Vision for DOH: Primary care system, the blueprint for change

Column-Dr Anthony Leachon

Preventive Health Education

By Anthony C. Leachon, MD

WHAT’S our vision of our healthcare system?

Paying for health did receive a major boost after President Aquino successfully pushed for the adjustment and increase in taxes on cigarettes and alcohol—the so-called “sin taxes.” The health budget went from PhP 25 billion in 2010 to PhP 87 billion last year, PhP 34 billion of that coming from sin taxes.

This has allowed the government to widen PhilHealth coverage to 90 percent of the populace. But the coverage is almost entirely focused on costs incurred when someone is hospitalized, while the vast majority of illnesses can and should be managed before the need for hospital confinement.

As a result, most of the time, Filipinos have to cover the cost of their treatment out of their own pocket. Too often, serious illnesses bankrupt families. Thus, wider, deeper coverage is an area where real attention is needed.

Even in countries with very broad coverage, there is continuing debate on who gets covered for what and for how much. Government focus should be on providing free medical service to all those who can’t afford it, and lesser payment for those who can. That provides the choice between public hospitals vs. private ones, generic drugs vs. branded ones, public health clinics vs. private ones, and government doctors and medical workers vs. private ones.

What I’d give more attention to is preventing illness and catching it early on when cure is simpler and cheaper. Strengthening primary healthcare and outpatient systems will help do this. It will also take pressure off overworked doctors and hospitals dealing with illnesses that aren’t serious.

Tied to this is the need for more clinics and an upgrading of those facilities with more space, better equipment and services—and a greater, closer involvement of local government units who at any rate are mandated to provide this support. That greater involvement is absent in many local communities; the sense of priority is lacking. You should see the grandiose design of some city halls versus the derelict condition of the local hospital.

In 2013, total spending on health was about 4.4 percent; this is below the minimum 5 percent that the WHO recommends. Worse, of that 4.4 percent, only 0.44 percent was spent by the government. That means people are spending their own money for most of health spending. The out of pocket expenses by patients is 56 percent, which is one of the highest in Southeast Asia.

Spending more is not of course the only thing that needs to be done. Better use of the money is as important. PhilHealth needs to expand its coverage of services, including the provision of medicines for primary healthcare and more cover for serious illnesses.

At present, only 6.5 percent of PhilHealth benefit payments go to primary care, while the majority goes to in-hospital services and other benefits.

There’s a thing called the Philippine National Formulary that lists all drugs that physicians in public facilities can use. If a drug is not listed, then a patient seeking treatment in a public hospital cannot be prescribed with it. A patient can purchase a drug not listed but must pay for it. The list must be regularly updated and become dynamic so that new life-saving drugs are available soon after approval of the Food and Drug Administration. And it’s important that drugs are available promptly through an effective supply chain management system.

The private sector should be a partner in all of this—not two separate systems but a holistic one that works seamlessly. The successful public-private partnership concept can be applied here. The private sector can build or rehabilitate hospitals, even health clinics, and maintain them. And let’s keep the doctors and nurses at home where they are truly needed. And that means paying them well.

In the final analysis, leading a healthy lifestyle should be the aim of everyone, and a major focus of the government’s efforts. To look after people’s health before they get sick should be a primary part of any health program.

It’s time for genuine change now or never.

Vital Signs Issue 87 Vol. 4, May 1-31 2016