These and related issues are tricky questions for public policy in healthcare provision. Posting below three articles related to universal healthcare (UHC) by the Executive Director of PHAP, Mr. Reiner Gloor, that can help shed more light and answers to these tricky questions and issues. The three papers posted in BusinessWorld in his weekly column are:
1. Making health by the people, for the people, 13 September 2012
2. Innovative medicine access collaborations, 20 September 2012
3. Protecting people's health, 27 September 2012
The first paper is about some insights after consultations at the grassroots level, where some poor rural folks expect the government health facilities to have more courteous and compassionate staff, more than having modern health facilities.
The second paper talks about huge price discount by innovator companies to patients of catastrophic diseases like breast cancer, prostate cancer, renal failure and leukemia under the PhilHealth "Case type Z benefit package". Another example of public-private partnership (PPP) with zero government coercion like the drug price control policy via Executive Order (EO).
And the third article is on the university student debates under the DOH Secretary's Cup, where protagonists will debate for or against more government regulations especially in (a) health professionals' fees, (b) advertisement of health products, and (c) distribution of health facilities, technology and services across cities and provinces in the country.
Good readings to start the week. Enjoy.
(1) Making health by the people, for the people
Posted on 05:18 PM, September 13, 2012
Medicine Cabinet -- Reiner W. Gloor
SAN ENRIQUE in Negros Occidental is a 5th class municipality with a population of more than 23,000 people. It is about 40 kilometers from Bacolod, or about an hour’s ride by public transportation.
Last week, I had the opportunity to visit this municipality -- consisting of 10 mostly coastal barangays -- as part of a partnership with the National Disaster Risk Reduction Management Council where we endeavor to prepare the people of the Western Visayas for calamities.
Apart from the information drive, the partnership sets in motion activities such as deworming, Oplan Timbang, immunization, medical and dental missions, backyard gardening and preparation of low-cost yet nutritious food and menu planning.
Hundreds of people, including the elderly, handicapped, mothers and children, came to the medical mission. Their overwhelming presence gave assurances that we must be on the right track. At the same time, the eagerness of the people to have themselves checked by health professionals in a covered basketball court is evidence that there remain healthcare gaps to be filled.
Also recently, two townhall meetings were held in Cabanatuan City in Nueva Ecija and Malolos, Bulacan with the objective of gaining insights and perspectives from the grassroots concerning key health issues. These were part of the Secretary’s Cup of which I have written.
Two films on health were shown to jumpstart the discussions. The first was about how a poor family copes with the illness of a family member while the second was an excerpt of Sicko, a documentary that probes healthcare in developed countries such as US, Canada and United Kingdom among others.
The discussions and reactions were insightful. However, three points struck me the most.
First, the participants were asked what they think is the most important attribute of a good health facility. I was expecting that a majority would say modern infrastructure or even free medicine. I was surprised to learn that most of them responded that a good health facility is where there are “kind, respectful and compassionate health staff.”
Apart from the information drive, the partnership sets in motion activities such as deworming, Oplan Timbang, immunization, medical and dental missions, backyard gardening and preparation of low-cost yet nutritious food and menu planning.
Hundreds of people, including the elderly, handicapped, mothers and children, came to the medical mission. Their overwhelming presence gave assurances that we must be on the right track. At the same time, the eagerness of the people to have themselves checked by health professionals in a covered basketball court is evidence that there remain healthcare gaps to be filled.
Also recently, two townhall meetings were held in Cabanatuan City in Nueva Ecija and Malolos, Bulacan with the objective of gaining insights and perspectives from the grassroots concerning key health issues. These were part of the Secretary’s Cup of which I have written.
Two films on health were shown to jumpstart the discussions. The first was about how a poor family copes with the illness of a family member while the second was an excerpt of Sicko, a documentary that probes healthcare in developed countries such as US, Canada and United Kingdom among others.
The discussions and reactions were insightful. However, three points struck me the most.
