Social solidarity in health
Business World Weekender: For every P100 spent on health care, about P54 is paid directly from the pocket of Filipinos. For the poor, health spending could even be higher.
Given the high out-of-pocket spending, health has become an additional expense, especially for most of the poor who barely have enough for food and shelter.
According to the National Statistical Coordinating Board’s Family Income and Expenditure Survey (FIES) of 2009, about 30% of the country’s population lives below poverty line.
The bottom 30% of the population spent 59.9% of their money for food, and another 16.2% for house rental, fuel, light and water. Transportation and communication was 3.9% while clothing was 1.9% and medical care, 1.7%.
For those living in Metro Manila, the same survey also revealed that spending for health care declines as one’s income decreases. The survey showed that those whose annual incomes were over P250,000 spent 2% for health care while those who earned less than P40,000 allocated a measly 0.4% of their budget for medical care.
The combination of poverty and high out-of-pocket spending has resulted in catastrophic health spending, giving rise to a vicious cycle where diseases worsen poverty, while poverty results in the rising incidence of diseases.
The World Health Organization (WHO) emphasized that catastrophic health expenditure and its accompanying health, social and economic consequences can be minimized with the adoption of health financing strategies that protect the poor and vulnerable.
In the Philippines, a readily available health financing strategy is Republic Act 7875 otherwise known as the National Health Insurance Act of 1995. The law paved the way for the establishment of the Philippine Health Insurance Corp. (PhilHealth), tasked to provide insurance coverage to all Filipinos and whose mission is to ensure adequate financial access to quality health care services. It adds that access to care must be a function of a person’s health needs rather than his ability to pay.
The 3rd Quarter 2011 Report of PhilHealth showed that more than 78 million Filipinos -- or 82% of the population -- has been covered by the government’s insurance arm. Almost 39 million are being covered under the sponsored program, of whom about 19 million are the poor identified by National Housing Targeting System (NHTS).
But as pointed out by Dr. Ramon Paterno of the University of the Philippines Manila National Institutes of Health (UP-NIH), insurance coverage must be “viewed in terms of breadth, depth, height and utilization by population groups that are most in need of financial protection.”
Utilization is important to establish as mere population coverage does not guarantee that the poor and sponsored members are able to actually use and benefit from their insurance coverage.
Such is the intention of universal health care or Kalusugan Pangkalahatan (KP) that mandates PhilHealth to deliberately put those with less first in line, with the end view of shielding them from financial catastrophe when availing of health care.
Under KP, the Department of Health (DoH) has instructed PhilHealth to redirect its operations towards the improvement of the national and regional benefit delivery ratios, or the cumulative likelihood that any Filipino is eligible to claim benefits; is aware of his entitlements and is able to access and avail of health services from accredited providers; and is fully reimbursed by PhilHealth as far as total health care expenditures are concerned.
Under KP, PhilHealth is also aiming to provide financial risk protection for all wherein 100% of Filipinos, especially the poor, are covered. As PhilHealth President and CEO Eduardo Banzon put it, “no one gets left behind.”
In-patient and outpatient benefits will also be expanded and made simpler so that everyone may be empowered to utilize what belongs to them. Expanded outpatient benefits mean care beyond the current TB-DOTS, maternal care, malaria and certain preventive vaccines coverage, among others.
Given the WHO warning of a continuing non-communicable diseases (NCD) epidemic in low- and middle-income countries, special benefit packages for certain catastrophic diseases will, likewise, boost health outcomes.
The DoH is also putting PhilHealth in charge of enforcing the “no balance billing” policy in government hospitals where members who belong to the poorest income quintile and their beneficiaries will not be required to pay out of pocket for costs for their confinement. This policy hopes to reduce, if not totally eliminate, heavy out-of-pocket health expenses.
High out-of-pocket expenditure can drive even the rich into poverty. While KP seeks to address the health needs of all Filipinos, it will place deliberate attention on those disadvantaged by sickness and poverty. Such is the principle of social solidarity.