The Duterte Administration is winding down, and the country is preparing to elect a new president two months from now. By June 30, a new administration will be in place to lead the government in the next six years. I tend to think that President Digong’s greatest achievement during his term was to pave the way for the enactment of the Universal Health Care Act.
Admittedly, we have yet to experience all the benefits of that law, Republic Act 11223, which was passed in 2019. More than two years since, many of the law’s provisions are still to be implemented or operationalized. Frankly, I deem it to be a “complicated” law, and I foresee transition to last beyond the next administration.
The law’s objective, of course, is to ensure that all Filipinos can access basic healthcare and ward accommodation, at the government’s cost. Or, simply put, everybody is, in effect, automatically considered a “member” of the Philippine Health Insurance Corp. (PhilHealth), which shoulders the cost of basic health services. Additional health services are also to made available through local governments.
Ideally, even the poorest of the poor and the marginalized should be able to walk into a medical facility in their locality and get medical attention without having to worry about doctors’ fees, hospital cost, procedure cost, or even basic medicine. The thing is, the Philippine health system is far from perfect right now, particularly after the devolution of health services under the Local Government Code was passed in 1991. The system, at present, is fragmented.
RA 11923 aims to address the fragmentation by clearly defining the responsibilities of the National Government, the Local Government Units (LGUs), and PhilHealth in the delivery of health services. However, this objective is far easier said than done, considering what these agencies have to contend with at this point.
PhilHealth, for one, appears to be in a mess — and the issue essentially boils down to questions regarding its management of funds. Controversy after controversy, scandal after scandal, all point to seeming mismanagement as well as gaps in accountability. After numerous congressional hearings on PhilHealth issues, it doesn’t seem we are any closer to truly insulating the institution from abuse and corruption.
This is not to say that PhilHealth cannot be fixed, or its issues cannot be resolved. But it will take time, resources, a lot of political will, and a great deal of competency within PhilHealth to effectively implement universal healthcare. PhilHealth, of course, deals only with the financing side of health service delivery. And, its effectiveness relies heavily on taxation and premium collection.
And this is one of the main issues against universal healthcare, which is funding relying heavily on a generally healthy population that can afford to pay taxes and insurance premiums. It is a matter of having a young and healthy population sustaining a health insurance fund that pays for everybody. Survival means more money coming in than going out.
In a worst-case scenario, somewhat similar to what transpired in 2020-2021, a global economic downturn significantly cut government’s tax collection. And with people losing jobs, some actually de-prioritize the payment of health insurance premiums. And then, with a pandemic wreaking havoc, more people getting sick means health insurance claims or payouts going up.
And then there is the factor of corruption which, to be honest, is a fact of life. Combine all this and you find yourself in a situation where health funds are being depleted faster than they can be replenished. In such a situation, where will universal healthcare go? Of course, this is oversimplifying the situation. However, a worst-case scenario is always a possibility.
A sick population spends more on health, and drains faster whatever pool of funds has been set up to pay for healthcare. A sick population is also less productive, and is less likely to pay taxes, and contribute less premium to health insurance. Overall, this situation makes it also difficult for the government — national or local — to continue subsidizing healthcare costs.
With what we have seen so far, I am inclined to think that the success of universal healthcare lies less on structure and more on reform, particularly in healthcare financing. Even assuming a structure and system where the collection of local and national taxes and health insurance premiums is sufficient and efficient, disbursement abuses, fraud, and corruption can still ruin the system.
Transitioning to universal healthcare is a major public undertaking that requires the support of all stakeholders, including a population that should be uninclined to abuse its benefits. Universal healthcare works only in society that has a strong sense of others, and more likely to think of common good rather than individual entitlements and personal gain.
Universal healthcare is an ideal system that is expected to benefit all. But its success will depend on a putting in place a structure and a system that is honest, tightly regulated, and with effective cost management and controls. And this, I believe, is the main challenge for those tasked to operationalize and implement the Universal Health Care Act and to lead the transition period in the next administration and beyond.
Universal healthcare can succeed only under an honest government, with efficient and effective public service as its main objective. Experience and history show us that the exercise of autonomy and regulatory discretion without accountability, abuse, fraud, and corruption can be its eventual downfall. A good structure and system work only with good people leading it.
Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council