Wednesday, August 22, 2012

Socialized Healthcare 6: Student Debates, Charity Beds and UHC

There is some positive twist in healthcare discussions in the country these days. And that is involving more non-healthcare students and professionals in various healthcare debates. Reiner Gloor of PHAP reports below that some 50 debate teams from different local universities will debate on various health issues, from no balance billing to corporatization of government hospitals and more, starting this month.

I am particularly interested how today's university student debaters would consider personal and parental/guardian responsibility in the overall healthcare discussions and public policy formulation. And how they would consider limiting government role in  dealing with infectious and communicable diseases like dengue. I just read today that for the first eight months of 2012 alone, some 74,784 people, mostly children, were hit by this mosquito-borne disease, with 448 deaths. This is 17.5 percent higher than last year's same months level.

A daughter of a friend who is a godfather to my second daughter, was admitted in a hospital the other day due to dengue. The son of another friend' also got that disease and was hospitalized for a week. These are middle class families who do not live in dirty places with many stagnant water. This disease which currently has no existing vaccine yet, is really nerve wracking for parents and other family members.

Anyway, former DOH Secretary Alberto Romualdez also discussed some of those health issues in his column. The three papers I am reposting below are:

1. Let's talk about health
2. The Secretary's Cup -- both by Reiner Gloor
3. Charity Beds and Universal Health Care -- by Alberto Romualdez


(1) Let’s talk about health

Posted on 05:53 PM, August 16, 2012
Medicine Cabinet -- Reiner Gloor

Creating a forum where ideas are challenged and differences resolved through critical thinking and rational arguments, not force, is one of the goals of competitive debates.

Towards this goal, the International Debate Education Association (IDEA) was established and has recently named five Filipino universities in its top 100 debate societies in the world. They are the Ateneo de Manila University, the University of the Philippines (UP) Diliman, UP Manila, the Far Eastern University and De La Salle University.

Debates aim to raise discussions of opposing views to help the public in making informed decisions on critical issues. And one of the important issues involves health.

While significant milestones on health have been achieved, overall health outcomes and goals can be improved. In many cases, the fundamental problem lies with the broader health system and its ability to deliver interventions to those who need them, observed the World Health Organization (WHO). The same is true for the country and thus, health system strengthening is very much in order.

Beginning this month, 50 teams from various schools will be competing in a nationwide inter-collegiate debate on the so-called building blocks of a health system. Each month, the debate topic will be based on a specific building block namely governance, regulation, service delivery, human resources, information, and financing.

The debates are part of the Secretary’s Cup initiative being led by the Department of Health (DoH) and the Universal Health Care Study Group of the UP-National Institutes of Health, along with partners including the Pharmaceutical and Healthcare Association of the Philippines. The series of health debates will be examining the state of health of Filipinos while at the same time seeking to explain the role of universal healthcare as the more comprehensive path to attaining health for all.

For August, the participants are gearing to debate on governance issues. Former health secretary Alberto Romualdez will open governance month while Department of Local and Interior Government Secretary Jesus Robredo will join in public discussions.

Placing focus on leadership and governance means strategic policy frameworks combined with effective oversight, coalition building, accountability, regulations, and incentives, said the WHO. Specifically, debaters will be asked to present their position on the questions if government hospitals must be corporatized and if the local health board should be given autonomy. These topics would delve on the pros and cons of corporatization and devolution of government. On one side, it may be argued that corporatization will boost efficiency while others may reason that the move may not benefit the poor.

Another debate topic under governance is the exemption of private hospitals from the “no balance billing” policy of the government. The policy will allow the poor patient access to healthcare services in hospitals without having to pay out of pocket. Among those points that will be argued will be the implications of the policy on patients and their choice of hospitals.

Also part of governance month is the issue on having the DoH to exercise oversight functions over all health facilities, public and private, at local and national levels. The topic seeks to establish whether the present mandate of the DoH is enough for it to be responsive to the health needs of the people or if the move will curtail local and private initiatives and innovativeness.

While governance issues are substantial in themselves, other equally important building blocks will have to be discussed and presented to the public. Following governance month, debates on health regulation will follow in September.

