POLICY ANALYSTS Paolo Syling and Arjay Mercado discussed reforms under the new Universal Health Coverage (UHC) Law and proposed additional courses of action in “Democratizing Access to Health Care through Universal Health Coverage” on October 10 at the Social Sciences Case Study Room.
They touched on key provisions aiming to make public healthcare more affordable and effective, and how these can be advanced through the Sin Tax Reform Law.
The talk was one of many organized for Talakayang Alay sa Bayan (TALAB) 2018, an annual event offering the LS community a platform to learn about and engage in national issues through various talks and alternative classes.
Four pillars of health reform
Syling, a health policy and systems research fellow at the Department of Health (DOH) discussed the key provisions of the UHC in relation to the four pillars of health reform: financing, service delivery, regulation, and governance.
He explained that the current Philippine Health Insurance System (PhilHealth) segments membership into different sectors: workers with formal contracts and fixed terms of employment, OFWs, individuals who have no source of income or whose income cannot sustain their families (indigents), senior citizens, lifetime members, and sponsored members. According to Syling, this makes it difficult to retain and much less, increase membership, which is self-initiated and voluntary with complex eligibility rules.
“Under the proposed UHC bill, everyone is a PhilHealth member by default,” he said.
He added that UHC will further simplify membership by categorizing beneficiaries only into two categories: direct contributors, comprising public and private workers who make premium contributions from payroll, and indirect contributors, who are fully subsidized by tax collections.
Syling then tackled service coverage as the second pillar of health reform, saying that benefits afforded under the current PhilHealth system vary per individual. He explained that as specific services are made available to some, but not to others, service coverage becomes insufficient and selective especially on the part of indigents.
He explained that this will not be a problem under UHC, as the bill outlines a uniform health benefit package.
On matters of regulation, he mentioned the poor implementation of No Balance Billing (NBB), which is the policy allowing a patient to avail of free services.
According to Syling, many health care providers still bill their patients for treatment they might not be able to pay “out-of-pocket.” He said that the UHC will provide for the imposition of stricter rules and sanctions in order to combat this
He also highlighted that the bill will also require return service of at least two years for all publicly-funded health professionals in order to address workforce gaps in the public health care system.
For the pillar of governance, Syling described that governance of the healthcare system suffers from a lack of research. He discovered through his work for DOH that there is very limited data that can be used to analyze and evaluate their services.
As such, the UHC will mandate all healthcare providers to submit encoded administrative, clinical, and costing data to be used for research, a practice Syling said would improve governance.
Sin tax
After this, Arjay Mercado, a researcher from Action for Economic Reform (AER), discussed the economics of UHC in relation to sin tax.
Mercado explained that a key feature of RA 10351, or the Sin Tax Reform Law, provides for the delegation of 85% of revenues collected from sin tax to UHC. To give a clearer picture of the percentage cut the UHC receives from sin tax, he said that in 2016, Php 31.26 B of the Php 69.4 B collected from sin tax revenue was spent for the PhilHealth premium of poor families.
He also pointed out that there is still plenty of potential growth in revenues collected from sin tax, as the price of tobacco in the Philippines falls short of the average cost globally.
Stating that the Philippines ranked 4th in the ASEAN of countries with the highest proportion of smokers in 2016, he clarified that increasing sin tax revenue is definitely an achievable goal, which does not run contrary to deterring people from smoking in the first place. “[Both are] possible because demand for tobacco is inelastic,” he said. Mercado explained that this means poorer, more disadvantaged social classes may be discouraged from buying tobacco as sin tax rates get higher, but other richer sectors will continue to purchase cigarettes regardless of hikes in price.
To support this, he showed a chart illustrating an increase in the number of people who have never smoked after the Sin Tax Law was passed, where in 2008, only 54.3% of the population consisted of what he called “never-smokers.” This percentage grew to 63.7% in 2015, 3 years after the legislation was passed.
A brighter future
For his portion of the talk, Health Sciences associate program director Dr. Norman Marquez synthesized the talks and circled back to a discussion on prioritization. He said that secondary and tertiary care—specialized care like cancer treatment, hospital care, and care provided at the emergency rooms)—historically take first place over primary care, or general practice at clinics and health care centers.
“‘Yung tendency kasi, pag may problema, takbo agad sa ER (The tendency is that when there are problems, we run straight to the emergency room),” he said, adding that this happens as a result of a lack of funding for primary health care centers. He relayed his hopes that the proposed policy will address this.
Marquez concluded the talk by clarifying what it means to democratize access to health care. He told the audience that when people talk about access, it is often pertained to in its literal denotation.
“But when we talk about access, it shouldn’t just be about availability, but also the quality, affordability, and sustainability of the services,” he said. “True access to healthcare creates an empowered population.”
