Later today, I will attend a round table discussion on
Health System Shapers (HSS), Patients and Consumers Sector, at the Department
of Health (DOH) main office. The goal of this and related fora is to further
fine tune the government’s universal health care (UHC) goal.
Last week, I also attended the two-days (July 25-26) “Policy
Dialogue on UHC and Access to Medicines “ held at the Asian Institute of
Management (AIM) in Makati. Here are two of the definitions or presentations
about UHC.
This one is from DOH UnderSec. Madeleine “Madz” de Rosas
Valera in her presentation, “The Philippine Response to Universal Healthcare and
Access to Medicines 2013”. She added that UHC is one of four major social
investments of the government to help the poor. The other three are public
education, housing and conditional cash transfer (CCT).
And this one is from Dr. David Lee of Management Science
for Health (MSH) in his presentation in the same forum last week, entitled “Medicines
as Part of Universal Health Coverage: The Global Dialogue”
Pondering on UHC, I think the health sector already has
among the monster budget in the country today. Consider the following:
1. Proposed DOH budget for 2014, P80.2 billion, from P50.5
B* this year and P34.0 B in 2012
2. projected PhilHealth revenue 2014, about P80 B, from
about P62 B this year and P47 B in 2012. (Revenues almost equal Benefits
payment per year)
3. PGH budget, P2+ B, from P2 B this year
4. AFP hospital, P1.5 (?) B, from P1.3 B this year
5. PNP hospital, Veterans hospital, etc.
6. Other state universities' hospitals
7. PCSO, PAGCOR, SSS, GSIS, etc. health spending
9. Provincial, District, City, Municipal hospitals **
10. Provincial, City, Municipal, Barangay health centers
11. WHO, WB, ADB, UN agencies, multilateral grants
12. USAID, JICA, KOICA, CIDA, EU, etc. bilateral grants
* I saw the DOH presentation last year for its 2013
budget, they were spending on a P42B approved budget, now it has been revised
to P34 B? What happened to the P8 B? Can an approved budget still be slashed? Weird…
will ask around why.
** Total number as of 2013: (a) DOH hospitals 60, (b) LGU
hospitals 584,
(c) Rural health units (RHUS) 1,285, and (d) Barangay
health stations (BHS) 962. The nearly 600 LGU hospitals alone, I think they will
have at least P50 billion budget next year.
Should be P300+ B next year alone? And that’s for
government spending alone.
I am wondering if there was any study conducted by the
UHC study group (UP Manila), Health Policy Development Program (HPDP, UPSE + UP
Manila + other colleges?) or other groups, detailing how much really is spent
by the public sector alone yearly, on healthcare?
It seems none, except that every year, there is belief
that there is "not enough money,
give more money, raise more money, to public health."
Meanwhile, there are various private and civil society
spending on health charities. PHAP Foundation gives about P100+ M a year , Unilab
another P100M? other PCPI-affiliated pharma. Zuellig Foundation, Rotary Foundation, GMA Kapuso
foundation, ABS-CBN foundation, St. Lukes Foundation, MMC Foundation, etc.
I think ALL foundations and private charity organization have
health spending in one way or another. Plus extra spending during calamities, like individuals
donating money or medical products and devices.
So we are talking of possibly P500+ billion health
spending in one year alone?
And many people still think that health spending is still
"not enough". hmmmm...
The first line of UHC for the poor are the RHUs, BHS, and
LGU hospitals. The second line will be the DOH hospitals, Philippine General
Hospital (PGH), other state universities’ hospitals, AFP hospital, other
departments’ health facilities. Plus the charity emergency/wards of private
hospitals. That is for outpatient services (have fever, or headache, stomach
ache, then go home after consultation) and wards in case of confinement.
PhilHealth should be considered as a third line in UHC of
the poor. Yet PhilHealth is the main discussion point when people talk about
UHC.
PhilHealth is NOT a healthcare provider, unlike those
RHUs, BHS, LGU hospitals. PhilHealth is only a health financier, for those who
are hospitalized, and assuming that they were not technically disqualified, say
they forgot to pay the premium last month or a few months back. Or they are
unmarried couple.
So the focus on expanding PhilHealth coverage may be a secondary
consideration compared to improving the healthcare delivery of those RHUs, BHSs
and LGU hospitals.
As an advocate of minimal government involvement, in
healthcare in this case, I maintain that PhilHealth membership should not be
made mandatory and obligatory for all people. What should be made mandatory is
that all people, children especially, should have health insurance – whether from
private charity organizations and foundations, or private HMOs, or some health
NGOs, or LGU schemes and hospitals, or from PhilHealth.