In support of the Secretary’s Cup to encourage public discussions, this column will, as much as possible, carry the debating teams’ arguments every third and last week of the month until February.

As French philosopher Joseph Joubert said, “It is better to debate a question without settling it, than to settle a question without debating it.” Several questions will be raised during the debates and hopefully, answers will be found through critical examination of health issues.

(2) The Secretary’s Cup

Posted on 05:28 PM, August 02, 2012
Medicine Cabinet -- Reiner W. Gloor

INTERNET search engine giant Google released in 2011 the biggest events, news, and people who shaped the year by taking a look at the billions of queries made through the search engine.

Also called Zeitgeist, a German word meaning “spirit of the times,” Google also zoomed into the Philippines’ top searches, from the fastest rising searches to fastest rising people, news, movies, TV, sports, food, travel destinations, and gadgets.

The Zeitgeist report in the Philippines included searches on news items about political events and personalities, natural calamities, security overseas, mobile phones, and sports and entertainment personalities.

At the moment, topics about territorial disputes, the appointment of a new chief justice, and the London Olympics continue to rage in public discussions. But how about issues on health?

“Let’s talk about health,” is the call to action of a seven-month health campaign being spearheaded by the Department of Health (DoH) and the University of the Philippines-National Institutes of Health (UP-NIH) when they launched the Secretary’s Cup last week.

The Secretary’s Cup message is clear. The time is now for universal healthcare.

Six health secretaries including Secretary Enrique Ona committed to bring health to the doorsteps of Filipinos through a public awareness advocacy on universal healthcare. The nationwide multi-sectoral campaign will gather the country’s health luminaries, namely former DoH secretaries Alfredo Bengzon, Alberto Romualdez Jr., Francisco Duque III, Esperanza Cabral, Jaime Galvez-Tan and Manuel Dayrit.

In his third State of the Nation Address, no less than President Aquino has emphasized his commitment to the realization of universal healthcare where there will be sufficient equipment, facilities and personnel in medical institutions. He also made reference to various health issues and goals, signifying his Administration’s political will to institute serious health reforms.

In 2010, the DoH launched its program, Kalusugan Pangkalahatan (KP), in pursuit of providing “health for all.” The universal healthcare agenda is expected to weave in previous major undertakings aimed at bridging inequities in health. It will build on the efforts of the DoH in the past five decades, during which programs like primary health care, health sector reform, an integrated referral system, and the National Health Insurance Program (PhilHealth) were developed and implemented.

The Secretary’s Cup will showcase a series of innovative activities that will spark discussions in various sectors of society targeting government leaders, the youth, the academe, the healthcare community, professionals, patients and the general public.

From August to February 2013, the DoH, and UP-NIH, along with partners, will hold the health secretary talk series that will demistify the six building blocks of health by relating each of them to everyday experience.

For August, Dr. Romualdez will explain governance as a building block while September will be health regulation month with Dr. Bengzon. Dr. Duque will expound on health financing in October, to be followed by health service delivery by Dr. Cabral in November. For his part, Dr. Galvez-Tan will talk about health information technology in December, while Dr. Dayrit will elaborate on human resources in January.

Secretary Ona will synthesize all the discussions in February.

Another innovative approach to understanding universal healthcare is the launch of an interschool collegiate debate series. At least 50 teams will debate on controversial issues on health from August until the national championship in February next year.

Among the debate topics are the corporatization of government hospitals, private hospitals and the no balance billing policy, and the DoH role in public and private hospitals. Also up for debate are health professional fees, advertisements on health products, removal of salary caps for PhilHealth premiums, mandatory social insurance coverage, medical tourism, access to medical records, and the production and deployment of health professionals.

Town hall meetings will likewise be organized as part of the advocacy.

The nationwide town hall meetings will gather patient groups, people’s organizations, health workers and professional groups to talk about key issues and solutions.

Universal healthcare may be an ambitious goal but that which is not impossible to achieve. The Secretary’s Cup seeks to take all stakeholders, especially the public, to the journey towards realizing better health for all.

