ON SEPTEMBER 6, the House of Representatives passed on third and final reading House Bill No. 5784, also known as the Universal Health Coverage (UHC) Act. The bill garnered a total of 222 votes in favor, with only the seven-member Makabayan bloc, who favor nationalizing the health care system, opposing it.

The UHC bill stipulates mandatory enrollment for all Filipinos under the National Health Security Program, a replacement for the current National Health Insurance Program. In addition to this, the five-category structure under the current law will be replaced by a simpler system, consisting of contributory members who pay premiums at a fixed rate and noncontributory members who are subsidized by funds to be earmarked in the national budget.

The measure also replaces the Philippine Health Insurance Corporation with the Philippine Health Security Corporation, and the National Health Insurance Fund with the National Health Security Fund.

The move bears the backing of the congressional leadership, and the Legislative-Executive Development Advisory Council, the agenda-setting body of Congress, has included it in its Common Legislative Agenda for the 17th Congress. Short of the far Left, the bill enjoys broad support across the political spectrum.

Proponents are confident that this measure puts the Philippines on the road to universal health care by bolstering the current supply for health services in the country as well as strengthening the main government insurer through funding and a revamped system of operations.

Through this, Congress seeks to solve the age-old problem where in spite of its mandate to cover all Filipinos, PhilHealth’s implementing rules and regulations actually constrain its ability achieve universal coverage.

Much ado about health insurance

There is a concern, however, that the UHC bill is merely a restatement of the current laws in effect. In fact, its rationale seems to have undercut the gains made by PhilHealth and the health industry for the past few years.

In 2016, PhilHealth claimed coverage of 92% of the population, up from 86% in 2010. Moreover, funding for PhilHealth is at an all time high—an additional Php 3 billion pesos was earmarked for the government insurer in the 2017 national budget, as well as Php 15.114 B in Government Owned and Controlled Corporation subsidies in July—allowing it to aim for the remaining 8% of the population.

By simply rebranding PhilHealth, the government is allowing its substantial pitfalls to go unaddressed: Poor health information management and unreliable coverage.

In a 2011 study, World Health Organization found that in PhilHealth, “members’ perceptions were that they have insufficient information and that the transactional requirements to make claims are too large.” Moreover, members also felt that that the financial protection provided by PhilHealth does not meet the actual medical needs.

In spite of this, the number of indigents enrolled into PhilHealth has increased dramatically since its establishment in 1995. From 15,000 indigent members in 1997, it surged to over 15 million in 2015, making it the largest group whose health care services are subsidized by the insurer.

The problem was now turned on its head. A 2016 study conducted by the Philippine Institute for Development Studies showed that after an aggressive campaign by PhilHealth under the Aquino administration to enroll indigents through the “Aquino Health Agenda for Achieving Universal Health Care for All Filipinos” campaign, numbers of enrollees identified as indigent went above even official poverty estimates.

Moreover, the “No Balance Billing” policy was implemented in Aquino’s term to cover fees in excess of common medical services as they will no longer be held liable to pay for them. This would theoretically reduce the risk of impoverishment as a result of medical expenditure. However, the rate continues to be especially high in the Philippines, with the Lancet Commission on Global Surgery estimating that 50.6% of the total population was at risk of going below the poverty line as a result of surgical care expenditure in 2014.

But despite this, critics point out that the policies of PhilHealth have hardly had an impact on the poor. A recent analysis of out-of-pocket expenditures in the Philippines found that the poorest quintiles are most likely to shoulder money for medicine in lieu of an actual visit to a health facility due to their heavy reliance on the former.

The burden of health payments has risen from 1.8% in 2000 to 4.8% in 2012 and is relatively higher among the richer quintiles as there is an increasing demand for care from them. Households incurring burdensome health payments rose from 0.49% in 2000 to 1.5% in 2012, which translates to about 1.5 million people setting aside 40% of their income on health care.

This means that despite PhilHealth’s efforts to recognize and cater to their needs, indigents still find themselves setting aside much of their already meager income to cover their medical fees. It seems as though whatever is spent for this bill is leaving the real health care problems of the country unaddressed.

Planning ahead

If not the demand, Congress will at least try to solve supply. There is at least one provision in the bill that looks to be significantly different. One of the stated goals of the UHC bill is to ensure “strategic supply side investments” to effectively serve the growing demand for health care in the country.

In line with this, the bill provides for the adoption of Health Technology Assessment (HTA) processes, and the creation of the Health Technology Assessment Council (HTAC), an advisory body to the Secretary of the Department of Health (DOH). The HTAC is tasked with providing recommendations for action to the DOH and PhilHealth with regards to medical technology in the country.

Interestingly, the composition of the council is multisectoral—nine members comprise the Core Committee and are to be of the following professions: A public health epidemiologist, a health economist, an ethicist, a citizen’s representative, a sociologist or anthropologist, a clinical trial or research methods expert, a clinical epidemiologist or evidence-based medicine expert, a medico-legal expert, and a public health expert.

Such a diverse array of views promise a more holistic approach to health so long as its members remain uncompromised; the addition of new perspectives might aid the government’s push for a more efficient system.

The HTAC’s mandate is also sufficiently broad, overseeing “any process of examining or reporting properties of a medical technology used in health care.” In line with this, the HTAC has specific subcommittees working on particular “health interventions.” These include medicinal drugs, vaccines, clinical equipment and devices, medical and surgical procedure, preventive and promotive health services, and traditional medicine.

Through this, Congress hopes to build up a health care industry paralyzed by a lack of proper organization. Government health care units, from the DOH-run hospitals up to the rural health centers under the jurisdiction of local government units, remain woefully inadequate in handling the demands of 103.3 million Filipinos. Private hospitals are medically advanced, but exclusive only to those who are able to pay its expensive fees.

But until then, any future projections on the effects of the bill are tantamount to an exercise in expectations. The UHC bill is ambitious in its scope—it would revamp the whole of Philippine health care, and then some. Such a feat does not happen easily.

The Senate, less inflamed by populist passions, may temper the revolutionary zeal of the Lower House, and bring clarity to parts of the bill. A counterpart bill with similar provisions was filed by Senators JV Ejercito and Nancy Binay on May 31, and is currently pending with the Committee on Health. But if the winds of the current administration are to be heeded, it is that change is definitely coming.

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