Reinventing universal health care

BANTAY GOBYERNO

Ike Señeres

At the outset, I originally thought that aiming for zero casualties in a typhoon or zero backlogs in a maze of bureaucratic targets. Eventually, I came to realize that universal healthcare is doable, depending of course on how we define the nature of the objectives. Obviously, the number of casualties in a typhoon is beyond our control and we could not even say that it is preventable.

Perhaps, we could say at most that we could try to aim for lesser casualties with some amount of safety precautions, in the same way that we could aim for lesser backlogs by adding more manpower. In the case of universal healthcare however, it involves more than just manpower, because it is an entire universe of factors that are interacting with each other, like planets colliding with meteors.

As I see it, it would be more practical to aim for “universal access to healthcare”, rather than aim for “universal healthcare” per se. I do not mean to sound sarcastic, but “having access” does not necessarily mean “unlimited access” or “open access”, if you know what I mean. In reality, everything in this equation boils down to “healthcare coverage” and further down, it boils down to what the patient pays at the bottom line. In other words, the real bottom line here is how much the patient still has to pay after deducting what the Philippine Health Insurance Corporation (PHILHEALTH) has to pay in terms of the coverage that is due to their members. In a manner of speaking therefore, it could be said that PHILHEALTH could be a tool in allowing most everyone to have access to healthcare, but it does not mean that everything will be paid for.

I recall that I was the one who prepared the first comprehensive Information Systems Strategic Plan (ISSP) for PHILHEALTH. I accepted the assignment based on the joint assumption that it is an insurance company, and not a social services agency. On the basis of that assumption, I submitted the completed plan that was then accepted and approved.

Later on, I found out that the ISSP was eventually disapproved, because a foreign consultant had opined that it did not provide for a social component. Having heard that, I realized that my original assumption had been demolished, and it saddened me, because I knew from the very start that because of that, the actuarial science of PHILHEALTH would not be precise, because I do not see how an insurance company could double up as a social services agency.

Fast forward to today, it appears that President Rodrigo Roa Duterte has found a solution to the problem, by coming out with a Universal Health Care (UHC) law that mandates certain government agencies to contribute funds so that everyone could be covered.

In other words, those who would have the capacity to pay would contribute their own money for the premiums, while those who do not have the capacity to pay would in effect have their premiums paid for by the mandatory contributions. It’s actually a simple idea but it is a brilliant move, because by doing that, everyone as in everyone would have coverage, and in other words, that could already be interpreted to mean universal access to healthcare.

Going direct to the point, we should all understand that universal access to healthcare should not only mean insurance coverage, but also it should mean being able to access all other medical services that are not covered by medical insurance, and that could mean a lot. In that context, having access to private hospitals and clinics is not part of the equation, because in those places, the private patients could presumably pay for every service or procedure, regardless of whether these are covered by medical insurance or not.

Again in this context, what should be in the equation are those patients who have no other choice but to go to the public hospitals and clinics, where in theory everything should be free, such that having medical insurance has no direct bearing at all.

In order to provide for all other medical services that are not covered by medical insurance, it would be necessary to upgrade the facilities of all public hospitals and clinics everywhere. That might sound too ambitious, but it is not any more ambitious than aiming for universal access to healthcare. Of course it could not happen overnight, but it could be a long term goal that could be achieved over the years.

In as much as President Duterte is trying to a lot of things at the national level, it is about time for the local government units (LGUs) to more at their level. After all, these are the local constituents that we are talking about. Perhaps in order to make that happen, we have to reverse history because in the past, many LGUs have not funded their own public hospitals and clinics.

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