UHC 26: Public and Private Spending on Health

The 3rd paper which I briefly discussed in Ateneo last Wednesday night was about healthcare spending. Some data here I belatedly added as I ran out of time preparing three different topics in one lecture.

I also used some old data, 2011, 2007, but current numbers should not be too different.

A time series data on number of physicians over 22 years in selected Asian countries.

Many people say that government spending in healthcare is "not enough". Really? These national and local agencies are not small. Public spending in healthcare is big. What makes them "small" perhaps is the huge amount of wastes and leakage. Like spending more money on salaries and perks of government personnel and officials who are not providing relevant or useful service delivery.

Universal healthcare (UHC) in the Philippines.

An example of wastes and leakage in the government health delivery system.

Private spending in health, at least in the corporate and pharma sector.

Average life expectancy of people anywhere in the planet is rising. Many people do not recognize this and only point out the pessimistic and negative scenario.

I made the following concluding notes.

* Reduce taxes on medicines and healthcare. import tax 1-5% + VAT 12% + local government taxes.

* Encourage, invite more players in pharma (innovators and generics), drugstores, hospitals. Competition from more players is often the best insurance to bring down prices and improve products and  services quality.

* Focus on fighting substandard, fake medicines, in partnership with civil society. Protect the public via quality control, not drug price control,

* Do not re-centralize healtcare, allow decentralization and competition among LGUs, among private health  insurance, drugstores, hospitals, pharma.

The 15-slides presentation is available in  my slideshare account.
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See also: 

UHC 22: Shortage of Doctors in the Philippines, February 10, 2014 

UHC 23: Orthopedic Hospital Corporatization, Not Privatization, February 21, 2014 

UHC 24: Corruption in Government Purchase of Medicines, April 02, 2014 

UHC 25: Some Physician Stories in Hospital ERs, Wards, July 29, 2014 

IPR and Medicines 31: The Policy Workshop's Hong Kong Dialogue, November 28,  2014

PhilHealth Watch 12: Assistance to Leptospirosis Patients

* This is my article yesterday in the online magazine,
http://www.thelobbyist.biz/perspectives/less-gorvernment/1348-philhealth-and-leptospirosis-patients
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Contribution to the Philippine Health Insurance Corporation (PhilHealth) is not strictly considered as a tax, similar to Pag-IBIG (housing), SSS and GSIS contributions, as they are dedicated funds and are not incorporated in the National Internal Revenue Code (NIRC).

But there is one thing that makes them very similar to ordinary tax measures: they are mandatory, obligatory or forcible payment to the government. Whether one believes in PhilHealth, SSS, Pag-IBIG or other mandatory contributions or not, these contributions are automatically deducted to one’s monthly pay. So that fixed income earners have no choice but to pay for these three mandatory contributions each month, on top of the monthly withholding personal income tax.

The Department of Health (DOH), the mother agency of PhilHealth, announced last week that

(P)ersons in areas affected by the heavy southwest monsoon rains and diagnosed with leptospirosis shall be automatically covered by the PhilHealth, including non-members…

According to PhilHealth Circular 39 series of 2012, non-members living in these flood-stricken areas shall also be accorded the benefits due the PhilHealth Sponsored Program members/beneficiaries. For non-members less than 21 years of age whose parents are neither member, one parent shall be automatically covered.

Being automatically covered as PhilHealth Sponsored program members mean that they shall not be required to pay premiums and that they shall be considered members for the period from August 1, 2012 to July 31, 2013, with a number card. This privilege shall be applicable for all admissions starting 7 August to the end of this month.

This would sound unfair to regularly-paying PhilHealth members as their contributions that can be considered as additional “health tax” are being used to support people who do not contribute to the fund. There is already the DOH budget that is partly financed by their regular tax payment (income tax, VAT, excise tax, import tax, etc.), or local government units that are financed by internal revenue allotment (IRA) and local taxes, that are supposed to help these people.

There is validity in this argument. Many regularly paying members in the formal sector complain that when they or their dependents are hospitalized, PhilHealth share or deduction to total hospital bill is sometimes small, that PhilHealth can be “stingy” to them who religiously pay monthly for many years while PhilHealth can be gallant in paying the hospitalization bill of those who do not contribute to the fund.

I share the above opinion. But I also recognize that leptospirosis, being an infectious and lethal disease, can be very costly to the poor whose houses are already submerged in floodwater for many hours or days. So social contribution like PhilHealth assistance can be a great support for these poor people.

The DOH reported that “a total of 2,471 leptospirosis cases were reported nationwide from January 1 to August 18 this year. This is 62% higher compared to the same time period last year (1,522 cases). There were 121 deaths…. hospital admissions of Leptospirosis in Metro Manila from August 5-22 already included 783 cases and 34 deaths.”