First, the participants were asked what they think is the most important attribute of a good health facility. I was expecting that a majority would say modern infrastructure or even free medicine. I was surprised to learn that most of them responded that a good health facility is where there are “kind, respectful and compassionate health staff.”
It would seem that many would go to great lengths just to go to a private service provider to avail of this “good” service. From this, I understood that health facilities must go through perception, if not culture change.
On the other hand, one must ask why some health facilities have such a reputation. We could understand that some of these facilities have more patients that they can handle or that they lack modern infrastructure.
Thus, the direction that the Health Department is going in terms of personnel and infrastructure development are very important.
Second, participants who were involved in or were recipients of government-led health initiatives like the Conditional Cash Transfer or the PhilHealth-sponsored program, were more optimistic when it comes to healthcare. For them, universal health care is an aspiration that is both possible and achievable. With this comes the lesson of involving the citizenry in government programs so that they, too, may come to appreciate, if not own, the initiatives.
Finally, not all of the participants appreciate the value of social insurance.
However, going around the country also provides the opportunity to recognize health innovations. One example is the PhilHealth LINK which is a call center for PhilHealth members. This project was launched by PhilHealth Region VIII in 2010. It is beneficial for those whose premiums are subsidized by local government units under the Sponsored Program, and who may not be fully aware of the benefits they are entitled to and how these may be availed of. (For more information on the program, please go to www.pids.gov.ph)
There is indeed value in going to the grassroots to help us know the demand-side of health. From the people’s perspectives, we can fine-tune strategies and pave ways for new ones. For universal health care to be truly universal, all sectors of society should be consulted and be made aware of government policy directions. There is much to learn and much to do for health to be truly “by the people” and “for the people” which is in fact, the essence of universal health care.
(2) Innovative medicine access collaborations
Posted on 05:35 PM, September 20, 2012
Medicine Cabinet -- Reiner Gloor
http://www.bworldonline.com/weekender/content.php?id=58786
A SURVEY conducted by the Social Weather Stations (SWS) in 2010 showed that majority of Filipinos worry about getting sick. Most of the respondents will go to public or private health facilities and would use their own money to pay for health to the point of borrowing money.
On the other hand, two out of 10 Filipinos will self-medicate, go to traditional or alternative healers, or will not even do anything if they get sick.
The results of the SWS poll demonstrated the characteristics of the Philippine health care system at the time of the survey -- high out-of-pocket spending in a country where about 30% of the population were said to live below the poverty line.
For every P100 spent on health care, about P54 is paid directly from the pocket of Filipinos. Given the high out-of-pocket spending, health has become an additional expense, especially for most of the poor who barely have enough for food and shelter.
The combination of poverty and high out-of-pocket spending have resulted in catastrophic health spending, giving rise to a vicious cycle where diseases worsen poverty, while poverty results in rising incidence of diseases. High out-of-pocket expenditure can drive even the rich into poverty. But for some, patients are confronted with the difficult choice of getting poorer or getting sicker with a preference for the latter.
The World Health Organization (WHO) emphasized that catastrophic health expenditure and its accompanying health, social and economic consequences can be minimized with the adoption of health financing strategies that protect the poor and vulnerable.
PhilHealth recognized that providing risk protection for the 97 million Filipinos is a monumental task but nevertheless possible through innovative stakeholder collaborations.
Under the banner of the Aquino Government’s Kalusugan Pangkalahatan agenda, PhilHealth launched the Case type Z Benefit Package with the objective of cushioning the impact of catastrophic diseases. The package is envisioned to achieve better health outcomes and financial risk protection for PhilHealth members, especially those who have less in life.
In partnership with medicine manufacturers and contracted government hospitals, PhilHealth President Eduardo Banzon announced the roll out of Type Z benefit packages for the estimated 14,000 breast cancer patients, 1,500 patients with prostate cancer, 10,000 patients with renal failure, and 1,500 children with leukemia.
