4 minute read
The Philippine Healthcare System
Phillip Ong
Introduction
The Universal Health Care Act (Republic Act No. 11223) was signed into law in February 2019. It aims to broaden the coverage to provide healthcare services. The law mandates the expansion of PhilHealth coverage to include all Filipinos which currently stands at 93%. The planned implementation in January 2020 was disrupted by the COVID-19 pandemic. It was only in February 2024 that PhilHealth announced a 30% increase in health benefits alongside the suspension of premium payments.
Healthcare Infrastructure
The Philippine public healthcare system operates on a devolved model where healthcare is managed by local government units.
The Philippines has 42,000 barangays (or neighborhoods, the smallest political unit). Of these, there are approximately 25,000 (60%) that have public health units called barangay health stations (BHS). Many of these, especially in remote areas, are but a one-desk affair with a clerk who refers cases to government hospitals in the municipal centers.
There are 2,300 such municipal health units which also range from undermanned, underequipped, and underfunded to being adequate for addressing local needs. Many low-income municipalities are visited by doctors only once a month.
Of the 1,400 hospitals nationwide, serving a population of over 110 million, only 500 are public.
Barriers to Access
The primary barriers to the availability of healthcare are:
A. Lack of Mobility
For an archipelagic country with limited road and port connectivity, transportation is a major challenge in the delivery of healthcare. In our work with poor pregnant women, the main reason for their nonavailability of prenatal examinations is the high cost of transportation to their barangay health center. They complain that the time and cost of transport exceed the benefits they receive from consultations. As such, even government-funded health care is not voluntarily accessed. This has resulted in infant malnutrition and mortality three times higher than neighboring Thailand and Malaysia.
B. Lack of Funds
High out-of-pocket expenses deter individuals
from seeking timely medical care, resulting in delayed diagnosis and treatment. On average, Filipino households have to shell out 44.4% of their treatment cost, according to the Philippine Statistics Authority [1].
Currently, The Philippine Health Insurance Corporation (PhilHealth) provides access to subsidized healthcare services to most Filipinos. Funded by contributions from some 65 million paying members (62%) of our population, it relies on the government budget to fill up the gap. In 2021, it disbursed P89 billion ($1.5 billion) in benefits [2]. In addition, the Department of Social Welfare (DSWD) coordinating through Malasakit Centers channeled around P450 million ($7.76 million) from the Philippine Charity Sweepstakes (PCSO) and the Medical Assistance for Indigent Patients (MAIP) [3].
The new Universal Health Care Act promises to allocate 50% of the Philippine Gaming and Amusement Corporation’s (PAGCOR) income for healthcare, but this legislative act is still far from implementation.
C. Lack of health workers
One of the most significant challenges facing healthcare delivery at all levels is the lack of qualified personnel. During the pandemic, various countries with higher incomes have been able to attract health workers by easing visa restrictions. It has triggered a substantial migration of experienced health staff from private and public hospitals.
The Philippine College of Physicians (PCP) estimates that there are only 2.3 healthcare workers per 10,000 population. Public health facilities are served by only 4.5% out of the 66,000 doctors and about 1% of the 500,000 nurses.
Compounding this is the suspension of nursing examinations during the COVID period. This reduced the pipeline of replacements for the industry. Some new hospitals and care facilities could not start operations due to a lack of personnel.
Conclusion
In my personal involvement in helping a poor teenage patient suffering from acute myelogenous leukemia (AML), I experienced the many faults of the system as narrated by her:
I was on this battlefield for three years, from 2016 to 2019. I saw countless fallen warriors. I experienced taking my chemo drugs for one week while we were three patients in the same bed. The insufficiency of hospital beds and rooms for infectious diseases. The lack of nurses and doctors that led to patients’ deaths because of not having proper care. The delayed chemo because of the drug shortage. Patients bleeding because of the inadequacy of blood bags in the hospital blood bank. The painful part is the scarcity. You died not just because of cancer, but you died because of not having money or any support from the government for the whole treatment. The treatment should not be only for wealthy people, but also for the people who are fighting for their everyday needs.
Having enumerated major problems in the Philippine Health Care system does not mean that improvements have not been implemented. Plagued by corruption and inefficiency, the system managed to provide adequate protection to the population during the COVID-19 pandemic. With well-informed public officials, it is hoped that the Universal Health Care Act will bring improvements at least in infant mortality.