There is lesson for the government here in the light of endless budget deficit (revenues are lower than expenditures) and ever-rising public debt. The limited funding of the DOH and local government units’ healthcare programs should be focused on dealing with infectious or communicable diseases as well as children’s diseases. There are many infectious diseases that remain lethal until now aside from leptospirosis: dengue, malaria, menningococcemia, hand foot and mouth disease (HFMD), typhoid fever, cholera and many others.

Using taxpayers’ money and the health tax or PhilHealth mandatory contribution to treat lifestyle-related diseases by non-members is not fair. No one put a gun on people’s heads so that they should over-drink or over-smoke or over-eat or ovet-sit. Engaging in the said activities will hasten the onslaught of various type of diseases like cardiovascular, cerebrovascular, malignant neoplasm or cancer various types, tuberculosis and diabetes.

The implication for the above case is to further deregulate private health insurance schemes. If people can afford to consume high volume of alcoholic or tobacco or fatty food and drinks, then they should also have the resources to purchase additional private health insurance on top of their PhilHealth mandatory membership. This dual health insurance should drastically reduce their spending should they get hospitalized or become more sickly someday.

The important point is that DOH budget, PhilHealth fund, and LGUs’ health spending should be concentrated in dealing with various infectious and pediatric diseases. And even to help people with physical or mental challenges like the blind, the deaf, crippled, autistic and related cases.

Taxpayers and PhilHealth members who regularly pay their taxes and mandatory contributions would not feel being cheated this way.
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See also:
PhilHealth Watch 6: Bogus claims and robbery, June 15, 2011
PhilHealth Watch 7: Deregulate PhilSick, October 09, 2011
PhilHealth Watch 8: Alternatives to PhilSick Monopoly, October 13, 2011
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

Childcare 9: Immunization and Government

Immunization of children of some preventable infectious/communicable diseases, well those diseases that tend to victimize the young and which there are existing vaccines already, whether patented or off-patent, is one important role that governments can provide. So again, I am no health anarchist, rather a health (or other social issues) minarchist.

For lifestyle-related diseases affecting many adult people, government should step back, allow people to take more personal responsibility in running their own lives. They can purchase private health insurance for instance, since they have the resources to buy plenty of alcohol and/or tobacco products, plenty of money to over-eat high-fatty, high-salt fast food, it should be fair that they also set aside money for their private health insurance, on top of government mandatory health insurance. This is one government coercion that is difficult or almost impossible to be shrunk and limited.

Sharing below three articles by the Executive Director of PHAP, Reiner Gloor, on immunization and vaccination of children, published in his column in BusinessWorld. These papers are about (a) immunization, (b) controlling pneumonia, and (c) anti-flu vaccines.

(1) Immunization as national priority  

July 13, 2012
Medicine Cabinet -- Reiner W. Gloor

http://www.bworldonline.com/weekender/content.php?id=55029

Ministers of health from 194 countries recently endorsed a global roadmap to prevent millions of deaths by 2020 through wider and sustained access to vaccines.

During the 65th World Health Assembly, health ministers set into action the Global Vaccine Action Plan (GVAP) that hopes to achieve an ambitious vision of a world where all individuals and communities enjoy lives free from vaccine-preventable diseases in a decade’s time until 2020.

The mission of the so-called Decade of Vaccines is to extend, by 2020 and beyond, the full benefit of immunization to all people, regardless of where they are born, who they are or where they live.

During the decade, one of the goals is to achieve commitments to eliminate and eradicate poliomyelitis, measles, rubella and neonatal tetanus at the global or regional level. The GVAP emphasized that attaining the goal within the decade is critical as success will encourage the realization of further goals while “failure means millions of preventable cases of disease and death will continue to occur.”

Apart from saving millions of lives by the end of the decade, realization of immunization-specific goals will result in economic productivity gains and at the same time, contribute to exceeding the Millennium Development Goal 4 to reduce child mortality by two thirds.

It is estimated that about 26 million future deaths could be prevented if the coverage targets for introduction and/or sustained use of 10 vaccines are met in 94 countries within the decade. The said estimate is for the 10 vaccine preventable diseases: hepatitis B, Haemophilus influenzae type b, human papillomavirus, Japanese encephalitis, measles, meningococcus A, pneumococcus, rotavirus, rubella and yellow fever.

Hopes are high about reducing vaccine preventable diseases following important milestones including the development, licensure and introduction of new and improved vaccines and technologies for high-burden diseases.

However, the GVAP stressed that these accomplishments will not be sustained unless countries take full ownership of their routine immunization programmes. As such, one of the six strategic objectives of GVAP to achieve the goals of the Decade of Vaccines is for all countries to commit to immunization as a national priority.

Acknowledging the value of immunization as an important public health intervention to save lives is the first step. Setting national targets and providing needed financial and human resource investments are relevant to demonstrate commitment to immunization.