For the initial implementation, the illnesses and their stages/risk classification are: standard risk acute lymphocyte (lymphoblastic) leukemia (ALL) in children - a package rate of P210,000 for the entire cost of treatment for three years; early stage breast cancer - package rate is P100,000 for the entire cost of treatment; the package rate for low to intermediate prostate is P100,000 for the entire cost of treatment; for patients with end stage renal disease requiring kidney transplant (low risk), the package rate is P600,000 for the entire cost of treatment.
Research-based companies Astellas, GlaxoSmithKline, Novartis, Pfizer, Roche and Sanofi-Aventis offered to bring down the prices of medicines for the Z benefit.
As partners of PhiHealth, the companies will ensure that quality medicines at discounted prices, ranging from 30% to 80%, will be made available to qualified Z beneficiaries at all 21 contracted hospitals.
The Z patients will still be able to avail of quality medicines after hospitalization at a price relatively lower than the market price.
Dr. Banzon said that the creation of the Type Z Package also intends to bring dignity back to patients where everyone will have the right to quality health care. This includes access to life-saving medicines that have been products of long, complex, and costly research and development process lasting up to 12 to 15 years.
Some people ask about the benefits of such partnerships to the medicine manufacturers. Some say it is guaranteed volume. The medicines industry views it as an opportunity for public-private partnership in support of the government’s universal health care agenda. After all, it is not everyday that we see the political will of stakeholders, particularly PhilHealth, in pushing universal coverage not by mere membership but with the depth of services it offers.
With these bold moves for innovative collaborations, social solidarity where the financially able subsidizes the poor will be much easier to embrace.
The results of the SWS poll demonstrated the characteristics of the Philippine health care system at the time of the survey -- high out-of-pocket spending in a country where about 30% of the population were said to live below the poverty line.
For every P100 spent on health care, about P54 is paid directly from the pocket of Filipinos. Given the high out-of-pocket spending, health has become an additional expense, especially for most of the poor who barely have enough for food and shelter.
The combination of poverty and high out-of-pocket spending have resulted in catastrophic health spending, giving rise to a vicious cycle where diseases worsen poverty, while poverty results in rising incidence of diseases. High out-of-pocket expenditure can drive even the rich into poverty. But for some, patients are confronted with the difficult choice of getting poorer or getting sicker with a preference for the latter.
The World Health Organization (WHO) emphasized that catastrophic health expenditure and its accompanying health, social and economic consequences can be minimized with the adoption of health financing strategies that protect the poor and vulnerable.
PhilHealth recognized that providing risk protection for the 97 million Filipinos is a monumental task but nevertheless possible through innovative stakeholder collaborations.
Under the banner of the Aquino Government’s Kalusugan Pangkalahatan agenda, PhilHealth launched the Case type Z Benefit Package with the objective of cushioning the impact of catastrophic diseases. The package is envisioned to achieve better health outcomes and financial risk protection for PhilHealth members, especially those who have less in life.
In partnership with medicine manufacturers and contracted government hospitals, PhilHealth President Eduardo Banzon announced the roll out of Type Z benefit packages for the estimated 14,000 breast cancer patients, 1,500 patients with prostate cancer, 10,000 patients with renal failure, and 1,500 children with leukemia.
For the initial implementation, the illnesses and their stages/risk classification are: standard risk acute lymphocyte (lymphoblastic) leukemia (ALL) in children - a package rate of P210,000 for the entire cost of treatment for three years; early stage breast cancer - package rate is P100,000 for the entire cost of treatment; the package rate for low to intermediate prostate is P100,000 for the entire cost of treatment; for patients with end stage renal disease requiring kidney transplant (low risk), the package rate is P600,000 for the entire cost of treatment.
Research-based companies Astellas, GlaxoSmithKline, Novartis, Pfizer, Roche and Sanofi-Aventis offered to bring down the prices of medicines for the Z benefit.
As partners of PhiHealth, the companies will ensure that quality medicines at discounted prices, ranging from 30% to 80%, will be made available to qualified Z beneficiaries at all 21 contracted hospitals.
The Z patients will still be able to avail of quality medicines after hospitalization at a price relatively lower than the market price.
