Before
tackling the costs and benefits of PhilHealth, here is an important situationer
on healthcare in the Philippines in 2009, the latest available data.
Source: National
Epidemiology Center, Department of Health; The 2009 Health Statistics
In red are non-infectious or non-communicable diseases (NCDs).
Diseases of the heart or
cardiopathy include coronary heart disease, cardiovascular disease, heart failure,
hypertensive heart disease, cardiomyopathy, and so on. Vascular diseases or
more commonly called as “stroke” refer to brain dysfunction related to diseases
of the blood vessels supplying the brain. Main cause is hypertension. Cancers,
there are probably 200+ different types of cancer.
In terms of the main causes of morbidity, NCDs
do not figure much, except hypertension. Infectious and communicable diseases
are the top causes.
Despite these, the average lifespan of
Filipinos is rising, 67 years and 73 years for male and female, respectively,
or average of 70 years for both sexes. This is lower than the Asian average but
higher than the global average.
Table 2. Selected Health Indicators, 2010
Source:
WHO, http://www.who.int/gho/countries/phl.pdf
The cost
of PhilHealth.
The budget
of the Department of Health has shown huge increases recently. From only P18.91
B in 2008 to P31.83 B in 2011, then P42.08 B in 2012 and P53.06 B this year. The big rise in recent years is due to
increased premium payment for the DOH sponsored program for PhilHealth
membership, some 5.2 million households were newly enrolled in PhilHealth. The DOH budget is from taxes and other government
revenues plus borrowings.
PhilHealth
spending does not come from taxes or borrowings. It comes from mandatory
contributions of those in the formal sector, government and private, from
individually-paying self-employed people, and from the DOH and LGUs who sponsor
the annual premum of several million poor households.
LGUs also
have their own healthcare programs for their poor residents, like having their
own city or provincial hospitals, barangay/municipal/city health centers, and
LGU payment and enrollment of some 5 million poor households to PhilHealth,
meaning the LGUs paid for their annual premium. And other government agencies
also provide free or cheap healthcare to the poor, like the Philippine General
Hospital (PGH), AFP hospital, PNP hospital, and so on.
Mandatory
contributions to PhilHealth are:
1. Formal/employed,
from 2.5 to 3.0 percent of monthly salary
2.
Sponsored program and informal non-poor, from P1,200 to P2,400 per year
3. OFWs,
from P900 to P1,200 per year
4.
Lifetime members/retired, none.
Benefits
of PhilHealth.
People who
get hospitalized due to serious diseases will worry less when the hospital bill
comes. PhilHealth will pay for various services such as physicians’ fee,
laboratory and diagnostic tests fee, hospital room fee, surgery if any,
medicines, and so on.
Traditionally,
PhilHealth covers only patients who are confined in accredited hospitals for at
least 24 hours. Meaning if the patient
stays in the emergency room for 23 hours or less and go home afterwards, the
corporation will not pay for any of the bill.
Recently,
PhilHealth also pays for outpatient services for poor members through the
primary care benefit (PCB) package.
In a
presentation last April 10, 2013 at the MeTA Philippines forum held at the
Asian Institute of Management, PhilHealth officials led by Dr. Riza Herrera and
Dr. Liezel Lagrada discussed an update about the corporation’s packages 1 and 2.
Among the striking facts in their presentation was the big jump in claims for four
major NCDs from 2002 to 2012. Claims for hypertension rose from 50,000+ to around
220,000; cancer-related claims rose also from 50,000+ to around 210,000; and
heart diseases, from about 25,000 to around 110,000.
Figure 1. PhilHealth claims for four
NCDs.
The above
chart confirms the prevalence of NCDs as leading causes of death in the country,
also worldwide.
In terms
of actual payment for the same period, hypertension rose from P0.5 billion to
around P3.6 billion; cancers rose from around P0.3 billion to around P1.8
billion.
Figure 2. Payment for Claims for four
NCDs.
The plan
of PhilHealth and the DOH, with signals from the UN and WHO, is to control
NCDs.
The
exchanges that followed the presentation were very lively and spontaneous as
the audience came from various backgrounds – drugstore owners, drug
manufacturers, academe, NGOs, health professional associations, DOH, PhilHealth
and so on. Most of the questions, comments and suggestions, explicitly or
implicitly, were directed at how PhilHealth should further consolidate and
centralize more healthcare delivery.
And this
is where I do not agree. People should not expect too much from PhilHealth.
More expectations, more disappointment. As mentioned above, there are other
government agencies, local and national, that provide free or cheap healthcare
for the poor even if they are not PhilHealth members and contributors. Then
there are private foundations, charitable individuals, civil society groups
like Rotary Clubs that conduct regular medical missions to the poor.
Limit
PhilHealth Payment and Contribution.
PhilHealth
must veer away from spending more on outpatient
services for NCDs. It must focus instead on infectious or communicable
diseases, pediatric diseases. A patient who has dengue or malaria can easily be
treated even if hospitalized for several days. After that the patient goes home
and may not come back to the hospital and take PhilHealth claims for several
years.
Contrast that
to someone who has lung cancer due to over-smoking, or has liver cancer due to
over-drinking, or fat and has various diseases of the heart due to over-eating
and sedentary lifestyle. This type of patients will keep coming and coming for
difficult and complicated treatment and maintenance medications. PhilHealth
reserves can sink if not go bankrupt with more of this type of patients. Or
PhilHealth will raise the premium from the current 3 percent to 5 percent or
higher just to prevent bankruptcy.
The
appropriate policy is to limit PhilHealth exposure to the former type of
patients for outpatient services and primary care package. If people can have
money to buy lots of alcohol or tobacco or fatty food and drinks, then they
should have money also to buy private health insurance, on top of their
PhilHealth insurance and DOH or LGU healthcare spending.
Let
private providers of healthcare offer various packages at various premium
payment for various people with various income. Those who are less responsible
of their own body or their family should get more elaborate private health
insurance. If they are poor, they can approach private charities, charitable
individuals and friends, to cover for their funding gap.
Private
healthcare providers are under pressure to produce good services to their
clients, to satisfy their customers. If their customers are unhappy, they can
go bankrupt. This pressure is absent in government healthcare providers because
their funding comes from forced and mandatory payment. Even if the public are
unhappy with their services, people are forced to contribute money to these
agencies.
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See also:
PhilHealth Watch 11: Is PHIC an Insurance Company?, June 12, 2012
PhilHealth Watch 12: Assistance to Leptospirosis Patients, September 03, 2012
PhilHealth Watch 13: SHInES on Social Solidarity, November 26, 2012
PhilHealth Watch 11: Is PHIC an Insurance Company?, June 12, 2012
PhilHealth Watch 12: Assistance to Leptospirosis Patients, September 03, 2012
PhilHealth Watch 13: SHInES on Social Solidarity, November 26, 2012
PhilHealth Watch 14: Not Yet 85 Percent Coverage, January 10, 2013
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