Who gives a care about healthcare?

by Aura Marie Dagcutan

IF health experts and activists aren’t feeling too good these days, it’s not just because the suddenly nippy weather could bring in chills, coughs, and even the flu (including the latest nasty version) among far too many people. It’s also because, the experts and activists say, effective healthcare remains beyond the reach of most Filipinos.

“Equity in health care means that every Filipino has a fair, just and equal access to medicines and hospital services,” said former health secretary Dr. Alberto Romualdez at a recent roundtable discussion on healthcare financing organized by the Philippine Legislators’ Conference on Population and Development Foundation. (PLCPD). Unfortunately, this has yet to happen – and may not take place even with the P33.7-billion proposed health budget for 2010.

The sum will be financing programs to reduce maternal and infant deaths, as well as cases of diseases such as tuberculosis, malaria, and HIV/AIDS. It will also help foot the bill for increasing access to safe drinking water and cheap quality medicines, and upgrading primary, secondary hospitals, and specialty centers, increasing access to cheap quality medicines, and responding to influenza A (H1N1) and other emerging diseases.

The proposed health budget, which translates to an allotment of P358.23 for every Filipino (based on a 2010 population estimate of 94 million), represents 2.2 percent of the total government budget of P 1.541 trillion. But as Dr. Ma. Virginia Ala of the Health Policy Development and Planning Bureau of the Health department pointed out, “The government allocation for health should be seven percent to decrease out-of-pocket expenditures.”

She then echoed others at the meeting held last Oct. 28 in calling for a “massive reform” in the country’s healthcare sector.

Romualdez, for one, noted that the “imbalance” in the healthcare system has resulted in less than 50 percent of poor women getting vitamin supplements compared to 80 percent of high-income women. Each year, too, only less than five percent of the estimated 3,000 new Filipino end-stage renal disease cases are able to have kidney transplants.

Romualdez said that the inequity plaguing the healthcare system could be traced to high-priced medicines and other health supplies, disproportionate distribution of human resources, an inefficient organization of health services, and dismal healthcare financing.

Indeed, despite the recent implementation of the cheap-medicines law, he said that the prices of medicines vis-à-vis the household incomes of Filipinos are still among of the highest in world.

“The high prices of most medicines in the country are beyond the paying capacity of most Filipinos,” Romualdez emphasized.

As an example, he cited the drug Ranitidine, which reduces the amount of acid in one’s stomach. According to Romualdez, a Filipino would have to give up a month’s salary just so he could buy Ranitidine for a 30-day treatment. In comparison, an ordinary employee in Sri Lanka or Brazil would have to part with his earnings for only 10 days for the same period of treatment.

Meanwhile, those in need of more care may forego treatment altogether because of the ever-escalating fees. Romualdez remarked, “Only those with money can fully pay for out-of-pocket payments and often than not, they already have generous health insurances. On the other hand, near-poor and the lower middle classes can become impoverished just to (make) such payments.”

To make matters worse for the have-nots, there is also a disproportionate distribution of human resources in the healthcare system. An estimated 70 percent of all health workers happen to be employed in the private healthcare sector, which serves only 30 percent of the entire population.

Still, even those at the meeting last week weren’t ready to give up just yet. Ala, for instance, had suggestions for vital national agencies in helping ease the country’s healthcare financing pains. To start with, she said, the Department of Social Welfare and Development (DSWD) should be critical in the identification of the poor to which subsidies will be entitled, while the Department of Budget and Management (DBM) and the National Economic Development Authority (NEDA) must enhance the public spending on health.

The Department of Interior and Local Government should be able “to develop policies on retaining income of health facilities, secure resources to fund the minimum health package to be offered by (local governments) to their constituents,” said Ala.

The National Anti-Poverty Commission can coordinate policies to increase accessibility to healthcare of remote areas by putting pressure on PhilHealth, she also said, while the Department of Labor and Employment (DOLE) must develop policies aimed at making every worker an active PhilHealth member.

“Health financing is an issue of nation welfare and competitiveness of our economy,” said Ala. “This will require a major effort from all of us.” – PCIJ, November 2009