SOS from the health front lines

Jeepy Perez, a doctor of medicine, specializes in public health administration, and has served as adviser to four Health Secretaries of four Philippine Presidents. He occasionally writes for Action for Economic Reforms. This piece was published in the July 12, 2010 edition of the BusinessWorld, pages S1/4 to S1/5.

Romuald called my wife in the middle of the night last week, but the person he wanted to talk to was really me, the doctor he could call “ninong.” Years back he had gotten married and my wife stood as sponsor at his wedding. He had gone home to Pampanga because he could not find work in Manila.

His problem: his father needed a triple bypass operation or a Coronary Artery Bypass Graft (CABG), fondly called a “cabbage” operation by the health staff at the Philippine Heart Center (PHC).

It would cost his 70-year-old father, a retired government employee, P500,000 and Romuald wanted advice if they would agree to the package; they were hoping that his sister’s health plan would be able to cover part of the cost. After some discussion he decided to take the risk and have his father admitted.

The day after the surgery he was calling again, asking how much Philhealth would cover (probably 10-20 I told him) and if the senior citizen card could be used. He called back and said the PHC would not agree to a senior discount because it was a “package” deal.

The last time I talked to him, he was considering going to PCSO for relief; his final option might be to sell the small farm his father had put up after retirement, Romuald’s only lifeline for his growing family.

Dante, on the other hand, is a state university professor of history who found out a couple of years ago that he needed a “cabbage” operation too. He has been postponing the decision to have the operation and he has been relying on medications to keep him working.

Despite the year or more that he has been postponing the decision to operate, Dante still finds himself short of the funds to have the operation. His fellow faculty members and students are currently raising funds for his several hundred thousand peso cabbage operation.

Fifteen years ago, President Fidel Ramos signed the law that created PhilHealth (it would take over the Medicare system which had been in place since the late 1960s). The law mandated universal coverage by 2010, and that it would cover outpatient as well as inpatient care and upgrade the benefits for its members during the time it would take to achieve universal health care.

Unfortunately, during the elections of 2004 and 2007 politicians took over the expansion program of PhilHealth. Membership would rise every election year and quickly plummet in the second year after the election.

Often PhilHealth cards meant for the poor would go undistributed for months and the beneficiaries would never be able to claim Philippine Health Insurance Corporation (PHIC) reimbursement simply because they didn’t know they were members.

PHIC was slow in expanding its benefits (only tuberculosis is covered as an outpatient curative service; SARS and AH1N1 are also covered but there have probably been no takers).

PhilHealth watchers (including some in Congress) have been watching the rise in PHIC’s reserves. It is one Government-Owned-and-Controlled Corporation that has never seen red ink since its creation in 1995, with reserves projected to hit P100B this year or next.

PhilHealth has clearly lost its way. PhilHealth was touted as a social health insurance initiative in the 1990s (particularly when then secretary Jaime Galvez Tan was its first Chair in 1995) but it has instead become the most successful commercial insurance company, paying regular bonuses to its managers and staff simply because it has successfully avoided paying for the health care its members need.

PhilHealth under this administration has boasted that it has achieved universal coverage with 85% of Filipinos covered this year. But as President Noynoy pointed out in his press con after his proclamation, the reality is that only 38% of Filipinos are covered by PhilHealth. The insult to that injury is that PhilHealth can only cover 30% of health costs at best. Cabbage operations will have even lower coverage.

People like Romuald and Dante can only go to the hilippine Charity Sweepstakes Office, and broadcast stations like ABS-CBN and GMA (the network) as a last resort simply because of PHIC’s abdication of its role.

President Noynoy certainly has own Augean stables to clean up in PHIC. He has called for Universal Health Care in three years (which is not the paper-thin coverage of the Arroyo administration but the facilities, staff and resources to match universal PhilHealth membership), and he probably has been given the blueprint to get it done.

If President Noynoy could start today, he should start with a clean slate rather than reappoint the same people who perpetuated the mirage of a “caring” administration. The poorest of the poor Filipinos have never been given a chance in the halls of Congress, Malacañang or PHIC to make the health system work for them, for once.

President Noynoy cannot neglect the health needs of the Romualds and Dantes. After all, it was the Cory Constitution of 1987 which guaranteed the Filipinos their right to health.

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