Commentary: Impact of Universal Health Care on most urgent concerns

Last week, Stratbase ADR Institute, in partnership with health advocacy groups Philippine Alliance of Patient Organizations, Bantay Konsumer, Kalsada, Kuryente, Health Justice, and Citizen Watch Philippines, launched an initiative to raise awareness on the urgent need to implement the Universal Health Care (UHC) Act fully. 

This new initiative, aptly called UHC Watch, is composed of civil society groups committed to being vigilant and watchful that all public health investments are fully in place and efficiently utilized to benefit the most number of Filipinos.

The launch event was timely, given that the UHC Act was signed into law by President Rodrigo Duterte in February 2019. However, despite the two years since its passage, critical provisions of the law remain unimplemented.

The discussion on UHC was also relevant given the context of the ongoing COVID-19 pandemic. The current state of the Philippines' public health and economic crisis is, in no small part, a consequence of our neglect of the country's health care systems. 

This pandemic has made it abundantly clear that strengthening the health systems through UHC policies is essential to responding to pandemics and delivering critical health services to Filipinos without them falling into poverty.  

Indeed, unlike COVID-19, the issue of public health is by no means novel. In fact, "to stay healthy and avoid illnesses" has regularly topped Pulse Asia's "Most Urgent Personal Concerns" survey. In its latest report, staying healthy was the top personal concern of 74% of Filipinos. 

Health, too, was one of the top issues in Pulse Asia's "Most Urgent National Concerns" survey. Ranked third on the list of 16 concerns, "controlling the spread of the novel coronavirus that causes COVID-19" was one of the most urgent concerns for 23% of the respondents.

However, while COVID-19, a health issue, makes a podium finish, some of you may be asking how, in the middle of a pandemic, is COVID-19 and staying healthy not the number one most urgent national concern of Filipinos? I argue that it is because of the most urgent concerns that rank right before and right after health. 

According to the Pulse Asia Survey, "controlling inflation" is the top concern with 43%, while "increasing workers' pay" is second with 34%. At the same time, coming in fourth just below our concern for controlling the spread of COVID-19 is "Providing assistance/subsidy to those who lost their livelihoods and jobs because of the COVID-19 pandemic" at 27%, while "Reducing the Poverty of Many Filipinos" and "Creating more jobs" come are tied at 6th with 26%.

What all six of these concerns have in common is that they are all economic in nature. 

The fact of the matter is, amidst a pandemic, many Filipinos do not have the luxury of worrying themselves with their health when empty plates, hungry mouths and the idea alone of out-of-pocket payments grossly outweigh one's regard for health and well-being. 

Indeed, this survey gives the popular saying "health is wealth" a run for its money.

However, if the UHC law is fully implemented, the law would expand access to health services by automatically enrolling all Filipinos in the National Health Insurance Program and would provide equitable access to quality and affordable health care services while protecting Filipinos against financial risk.

Despite the two years since the law was passed and the public health and economic crises that we have all faced in the past year, the UHC Act's key objectives have still not yet been fully realized.  

One example is the effective implementation of population-based and individual-based health services provided for in the act. If implemented fully, it would call for deeper collaboration between the Department of Health and local government units for interventions that address population-wide concerns such as public health campaigns, disease surveillance, or controlling mosquito breeding grounds, for instance.

UHC Act provisions that ensure access to health technologies by improving government procurement mechanisms, such as pooled-procurement, should also be implemented. Under this provision, the government will become the key purchaser of medicines and health services. By pooling medicines or services Filipinos need, it will negotiate for fairer prices and ensure that these get to where these medicines and services are required.

That said, UHC is not just about health financing. Provisions in the Act cut across the health system, from health policy and governance to communications networks and health information systems. The last example of health information systems in UHC is one that Filipinos could benefit from immediately. Currently, copies of patients' medical data are floating around siloed information systems. 

However, the UHC Act mandates that necessary health data should be consolidated and stored in interoperable information systems that would lead to more efficient health services. In more immediate terms, this means patients no longer have to fill in patient records forms every single visit, and your doctors could also have access to relevant medical information at the tip of their fingers.

If fully implemented, the UHC act could have profound impacts on Filipinos' most urgent concerns. First, given that "stay healthy and avoid illnesses" is an already top personal concern, UHC could fundamentally change how Filipinos take care of themselves. 

Second, by lifting the financial weight associated with medical care and out-of-pocket expenses off the shoulders of Filipinos, the UHC act might even re-shape how economically-concerned we are. 

While it is unlikely that our economic concern will go away with the full implementation of a single law, perhaps knowing one has UHC coverage might still be enough to shift the reason behind our concern away from drab medicals bills and towards more cheerful activities. 

Paco Pangalangan is the executive director of think tank Stratbase ADR Institute.