Can we achieve universal health care in the Philippines?

By Nickky Faustine P. de Guzman

CAN we copy Cuba’s universal health care program? The socialist nation has one of the best examples of a Universal Health Care (UHC) program in the world: it gives incentives to its doctors to stay, it has a low doctor-patient ratio (currently 1:1,075), and no patients pay out of pocket. All these, and more, were documented in filmmaker Michael Moore’s 2007 documentary, Sicko, where he personally went to Cuba to see how people could just come and go without the need to line up and wait, and no money transactions were ever involved. While there was a “cashier” window, the people do not really pay for health care, but instead get a reimbursement for their travel expenses.

Our own Department of Health (DoH), led by Secretary Paulyn Jean B. Rosell-Ubial, visited Cuba in August to see how the system works and to study what we can copy. The DoH said in previous reports that in order to copy Cuba’s system, we need P57 billion. The proposed DoH budget for 2017 is P140 billion, with P50 billion going to PhilHealth, the national health insurance.

According to Dr. Manuel Dayrit, DoH Secretary from 2001 to 2005 and currently the dean of the Ateneo School of Medicine and Public Health, there is one aspect of Cuban UHC we can adopt:

“The strength of its medical education for community-based care. But in order to do that, we have to revamp the curriculum and revamp the way the market [and] the people, whom want to be doctors [think], you have to get them to think about different ambitions,” he told ����ý on Nov. 15 during the fifth Universal Health care convention in Diamond Hotel, where he served as the panel moderator.

He added: “Right now, the ambitions of different doctors is usually super specialization, and large proportion of them want to go abroad.”

The other factors like Cuba’s smaller population and geographic size and its socialism structure, he said, should be taken in consideration when studying why Cuba was able to push for a successful UHC.

BRAIN DRAIN
One of the challenges in developing UHC here is the growing exodus of practitioners. While there is the Doctors to the Barrios Program, which aims to address the lack of doctors in secluded towns, Dr. Enrique Ona, also a former DoH Secretary and one of the forum’s reactors, said it was only “partially successful.”

“After two years [of finishing the service], they leave. To me it’s partially solving [the need to] entice our young practitioners to the rural areas. [It] was initially a good program but [got] stuck looking into supporting students as scholars, especially those coming from the identified poor localities so that they would be supported for the entire medical education. We need a contract of, for example, a year of education and return of two-year service. If you have a five-year medical school program and the graduates from rural areas stay in those localities for say, 10 years, chances are they won’t leave,” he said.

But then again, we are not a socialist community like Cuba, where major industries are not owned by capitalists but by the government. In the Philippines, majority of our health infrastructures is private, said Mr. Dayrit.

“We are a democratic country, so we cannot force our students to stay,” added Mr. Ona.

A.C.H.I.E.V.E STRATEGY
Part of the current Philippine health care agenda is to have at least one health care worker in each barangay. Also included in the agenda is to provide a mandatory basic check-up for the 20 million poorest Filipinos. The target goal is by the end of the year. Currently, the doctor-patient ratio in the Philippines is 1:30,000 compared to Cuba’s 1: 1,075.

According to Ramon F. Aristoza, Jr., PhilHealth acting Chief Executive Officer, 92% of the population is already covered by PhilHealth, including “the poorest of the poor,” 90% are covered by accredited health facilities where 80% are by the private sector.

To achieve a UHC, the DoH will use the “A.C.H.I.E.V.E.” strategy which stands for:

• Advance primary health care and quality;

• Cover all Filipinos against financial health risk;

• Harness power of strategic human resource;

• Invest in e-Health and data for decision making;

• Enforce standards, accountability, and transparency;

• Value clients and patients; and,

• Elicit multi-sector, multi-stakeholder support for health.

Asking Mr. Dayrit as a former DoH Secretary and now member of a private organization, if he sees the Philippines achieving genuine UHC in the near future, he said:

“We still have a long way to go — you look at it in terms for UHC. There is no financial protection: middle class people, rich people, when they get seriously ill, they have to pay out of pocket,” he said.

He said UHC is about examining issues “particularly how you protect the population from all of the cost.”

Our carefree lifestyle adds to the problem, too. “But also, we really have to strengthen the preventive measures across the board so that fewer people really get sick. Our diabetes, hypertension [rates] are going up, all the lifestyle [related diseases] have to be addressed. And you have to attack it lock, stock, and barrel. People are thinking, ‘Ay may doctor naman eh. I can do what I want’ (There are doctors anyway so I can do what I want). But in the end it is very expensive for society.”