Monday, November 26, 2012

PhilHealth Watch 13: SHInES on Social Solidarity

PhilHealth President, Dr. Eduardo "Dodo" P. Banzon, gave a nationwide lecture via teleconference this afternoon (2-5pm). It's the PhilHealth SHInES (Social Health Insurance Educational Series) at the Asian Institute of Management (AIM) in Makati and to aired live at Central Philippine University (CPU) in Iloilo City; Silliman University in Dumaguete City, USEP in Davao City, Ateneo De Naga in Naga City, and  SPU in Tuguegarao City. The Zuellig Center at the AIM organized the forum.

My events alarm failed to remind me of this important forum, I realized it only past 5pm when I saw the email invite from Zuellig Center. Oh my, signs of ageing I guess.

So I better write about the event. The objective of this exercise is for PhilHealth together with the Department of Health, further inform the public so that
The country can attain Universal Health Care (UHC) or Kalusugang Pangkalahatan (KP). Through the National Health Insurance Program (NHIP), PhilHealth seeks to provide financial risk protection to all Filipinos and ensure that no Filipino will be afraid of getting sick. There is need for a thorough understanding of the philosophy behind social health insurance – social solidarity and equity.
Dr. Banzon would talk on five presentation Topics:

1. Social Health Insurance and Social Solidarity
2. Legacies of Social Health Insurance
3. Health Inequalities in the Philippines
4. Universal Health Care, Redefined
5. Social Health Insurance Towards Universal Health Care

I think many of those topics are self-explanatory, like UHC, meaning all Filipinos and Philippine-based foreigners, will get government-health insurance at least portions of their total bill when they are hospitalized, which is good. Currently, PhilHealth also gives outpatient coverage for the poor, the CCT beneficiairies. But there are two subjects that I think are misunderstood or misdefined by PhilHealth: solidarity and health insurance..

On social solidarity, for me this is voluntary, it is never done via coercion. Each huge flooding in the Philippines for instance affecting hundreds of thousands of individuals or households, millions of Filipinos and foreigners who were not affected or only slightly affected, would quickly send in whatever resources they have -- canned foods, drinking water, medicines, old clothes, shoes and blankets, construction materials, money, and so on. This is solidarity, spontaneous assistance to the less privilege without coercion or a big agency like the government penalizing people if they will not give anything.

Thus, "social solidarity" cannot apply in the context of government-mandated programs. PhilHealth membership and contribution is not done via volunteerism but via coercion, like membership and contribution in Social Security System (SSS) and housing fund (PAG-IBIG). Whether people like those government services or not, whether they benefit or not, they have to pay a monthly or yearly contribution to the government.

On social health insurance, I do not think that this should imply government monopolization or nationalization of the service, something that is happening in many countries around the world, in both the rich and developing countries.. The important point is that all people, each individual, young and old, rich and poor, men and women, legitimate or non-legitimate children, should have a health insurance card that will cover not only hospitalization or in-patient services, but more importantly, outpatient services. Serious illness and diseases leading to hospitalization can often be prevented if people get treated early enough.

In food, there is no government restaurant or carinderia corporation, or a government supermarket and talipapa. There are a few government restaurants in government schools and offices but majority are privately-owned and operated. And yet people are eating. Why? Because of differentiated pricing, of market segmentation. People can choose to buy or cook food from the cheapest to the most expensive price levels. So the one that gives "food insurance" to the people is access to different food products at different prices for different needs and food taste of different people. There is no single price for each food item.

When government insists on service monopolization, it is courting financial disaster, either for the patient or for the government coffers in the long term, or both. In many countries in welfarist Europe, their public spending for healthcare is among the biggest items in their annual budget, which significantly contributes to their huge public debt and economic instability. A "free" or a heavily subsidized service like healthcare would attract huge demand, which outpaces the supply, always.

Demand larger than supply in healthcare shows in various ways. One is lousy service, say a government physician sees a patient, writes a few prescription and calls the next patient after just one or two minutes. Since government healthcare personnel are on fixed income, whether they treat 10 or 50 or 100 patients a day, the pay is the same. So in cases of high volume patients, the tendency is to cut the quality of service or the average time spent for patient education and preventive healthcare.

Two is modest or good service but patients have to wait for several days or weeks before they can get an appointment with a government physician or other healthcare professionals. If a doctor has to spend at least 30 minutes for each patient and he can spend only five hours a day on consultations as he has other work to do like hospital or school administrative assignment, or teaching in a medical school, or doing a clinical research, or oall of them, then he can see only 10 patients a day maximum. If there are 30 or more patients wanting to get his service, then the other 20 have to wait for days or weeks before the physician can see them.

Three is high number of government physicians and other health professionals to take care of high number of patients to minimize or eradicate long waiting period, but this will result in huge public spending and perennial budget deficit, leading to ever-rising public debt. Healthcare, preventive or curative, is not composed of seeing a physician alone. There are diagnostic tests to take, from urine test to blood test to X-ray to CT scan, etc., and these procedures are more often than not, very costly. So if we add up the professional fee + diagnostic tests fee + other hospital or clinic fee, the cost per patient will easily rise.

In order to avoid these pitfalls and financial catastrophe, both at the short- and long-term, it is important to give huge leeway or room for personal, parental, corporate, and civil society responsibility in healthcare. Government responsibility in healthcare should be a supplement only, not a primary source of financing.

I suggested in my earlier paper,

Socialized Healthcare 11: Private Health Insurance and HC Vouchers (November 16, 2012), that government involvement in healthcare can be in the form of giving people health vouchers, a flat rate per person per head. So instead of creating new government hospitals and spending huge amount for their maintenance, government can give each household a voucher, and the people, rich and poor alike, can choose which among the various hospitals, clinics, HMOs and other health facilities, can give them the kind of healthcare they need. Different HC services for different people with different budget and different health needs. Those who tend to abuse their body, they over-eat, over-drink, over-sit, over-smoke, must get a more expensive health insurance as their HC needs will be higher than the average person.


See also:
PhilHealth Watch 9: Physicians talk about PHIC, October 16, 2011
PhilHealth Watch 10: Hospital Bill Deductions, December 29, 2011
PhilHealth Watch 11: Is PHIC an Insurance Company?, June 12, 2012
PhilHealth Watch 12: Assistance to Leptospirosis Patients, September 03, 2012

1 comment:

GabbyD said...

i often wonder where u get your info: "In many countries in welfarist Europe, their public spending for healthcare is among the biggest items in their annual budget, which significantly contributes to their huge public debt and economic instability"

where did u find that healthcare spending causes economic instability?

if anything, the europeans are proud of their healthcare system, and the financial crises that struck SOME european countries having nothing to do with healthcare.

of course, if you have any evidence in this regard, it would be great to read...