Part 2 of a 3-part series
A well-functioning healthcare system, according to the World Health Organization (WHO), provides equitable access to quality care regardless of people’s capacity to pay while protecting them against the financial consequences of ill health.
The WHO definition clearly does not apply to the Philippine healthcare system. In his speech during the 2010 World Population Day Celebration, Department of Health (DOH) Secretary Dr. Enrique Ona gave a long litany of ills besetting the country’s healthcare system.
low overall government spending on health; high out-of-pocket spending that impoverishes thousands of Filipino families; persisting high maternal and newborn deaths that are among the highest in the Southeast Asian region; high fertility rates among the poorest Filipino women; the continuing challenge of infectious diseases like TB, dengue and malaria; emerging diseases like HIV/AIDS and the interlocking crisis of non-communicable diseases; shortage in human resources for health, particularly doctors…”
Infirmity could mean penury
The way a healthcare system is financed and organized has a major influence on a population’s health and wellbeing. In a 2012 review, the WHO described the country’s health financing system as “fragmented with insufficient government investment, inappropriate incentives for providers, weak social protection and high inequity.”
The National Demographic and Health Survey revealed that the majority of patients confined in both public and private hospitals pay out-of-pocket, using their salary or income and dipping into their savings. Out-of-pocket payments were significantly higher among patients confined in government hospitals.
Citing PhilHealth’s limited population and service coverage resulting in high out-of-pocket payments, the WHO review concluded that…[pq]…in general, the Philippine health financing system does not provide a safety net from the financial consequences of illness. Because PhilHealth is unable to provide full insurance coverage, Filipinos who get sick can easily slide into poverty.[/pq]
Disparity in quality of care
According to a 2007 report by the Asian Development Bank (ADB), higher-income Filipinos prefer private health facilities, which they considered as providing better-quality services. Lower-income Filipinos usually go to public health facilities such as rural health units and village health stations, which are generally perceived to provide low-quality health services.
In public health facilities, the ADB report described “diagnosis [as] poor, resulting in repeat visits; medicines and supplies are inferior and rarely available; staff members are often absent, especially in rural areas, and are perceived to lack medical and people skills; and waiting time is long, schedules are inconvenient, and facilities are rundown.”
About 40% of hospitals in the country are public. Of the over 700 public hospitals, around 10% are managed by the DOH while the rest are managed by local government units (LGUs) and other national government agencies. The DOH categorizes both public and private hospitals based on their service capabilities, from Level 1 (primary), Level 2 (secondary), to Levels 3 and 4 (tertiary). Level 1 hospitals, which have very limited capacity comparable only to infirmaries, account for more than half of the total number of hospitals in the country.
Private hospitals outnumber government hospitals in all categories. The disparity is most glaring in tertiary hospitals where the number of private hospitals is four times that of government hospitals. Level 1 and Level 2 hospitals are relatively well distributed across the country. However, Level 3 and Level 4 hospitals are highly concentrated in Central Luzon and Metro Manila. Of the country’s 17 regions, only four meet the WHO recommendation of 20 hospital beds per 1,000 population.
Uneven distribution of health force
According to DOH Secretary Ona, 70% of Filipino health professionals are working in the private sector serving about 30% of our population. Only 30% of health workers are employed by the government to address the health needs of the majority of Filipinos.[pq]Our health human resources are concentrated in urban areas such as Metro Manila and other cities. This uneven distribution seriously limits the rural population’s access to quality health services.[/pq]
The WHO notes that over the last decade an increasing number of Filipino health professionals looking for better-paying work have migrated to other countries. As a result, there are not enough doctors, dentists and other health professionals to address the health needs of Filipinos.
Positive developments under PNoy administration
Through President Noynoy Aquino’s Universal Health Care (UHC) program, government funding for health has increased substantially. In 2008, the DOH budget was just under P19B which increased slightly to almost P24B in 2009. When PNoy took office in 2010, the DOH budget was about P25B. The 2014 DOH budget is almost P90B.
According to PhilHealth, there has been a 65% increase in enrolment among the poor. As of 2012, 82.4M Filipinos of the 95.8 M projected population for that year have been enrolled in PhilHealth, a coverage rate of about 86%.[pq]The DOH said that from 2010 to February 2013, more than 3,500 public health facilities across the archipelago were upgraded and rehabilitated.[/pq]
These include hospitals, rural health units and barangay health stations. For the remainder of 2013, an additional 2,487 health facilities were upgraded.
Through its Doctors To The Barrios and RN Heals programs, the DOH is deploying more doctors and nurses in underserved rural areas. The DOH is entering into Public-Private Partnerships (PPP) to modernize government hospitals and build new, modern health facilities.
Planned PPP projects include the modernization of the Philippine Orthopedic Center, construction of the Philippine Center for Hematologic Diseases and Blood Transfusion, and the development of a modern medical complex within the San Lazaro compound consisting of the Jose Reyes Memorial Medical Center, San Lazaro Hospital and Dr. Jose Fabella Memorial Hospital.
The DOH and its private-sector partners plan to build nine cancer centers, eight heart centers and seven transplant centers in strategically located DOH regional medical centers.
Such reforms in the health sector, which have yielded some positive results, are laudable. However, our country still has a long way to go in achieving a sustainable, high-quality, and cost-efficient healthcare system that can be accessed by all Filipinos.
In the third and final part of this article series, we will look at why Singapore’s healthcare system is considered among the best in the world.
– Eric Michael Santos, Medical Observer
6. UHC Implementation in Government Hospitals – presentation by DOH Undersecretary Teodoro Herbosa