Universal health care: from bill to reality

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My social media feeds lit up a few days ago when the Philippine House of Representatives passed House Bill 5784, or the Enhanced Universal Health Care Act. Before discussing its salient features, I would like to briefly explain key elements of what it means to finance health care on a national scale, which I share from my limited experience as a health policy researcher. Since health financing is quite a busy topic, I will just try to enumerate examples of how it is run in particular countries, and compare with how it is currently in the country and how the bill proposes to change things.

Universal health care is a concept that aims to pay for health services to avoid impoverishment due to unmitigated cost, or what is known as catastrophic health spending. Through the years, health care has become expensive, because of its services, its medicines, and its human resources. This represents a concern for Filipinos who are more prone to getting sick because of factors related to their socio-economic status and way of life, or the “social determinants of health.” Furthermore, there is a significant segment of the Philippine population that can be pushed towards bankruptcy due to a significant health cost.

Countries around the world have adopted various approaches to financing health. The United Kingdom has adopted a system financed by taxes of citizens and visa fees of visitors, and runs the health care services itself, thus prices are somewhat under the control of government. Singapore makes use of medical savings accounts, which set aside a percentage of one’s earnings towards accumulating a certain amount to be used for particular health needs. Additionally, Germany‘s approach is putting up a health insurance system, financed by tax surpluses and by two kinds of insurance premiums: one from what is known as statutory health insurance, which is compulsory for all citizens and migrants, and private health insurance, which can be accessed optionally if one wants a quality upgrade in an already desirable health services system.

Meanwhile, the United States has relied on health maintenance organizations, mostly privately-run and are thus beholden to profit-oriented interest, to finance the health needs of its citizens. The 2010 Affordable Care Act (ACA) has attempted to strengthen government control over health insurance by covering persons who are not employed or who are in the informal sector.

In my view, the Philippines has a mix of these systems: a model covering for the needs of employees, which also are obligated to contribute to a common health insurance fund run by the Philippine Health Insurance Corporation, Philhealth. This fund is also financed partly through taxes. But what is interesting with the Philippine situation is how services are insufficiently financed: most of the time, not all services are sufficiently paid for by Philhealth, and still cause a significant financial burden on indigent patients.

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This is where health financing will impact the most: in community health centers. Here’s a throwback of where my interest in health financing began, in 2012 in one of my clinics in Benguet.

I remember this one scene back when I was still a municipal health officer a few years ago: a man came to my clinic with papers in hand, his face visibly burdened. He opened up to me about how Philhealth only covered a few days of his hospital stay, and did not cover for his prescribed combination medicines, which for some reason were not included in the drug formulary, and were thus not covered. This situation actually moved me to do research on this area after my stint as a government doctor.

It is this kind of situations that the Enhanced UHC Act aims to target. A few of the bill’s salient features are the following:

  • The Philippine Health Insurance Corporation, or Philhealth, will be renamed as the “Philippine Health Security Corporation,” representing a transition from a source of financial assistance for health needs, to a full-fledged “purchaser” of health services.
  • Fixed co-payment for members who are contributors to the fund, mostly employees, overseas workers, and individually paying members.
  • For poor families, who are certified as such by local authorities and the Department of Social Welfare and Development, and are usually non-contributors to the pooled health insurance fund; they will be fully subsidized by government for their health insurance premiums.

These are much welcomed developments indeed, but questions remain on how these reforms will be implemented, and how can these reforms contribute to the elusive ideal of “health for all,” which will cover for all health needs, no questions asked. Left-leaning legislators have voiced concern on how these reforms seem to perpetuate an insurance-oriented health system, instead of transitioning towards a health care system fully financed by the state, similar to the UK model.

These issues actually boil down on these two things: how can UHC happen in a country with a significant percentage of households under the poverty line, and how can our health system cope. An additional concern for #HealthXPh is how technology can facilitate this uptake, which is important for an archipelagic country like ours.

Let’s therefore discuss these questions tonight:

1) What is your idea of universal health care?

2) In your current health care system, what should change in order to make UHC happen?

3) How can IT and other emerging technologies help implement UHC in your health system?

Join us tonight, September 9, Saturday at 9PM Philippine Time, 9AM US Eastern Standard Time, at #HealthXPH on Twitter!

PS: I will be sharing the #HealthXPH experience at the PharmacoMedia Summit, organized by the UP Sandigan, an organization of pharmacy students, this afternoon, September 9. See you!

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