* For more information, consult your doctor or log on to or Join us on E-mail the author at

(3) Charity beds and Universal Health Care

Published on Wednesday, 25 July 2012 00:00
Written by A.G. ROMUALDEZ

‘Installing a fully functional universal health care model that benefits most Filipinos requires serious and rational debates.’

IN the run-up to the President’s third State of the Nation Address, the Aquino administration’s program of government came under a barrage of criticism from a broad range of sectors – from well-meaning allies sincerely trying to be helpful to impatient advocates demanding instant social change to implacable political ideologues who believe that they have sole possession of all social cures.

Some of the observations are valid and need to be addressed. Others are the result of misconceptions, wrong perceptions, or plain misunderstanding that need to be explained and corrected. Finally, there are also deliberate distortions of reality by those who, for one reason or another, simply do not wish present reforms to succeed – these should be exposed or their purveyors convinced that societal interests should override narrow political concerns.

One of the most strident notes of protest was the reaction to a statement from a ranking Department of Health official to the effect that charity beds in government would be “phased out”. The extent of misrepresentation of the impact of this “phase out” is encapsulated in the comment from a group calling itself the “Movement for Good Governance” which stated without any basis that “this would mean that the 42,997 charity beds in 703 government hospitals would no longer exist.”

The notion of charity beds for indigent patients is an old-fashioned concept of free health services given to the poor out of the goodness of the hearts of health providers. Charity wards were those in which the patients were to be admitted for free – meaning without having to pay out of their pockets for the services they consume.

However, the fact is that services for “charity” patients were never truly free. Private hospitals (generally affiliated with religious groups) initially funded these from charitable donations and from profits from hospital services for rich patients. In addition, most of these also collected “user fees” from the poor families themselves – purportedly to counter an imagined “dole-out mentality” that could develop in beneficiaries who were fully subsidized. This model was transferred to government hospitals.

Over time however, rising costs meant that financing such services could no longer be sustained and user charges were increasingly adopted as the norm by all institutions, government and private, who provided “charity care”. In time, in all “charity health operations”, the beneficiaries increasingly paid some amount out of pocket – whether for diagnostic tests, food and board, or incentives to providers.

The idea of supporting services to indigents from an insurance-like financing system simply means that payments for services are made out of a combination of general tax revenues and an effective health tax called premiums (paid through a payroll tax system or a form of individual subsidy contributions from government). It is for this reason that the hospital services, paid for by a third party or direct subsidy, may strictly speaking no longer be termed “charity” services or beds.

The other distortion commonly perceived by health advocates is the notion that “corporatization” of government hospitals is simply a way to disguise “privatization”. This notion, equating corporate governance structures with the conversion of institutions into for-profit or private institutions, is simply wrong. The fact is that hospitals that are run like corporations remain government-owned and retain their public functions and obligations even as they are managed as autonomous corporate bodies – the specialty centers in Quezon City have long been examples or models of this mode of hospital operations. (Even the venerable Philippine General Hospital can be cited as an example because it is essentially responsible to an autonomous governing body, the University of the Philippines Board of Regents.)

Another charge against the health program of the Aquino government is that the out of pocket component of health expenditures in the Philippines, at 54 per cent, is one of the highest in this part of the world. They overlook the fact that this figure is from the 2007 National Health Accounts (NHA). If there is something to criticize in this regard, it is probably the fact that the National Statistics Office has been slow to come out with more recent figures for total health expenditures. It should be pointed out that the first time NHA was used for health policy formulation in 1998-1999, the figures came from the 1997 survey, then just over a year old.

The fact that misconceptions, outdated notions, and false impressions concerning the universal health care initiatives of the present government persist two years after its assumption of office may in fact constitute one of its failures in the health sector. Whatever attempts have been made to inform, educate, and communicate with the public on these different health issues have apparently been ineffective to date. This is a serious flaw because installing a fully functional universal health care model that benefits most Filipinos requires serious and rational debates on the many approaches to health services. This can only be done if all stakeholders are sufficiently informed to participate meaningfully in such discussions.


Opponents of reproductive health and responsible parenthood should note that one of the most applauded proposals in President Aquino’s SONA was his mention of the need for passage of legislation to help reduce the burden of large family sizes on women, their families, and society at large.



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