serve for three years in either a remote area or the public sector.

Photo Credit: 12019/Pixabay

The timing is good for Duterte

There is still plenty of work to do to reform the Philippines’ healthcare system. However, introducing the UHB ensures the country meets the World Health Organisation’s definition of providing universal healthcare. It follows Singapore and Thailand as the third ASEAN nation to do so.

The Department of Health (DOH) describes the new law as a “new chapter in reform.” While reform is long overdue, there is significant political capital to be gained. With mid-term elections coming up in May, now is the ideal time for politicians to remind voters of their ability to keep campaign trail promises.

Healthcare reform, particularly if it makes care accessible and affordable, is a vote winner. As Duterte battles declining ratings, he has an eye on ensuring as many of his allies as possible are elected to the Senate. He is hoping that the electorate rewards those that supported the bill.

Opponents to the law have raised objections

As the bill progressed, a growing number of dissenting voices emerged in opposition. Some politicians, among them Arlene Brosas and Emmi de Jesus, opposed the bill, arguing that the UHB will lead to the privatisation and commercialisation of healthcare.

They claim that hospitals will lose funding and private facilities will dominate because, under the terms of the law, PhilHealth will take responsibility for offering extra health coverage through private organisations and private health insurance.

P257 billion (US$4.93 billion) has been set aside for the UHB, but it will not receive all of that amount in its first year. There could be a shortfall of around P2 billion (US$38.5 million) because there is not enough money available from the funding sources. Those sources include sin tax revenues, money from the Philippine Charity Sweepstakes Office, the Philippine Amusement and Gaming Corporation, contributions from members and government subsidies.

Initially, a higher shortfall was anticipated, with the knock-on effect that some hospitals and facilities would not have been built. That should no longer be the case. “There will be no health services and no programs that will be sacrificed with the Universal Health Care Act,” forecast DOH Undersecretary Mario Villaverde.

Will it be enough? Broken down, the UHB works out at around P2,500 (US$47.95) per person per year. That sum will not go very far. There will be limits to what the UHB can achieve without more funding. Spreading the funding too thinly means patient care is compromised.

The UHB could still help ease the strain on the healthcare system

Nevertheless, the new law provides a structure for how healthcare is provided and defines eligibility criteria as part of the Philippines’ overall healthcare strategy. Healthcare in the Philippines remains predominantly prescriptive rather than preventative. There are signs this could be changing. The government implemented the sugar tax in a bid to curb diabetes levels and discourage unhealthy lifestyles.

In theory, universal health care encourages preventative medicine. Patients will seek medical help earlier if they do not have to bear the costs. That reduces the strain on emergency rooms and is more cost-effective for hospitals.

Among the challenges the Philippines healthcare system now faces are the country’s high proportion of smokers and growing obesity levels. On its own, the UHB will not meet those challenges. However, by enabling access for all, in conjunction with other policies and programmes, it can help.

The Philippines has committed to universal healthcare, but at what cost?

The population of the Philippines is forecast to grow from 105 million in 2018 to 142 million by 2045. This will place pressure on infrastructure throughout the country and healthcare in particular. Hospitals and the availability of beds are not growing quickly enough to keep pace with the rising population.

Continuing to expand the healthcare system to keep up with demand will place additional stress on state and national budgets. At the same time, cutting healthcare funding would prove unpopular and politically dangerous.

However, as the budget deficit slips dangerously close to the 3% limit set by Duterte’s government, funding universal healthcare could force the government to make cutbacks elsewhere. With the nation’s health at stake, it might just be a price worth paying.