In September 2017, the House of Representatives passed House Bill 5784, also known as the “Universal Health Coverage Act.” The bill aims to transform our health system to make quality health care accessible to all Filipinos without financial hardship.
Three versions in the Senate have also been passed: Senate Bills 1458, 1673, and 1714, authored by Senators JV Ejercito, Sonny Angara, and Risa Hontiveros, respectively. If all goes well, we could very well see the first steps toward Universal Health Coverage (UHC) by next year, with several key components up and running by the end of the Duterte administration.
But what is UHC, anyway? Why do we need it? Here, we tackle the basic proposals of UHC, the urgency behind instituting them, and what it will take for us to achieve the dream of quality health care for all.
THE STATE OF HEALTH IN THE PHILIPPINES
The impetus for UHC in the Philippines stems primarily from the pivotal role our health plays in determining the overall well-being of every Filipino. In the current health system, staying healthy can make the difference between many families’ economic stability and vicious cycle of intergenerational poverty. The ubiquitous risk of life-threatening illness combined with the stratospheric costs of the services needed to address them makes for a hazardous combination
In 2013, significant steps were taken to respond to this situation. We passed the Sin Tax law, which tripled the health budget from 2012 to 2016 and increased the percentage of the population covered by health insurance to over 90%. Revenues from tobacco and alcohol taxes defrayed the health care costs of many Filipinos, with over P31 billion contributing to the coverage of indigents in 2016. The same year, on average, Philhealth covered 50-60% of the value of health services for processed claims, and the entire cost of 63% of claims made by indigents.
While these gains are undeniable, however, many health care gaps persist. A sizeable portion of the population remains uncovered, many services are excluded from insurance packages, and the level of coverage provided is not always sufficient to alleviate the financial burden of major health care costs. Moreover, many inequities persist which exacerbate these issues, such as the severe mismatch in the number of health workers to the number needed per region, and the inadequate or inappropriate level of services provided by most health care facilities in remote areas.
TRANSFORMING THE SYSTEM WITH UHC
Surmounting these recurring problems will require comprehensive reform of the health system. To repeat, the UHC bills aim to achieve the transformation of the health system to make health care accessible to every Filipino without financial hardship.
First, UHC proposes the automatic inclusion of every Filipino into the National Health Security Program (currently the National Health Insurance Program of PhilHealth). Based on a rigorous process of health technology assessment, services will be available on a negative list — meaning, services are considered covered by default, unless specified otherwise. This greatly widens the safety net for all kinds of health needs. For basic accommodation, Filipinos will no longer have to pay a centavo; a fixed co-pay will be determined for higher levels of accommodation.
Besides vastly expanding the financing of health services, UHC reorients the health system toward primary care and service delivery networks. Every Filipino will be assigned a primary care provider, who serves as the first point of contact in the health system and addresses general health needs. This aligns with the fact that Filipinos do not need to see a specialist for everyday health services. When higher levels of care are required, the primary care provider helps patients and their families navigate the health system, which will be organized by networks of facilities, or service delivery networks. Such networks guarantee a minimum level of service capacity per catchment area, so that every Filipino will certainly receive the care she needs.
Finally, to make sure all these changes will truly materialize, UHC undertakes a strategic plan for developing and distributing health human resources. The bills safeguard the right number of doctors, nurses, midwives, and barangay health workers for every barangay, municipality, city, and province — especially for geographically isolated and disadvantaged areas (GIDAs). To achieve this, UHC expands available scholarships for health professionals and ensures they are all paid well no matter where they work.
WHAT IT WILL TAKE TO GET THERE
Based on the main provisions of the UHC Bills, the proposed legislation is clearly an ambitious one. Such scale and depth, however, are necessary to achieve sustainable changes that make our health system truly equitable and responsive to the needs of all Filipinos.
But even as it is all well and good to dream and make plans, how do we turn UHC into a reality? How do we fund these big changes in our health system?
At current estimates, to implement UHC over a period of five years will cost an average additional amount of P90-100 billion every year. This amount is no small matter, given that it already accounts for the entirety of the health department’s budget and the contributions of all Filipinos counted as part of the contributory group. At their current rates, even the sin taxes will not be able to cover the costs of instituting UHC. Neither will pooling funds from the Philippine Amusement and Gaming Corp. and the Philippine Charity Sweepstakes Office, a suggestion which has already been floated at the Senate. Hence the need to further increase significantly the tax rates for alcohol and tobacco, given that the law on sin tax earmarks the bulk of additional revenues to UHC.
The promise of UHC is an urgent one. It has also been a long time coming. Affirming the right of every Filipino to quality and affordable health care, it is finally within reach. But to get there, a significant and sustainable source of financing needs to be found and fought for very soon. Otherwise, the promise of UHC will remain just that: a promise, a dream finally within our reach but which we did not take.
Joshua Uyheng is Action for Economic Reforms’ research associate specializing in public health and health financing.