But ever since “health reforms” such as devolution and corporatization were implemented, public health care in the country increasingly began needing more and more out-of-pocket payments as well from patients. After devolution, public health care became the responsibility of local government units, Thus, many government hospitals turned over by the DoH to local government units deteriorated because of the lack in budget, especially in poor provinces , cities, and municipalities. Worse, health-care services have become so “politicized and dependent on the generosity of the local government,” said former Bulacan governor Josie dela Cruz. The result is that even a skilled municipal health officer could not do much if the mayor refused to allot sufficient budget for health.
“If only there are properly equipped people in health centers, patients would no longer go to hospitals,” said dela Cruz. But even in public hospitals, where the thrust of corporatization is being implemented to be able to raise its own budget because of the reduction in government subsidies, patients have to pay for a lot of the services and use of facilities before he or she could get well, Emma Manuel, president of the Alliance of Health Workers, told Bulatlat.com in a separate interview.
Health as Business
“(The) DOH is mistaken in its premise that its measly budget will enable it to fulfill its obligation to provide much needed and life-saving health services for more than 70 percent of Filipinos who could not even afford to buy antibiotics, pay for X-ray and other laboratory exams,” said de Jesus of Gabriela. The women’s group affirms that among their poor constituencies, patients tend to forgo going to the health center because of the absence of medicines or physicians who will attend to them. “Others requiring tertiary care will go to the hospital at the very last minute because they know they could not afford the attendant expenses of seeking health services, even in public health facilities,” de Jesus said.
The budget for Maintenance and Other Operating Expenses (MOOEs) of public hospitals have been reduced by as much as 50 percent in the national budget for 2011. “The MOOEs are the operational funds of these hospitals, their very life-blood,” said Dr. Geneve Rivera, secretary-general of HEAD. “If these are not enough, then the provision of direct health services will be adversely and severely affected. Filipino patients will suffer for this.”
The cutbacks in the budget for public hospitals have also resulted in a chronic shortage of health professionals and workers. The number of nurses in public hospitals has gone down from 19,052 to 17,000 in 2003-2008 according to data from the National Institute for Health. Since 1985 the plantilla positions for nurses remained the same, despite the increase in the population and the number of qualified nurses willing to work in the country.
The only major increase that HEAD noted in the health budget was in the Health Facilities Enhancement Program, which since 2008 had received huge allotments as the government also began pushing for medical tourism.
Limits of PhilHealth’s ‘Universal’ Coverage
The Aquino government has aggressively been pushing for “universal” coverage of PhilHealth. But as Dr. Alvin Caballes from the Social Medicine Unit of the UP College of Medicine said in a health workshop last month sponsored by Newsbreak and the Pharmaceutical and Healthcare Association of the Philippines (PHAP), “Everybody’s being urged to enroll in PhilHealth but nobody’s urging us to use it.”
The PhilHealth card is not being accepted in most private hospitals and is also useless in poorly provisioned public hospitals with no medicines, the HEAD said in a statement. Health Secretary Ona told a gathering of pharmaceutical executives last August that they intend to increase the benefits being enjoyed by PhilHealth members, and reduce their out-of-pocket expenses which, by Ona’s reckoning, was at least 54 percent. It was higher in reality, said health advocates.
According to Dr. Caballes, PhilHealth has been accumulating savings faster than its spending on health. “In reality, 85 percent of poor Filipinos are supposed to be covered, but they don’t avail of it.” They may be enrolled but they don’t use it because, according to complaints, the processes involved are so “labyrinthine,” Caballes said.
Run like a corporation, PhilHealth in 2008 granted only P18.1 billion ($412.4 million) in benefit payments yet collected premiums amounting to P28 billion ($638m) in the same year. In 2009, PhilHealth saved less than P2 billion ($46 million) as it collected P26 billion ($592m) in premiums and disbursed P24.3 billion ($554m). From 2008 to 2009, PhilHealth grew its investment portfolio from P85.2 billion to P92.1 billion ($2.1 b).
Even former Health Secretary Alberto Romualdez stressed in a Health Outlook Forum the “need to increase tax-based coordinated government spending and the reorientation of Philhealth as a true social health insurance.” It appears that the compulsory health insurance coverage for all Filipinos is just a major step to generate funds.
Health experts say Filipino households are spending more for health care but not getting the benefits due them. Despite high contributions for social insurance, the DOH itself reportedly admits that access to health services and products is not enough and health care protection does not happen where it is needed most.
But instead of directly addressing this, the Aquino government appears set on increasing PhilHealth and membership contributions even as it forces public hospitals to raise its own funds. The result is that public hospitals charge patients for much of the services it provides them.
In October this year, as the DOH restarted its aggressive PhilHealth registration, it also started implementing a 100-percent to 200-percent hike in the premium of individually paying members (IPMs). Members of urban poor group Kadamay and progressive labor center Kilusang Mayo Uno protested.
“While people are made to pay two to three times more for health services, the government budget for PhilHealth is slashed by one third under president Aquino’s budget proposal,” KMU general secretary Roger Soluta during a protest in front of the PhilHealth head office in Pasig last October.
KMU also countered statements of PhilHealth officials and Aquino spokespersons claiming that the premium increase will not affect ordinary workers, as the list of professions qualified for the increase include accountants, librarians, social workers, and nurses.
Under the new payment scheme, IPMs falling under the more than 40 professions listed by PhilHealth will be made to pay P600 ($14) per quarter for one year, then P900 ($21) per quarter for the next year. The old rate of P300 ($7), which has been the rate for all PhilHealth members for nine years already, will be retained only to those with annual incomes below P25,000 ($570).
“The P25,000 ($570) annual income ceiling will not even exempt minimum wage earners and contractual workers from the 200 percent increase,” Soluta said.
In Davao City, members of Kadamay picketed in front of the PhilHealth office in time of Aquino’s first 100 days in office. “Where is the ‘health within our reach’ program that he promised during his State of the Nation Address?” asked Franchie Buhayan, spokesperson of Kadamay in the area.
The Aquino administration seems bent on making health care a profitable venture rather than a social obligation to the people, critics say. “It is pushing for the further privatization of health care. Sadly, the promised changes are all illusory,” said Dr. Rivera of HEAD.