Spelling out U-H-C

LAST September 12, the PhilHealth Board approved the implementing rules and regulations (IRRs) of the National Health Insurance Act of 2013 or what has been dubbed as the “Universal Health Care Law.” Universal Health Care (UHC) or Kalusugan Pangkalahatan (KP) has been a buzz term since President Aquino adopted it as the title of his administration’s entire health program, yet, halfway through his term, few Filipinos really understand what it means.

What does Universal Health Care mean and what does it take for our country to realize it? To answer these, I look back at the original blueprint drafted in 2009 by the Universal Health Care Study Group, a diverse team of health experts and advocates from UP Manila. This blueprint, though partially adopted, eventually became the foundation for the Aquino Health Agenda for UHC.

The Study Group defines UHC as “the provision to every Filipino of the highest quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public.” In other words, we know that we have achieved Universal Health Care if, at any point in time, any Filipino who needs essential health care services, regardless of his or her capacity to pay, is able to seek and receive such in the most effective and efficient way.

Clearly, UHC goes beyond providing health insurance for the poor (thanks to whoever branded the National Health Insurance Act as Universal Health Care Law). It covers the whole health system — from promotive and preventive to curative care, requiring interventions that affect both supply and demand for health care. Its attainment depends on the success of reforms that extend from financing and delivery of services up to regulation and monitoring of suppliers and providers.

SIX BUILDING BLOCKS
According to the Study Group, full implementation of Universal Health Care in the Philippines entails “radical reforms” in the six building blocks of the health system. These are “focused and directed governance based on a policy of equity, a dynamic health information system usable for health policy formulation, regulation of health care, integrated and rational health service delivery, an adequate production of well-motivated human health resources, and an adequate and equitable health financing.”

To address issues of health inequity, the team of health experts suggests the formulation of “an encompassing policy of health service provision” using the Primary Health Care (PHC) Approach. The Primary Health Care Approach corrects the common misconception of reducing health care to mere medical care and involves the full participation of individuals, families, communities, and, in addition to the health sector, other related sectors such as agriculture, food, education, housing, public works, etc. Assessment of health problems starts from the social and economic determinants and interventions are more skewed towards promotive and preventive rather than curative and highly specialized care.

The development of a national health information system is also crucial to effectively aid policy formulation. Data collection must begin at the point of care and must support “health care services, health surveillance, health literature, health education, knowledge and research.” Various health information, including health statistics that are disaggregated by socio-demographic characteristics, must be integrated in a timely manner to guide decision-making of higher offices.

To ensure that Filipinos, especially the underprivileged, are able to fairly access quality health services, the Philippine health regulatory authority must be strengthened. Regulation of health providers is important given that patients and consumers are usually incapable of judging quality. Due to lack of resources and technical capacity of regulators, health policies and regulations are often poorly enforced, resulting in either the abuse of patients or substandard health services.

Improvement in the effectiveness and efficiency of health service delivery also requires the integration and UHC-alignment of public and private providers, especially at the local levels. Primary care must be consolidated to address basic health needs in communities and, serving as “the gatekeeper between patients and hospitals,” be linked to a referral system, which will then usher the patients to more advanced and specialized services if need be.

The Study Group also emphasizes the need for genuine reforms in the management of health human resources. The unregulated and market-oriented production of health care professionals has contributed to the worsening gap of urban-rural health-workforce-to-population ratios and the irrational imbalance between the number of specialists and general practitioners. For example, as of 2009, the specialist-generalist ratio is 4:1 based on the Philippine College of Physicians membership data, while the American College of Physicians already declared a health crisis when the same ratio was 2:1 in 1994. To address this, regulations in the production, practice and deployment of health professionals should be put in place.

An adequate and efficient health financing is another challenge that needs to be resolved to support these reforms. As of 2011, total health expenditure (THE) was only 4.4% of GDP and out-of-pocket (OOP) expenditure was 52.7% of THE. The Study Group proposes increasing THE to WHO’s recommended 5% of GDP and reducing OOP to 20% of THE by increasing government’s and PhilHealth’s share. Allocation must also be increased for “more cost-effective public health interventions and primary care services, while maintaining the quality of tertiary level health services.”

MILESTONES IN PURSUING UHC
The recent passage of the National Health Insurance Act of 2013, coupled with the back-to-back legislation of the Sin Tax Law and Responsible Parenthood and Reproductive Health Act in 2012, is indicative of the President’s commitment in pursuing UHC. However, while progress is already evident in the areas of targeted health insurance coverage, increased resources for health, and improvement of health facilities, much has yet to be done in matters relating to health human resource management, Primary Health Care approach, and health information systems. Nevertheless, the said milestones in pursuing UHC can also be the stepping-stones to remedy the gaps that have been overlooked so far.

Diosana is a fellow of Action for Economic Reforms (www.aer.ph).

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