The ‘universal’ in universal healthcare

By Reyshimar Arguelles

The rationale of universal healthcare is not that difficult to understand. The term “universal” describes the need to make quality healthcare accessible to all, especially those who are hard up. But how is better accessibility attained?

For the World Health Organization, such a system ensures “people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the (sic) financial hardship.”

Let us take a closer look into the issue of financial hardship. A 2018 report released by Aon noted a rising trend in global healthcare costs due to “population aging, overall declining health, poor lifestyle habits becoming pervasive in emerging countries, continuing cost shifting from social programs, and increasing utilization of employer-sponsored plans.”

Despite rising healthcare spending among low-income and middle-income countries, governments in these countries get an average 35% of their healthcare funding from out-of-pocket payments. According to the WHO, this could result in pushing people into extreme poverty.

Sure enough, the Philippine Wellness Index released last year found that 40% of Filipinos were uncertain if they could afford their hospital bills and 37% said they could use up their savings to afford medical care. With the current CoViD-19 pandemic in mind, the affordability of healthcare facilities would have created another crisis on its own, which was at least alleviated by the introduction of the Universal Healthcare Law last year.

The law seeks to enroll all Filipinos to the National Health Care Program, providing for immediate access to a variety of health services. Indeed, the enactment of universal health care — which is a hallmark of progressive societies — is timely in the face of a serious global health emergency. With public hospitals being overrun by serious cases of CoViD-19, patients may have to seek a costly room at a private hospital where they are charged millions of pesos.

Recently, the Philippine Health Insurance Corporation said that it will shoulder the full costs of severe CoViD-19 cases — which is a good thing since we all need the government to take this crisis seriously after it had wrongly underestimated the virus’ lethal potential.

Through the Universal Health Care Law, the government is able to offset the cost of tests, hospital equipment, professional fees, and other expenses. It gets the bulk of its healthcare funding from sin taxes, revenues from the Philippine Amusement and Gaming Corporation, member premiums, and other sources. But what is most controversial is the fact that Overseas Filipino Workers — who make up a sizable support base of the Duterte administration — are required to pay increasing premium rates.

The purpose for this is to increase the healthcare system’s risk pool by getting more contributions from low-risk members so that the government could afford to treat those who pose a higher health risk and could not afford paying high medical bills for that. Such a concept is not alien to countries that support lower-income individuals.

When Philhealth announced that OFWs must pay this year’s premium (a rate of 3% for members earning between P10,000 to P60,000), the government was met with backlash from within its ranks and the Left who lamented the added burden to a sector that has contributed much to the country’s economic growth.

But much of the protest comes from actual OFWs who saw this as unfair treatment. Duterte would later order that premiums for OFWs be made voluntary. And no doubt, once the CoViD-19 situation relaxes, the law may very well be reviewed on account of its funding sources.

The Universal Health Care Law, for all its utopian features, is still limited by the larger market where it exists. If ever we have a genuine need to recognize healthcare access as a human right, we need to create a rational healthcare system that does not create additional problems in the long run. It takes time, but advocating and debating for it is a good start.