Dr. Banzon said that the creation of the Type Z Package also intends to bring dignity back to patients where everyone will have the right to quality health care. This includes access to life-saving medicines that have been products of long, complex, and costly research and development process lasting up to 12 to 15 years.
Some people ask about the benefits of such partnerships to the medicine manufacturers. Some say it is guaranteed volume. The medicines industry views it as an opportunity for public-private partnership in support of the government’s universal health care agenda. After all, it is not everyday that we see the political will of stakeholders, particularly PhilHealth, in pushing universal coverage not by mere membership but with the depth of services it offers.
With these bold moves for innovative collaborations, social solidarity where the financially able subsidizes the poor will be much easier to embrace.
(3) Protecting people’s health
Posted on September 27, 2012 05:56:05 PM
Medicine Cabinet -- Reiner Gloor
IN 2009, Congress passed RA 9711, or the Food and Drug Administration (FDA) Act, to strengthen the capacity of what was formerly known as the Bureau of Food and Drugs. The Act enabled the government to establish, upgrade and augment testing laboratories, field offices, equipment, and human resource. It also allowed the agency to retain its income.
The provisions in the FDA Act were designed to “protect and promote the right to health of the Filipino people” while at the same time “help establish and maintain an effective health products regulatory system” consistent with enhancing its regulatory capacity and strengthening its capability in relation to “the inspection, licensing and monitoring of establishments, and the registration and monitoring of health products.”
Health regulation is one of the six building blocks of universal health care. It is responsible for ensuring access to quality health products, professionals, facilities, and services for the Filipino people. For the Philippines to attain universal health care, reforms in health regulation are necessary to strengthen authorities and finally bring equity in health services.
Part of the Department of Health-Universal Health Care Study Group’s “The Secretary’s Cup” campaign, which aims to inform and engage various sectors in issues concerning the implementation of universal health care is a nationwide debate that discusses the different building blocks of a health system. This month, the debate topics focus on health regulation. Teams from five schools will argue for or against three motions.
First is the motion “That health professionals’ fees be regulated.”
At present, there is no regulation of the fees set by health professionals. Traditionally, they have set their own fees according to what they feel is just compensation, and this is validated by what their own peers have set for the same service rendered. What will be the impact on the practice of medicine if fees were regulated? Will this stifle competitiveness, since fees might be the same regardless of clinical experience and skills? On the other hand, it is also argued that professional fee regulation will protect the patients from being overcharged, and will also make it easier for health professionals to be taxed.
Second is the motion “That advertisement of health products be banned.”
Has the advertisement of health products promoted self-medication and other practices that are said to be detrimental to the people’s health? On the other hand, others may argue that it is the right of the people to be informed about health choices, provided that the cascade of information is consistent with a set of ethical standards. By health products, it refers to products marketed, implicitly or explicitly, to have health benefits. Former Health Secretary Esperanza Cabral attempted to challenge the therapeutic value of some of these products. Was she on the right track?
The third motion is “That the distribution of health technology, health facilities and services be regulated.”
Supporters of this argument cite examples of towns where there are too many specialized diagnostic machines because each hospital bought its own. But in regulating distribution, is the government violating the rights of hospitals and health providers to conduct their business as they see fit? Another example is the distribution of health professionals. Should the government prevent a specialist from practicing in his or her hometown, because it thinks there are too many specialists in that area?
With these discussions, it is hoped that these important issues will be placed in the spotlight as we seek ways to improve health in the country. As former health secretary Alberto Romualdez said, health regulation is all about placing the health of the majority above any other interests.
For more information log on to www.phap.org.ph or www.phapcares.org.ph. E-mail the author at reiner.gloor@gmail.com
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See also:
Socialized Healthcare 4: On Health for All, May 02, 2012
Socialized Healthcare 7: Degnan and Wagner on ICIUM and UHC, September 04, 2012
Socialized Healthcare 8: Anita Wagner on UHC and Medicines, September 05, 2012
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