Indigenous people in Bicol rarely benefit from gov’t taxes, services

By Rhaydz B. Barcia Conclusion IRIGA CITY --- Dir. Orlando Iñigo, Philhealth regional director in Bicol, said the bulk of the sin taxes go to Philhealth coverage under the universal health care, that includes 4Ps. But the big portion of sin taxes, according to Iñigo, went through private hospitals, as government hospitals’ usual problem is the availability of medicines or lack of them, that in effect defeats the purpose of the zero balance billing policy for indigenous tribesmen. Philhealth records showed that as of December 2016, at least P3.17B was paid to hospital claims from both private and government hospitals. The government is paying higher claims to private hospitals than government hospitals here. Among the six Bicol provinces, Camarines Sur has the highest number of claims paid in the amount of P536,030,319 for private hospitals and P442,321,050 for government hospitals, or a total of P978,351,369 out of 110,769 number of hospital claims. Next is Albay with claims amounting to P434,998,295 paid for government hospitals, and P532,195,756 for private hospitals, or a total of P967,194,051 out of 107,114 claims; Camarines Norte, P207,867,525 for government and P315,251,858 private hospitals, or a total of P523,119,383 out of 55,714 claims; Sorsogon, P208,402,862 for government and P181,732,687 for private, or a total of P390,135,549; Masbate P121,850,261 for government and P39,294,248 for private, or a total of P161, 144,509; and Catanduanes with least claims of P120,660,032 from government and P36, 391,429 private hospitals, or a total of 157,575,461 out of 19,356 claims. Philhealth Bicol also paid P4,055,100 in 2015 for top 10 medical cases. The leading diseases in Bicol with highest claims are community-acquired pneumonia III with 4,778 claims followed by acute tubule-interstitial nephritis; pyelonephritis; acute infectious interstitial nephritis; acute pyeitis; acute pyelonephritis with 2,769 cases; urinary tract infection, 2,647; hypertension stage II, 2,408; acute gastronenteritis, 2,275; community-acquired pneumonia 1V, 2,152; bronchial asthma in acute exacerbation, 844; congestive heart failure; congestive heart disease; right ventricular failure (secondary to left heart failure), 682; other acute gastritis, 617; and typhoid fever with 600 cases. There are 5,189,701 Bicolanos covered by Philhealth including dependents out of 5,871,562 population; and out of these number, 1,169,719 members were indigent, and 2,304,346 dependents as of December 2016 record here. Inigo said that at least 89 percent of the Bicolanos are covered by Philhealth, including paying members. He said Philhealth does not have any idea how much budget from the sin taxes is downloaded for universal health care as its central office usually sends the billing direct to the Department of Budget and Management (DBM). He said that Philhealth Bicol is collecting almost P1B annually but is paying more than P3B for claims. But despite the small collection from members and incurring bigger expenses, Inigo said Philhealth is stable and will not go bankrupt because of sin taxes fund. The Sin Tax Reform Law or RA 10351 enacted in 2012 aims to be a health measure with revenue implications. The law imposes taxes on cigarettes and alcohol products and has brought increased revenue for the government. In 2015, collections amounted to P142B, with P100B from cigarettes. Gains from the Sin Tax finance the government’s universal health care system. Dr. Ivy Sarmiento, head of non-communicable disease prevention and control cluster of DOH regional office, said that 80 percent of the sin taxes go to health infrastructure facilities and the rest is channeled to Philhealth’s universal health care. “That’s why we have cancer and kidney centers constructed to cater the patients,” she said. Bicol is one of the 17 regions in the country with smoking cessation clinics set up by local government units (LGUs) while the province of Albay and Legazpi City are strictly implementing the anti-smoking ordinance for the past few years to save the people from the exposure and impact of smoking. The province’s anti-smoking ordinance was enacted during the incumbency of former Albay governor now Second District Rep. Joey Sarte Salceda. Legazpi City Mayor Noel Rosal, was noted to have strictly implemented the anti-smoking laws in the city earlier than when the provincial government of Albay actually imposed the ban. Sarmiento said smoking cases decreased in Bicol specifically in Albay following the strict implementation of local ordinances in order to save the people from the main cause of the country’s leading number of deaths. She said that consumption of tobacco products -- bet it nganga chewing and smoking – causes deadly diseases. “There are inherent nicotine and cause addiction even with nganga chewing. Tobacco per se has nicotine from plant to processing laden with chemicals. The raw materials go through chemical spray from planting, harvesting and processing. So-called second-hand smoke is also as deadly as actually smoking cigarette because both smokes that are inhaled remain to be toxic,” Sarmiento said. The Department of Health (DOH) national mortality trend said that smoking is PH’s top killer. DOH said smoking does not just cause cancer and lung diseases. It is also the Number One cause of stroke and heart attack (approximately 50,000 deaths per year). In fact, smoking causes more stroke and heart attack than diabetes, hypertension, obesity and high cholesterol, based on the National Nutrition and Health Survey in 2008. DOH Bicol record shows that the top ten causes of deaths in 2011 were respiratory diseases (pneumonia/CORD) as number one leading causes of death; followed by heart diseases; stroke, tuberculosis, malignant neoplasms; accidents; diabetes mellitus; kidney diseases; liver diseases, and diarrhea. Sarmiento also said that smoking can cause deadly chronic obstructive pulmonary disease (CORD); cardiovascular disease and diabetes mellitus for smokers including second and third hand smoke. Cigarette contains 7,000 toxic and poisonous chemicals; 70 are cancer-causing, such as lung cancer. Tobacco use cause death and disability agents while the impact for second hand smokes increases risk to heart attack by 25-35 percent and risk to develop lung cancer by 20 to 30 percent and numerous chronic respiratory symptoms in non-smokers such as cough, asthma attacks and tuberculosis (TB). Philippine Statistics Authority (PSA) reveals that ten Filipinos die by the hour from tobacco-related disease. Twenty-eight percent or 17.3 million Filipino adults, aged 15 years and older, are current tobacco smokers, according to 2009 Global Adult Tobacco Survey (GATS). Almost half (48 percent or 14.6 million) of adult males and nine percent (2.8 million) of adult females are current smokers. At least 23 percent of Filipino adults are daily tobacco smokers, comprising 38 percent males and 7 percent females. Based on GATS in 2009, the Philippines has an estimated 17.3 million tobacco consumers. GATS study also claims that on the average, Filipinos consume 1,073 cigarette sticks annually. The huge large number of tobacco consumers prompted Congress to pass Republic Act (RA) No. 10351, commonly known as the “Sin Tax Law,” which aims to restructure the existing taxes imposed on alcohol and tobacco products in 2012. The Philippine government saw the duties on these products as potential income source to fund its Universal Health Care Program. Thus, the higher levy and higher costs are seen as a pre-emptive consumption of “sinful” products, whose adverse impact is mostly shouldered by the marginalized people. Following the imposition of sin tax to sinful products, the tobacco use prevalence among Filipinos, 15 years old and above, has gone down from 17 million in 2009 to 15.9 million in 2015 based on the recent study of GATS. Similarly, the number of smokers, victims of second-hand smoke has also gone down tremendously in houses from 54 percent in 2009 to 34 percent in 2015; and in the workplaces, from 32 percent in 2009 to 21 percent in 2015. Tobacco use and second-hand smoke exposure among Filipinos also dropped to 23.8 percent in 2015 from 29.75 percent in 2009, a decline attributed by DoH due to imposition of higher taxes through the Sin Tax Reform Law implemented since 2013. According to DoH Secretary Paulyn Ubial, the five-year implementation of sin tax law, reduced the number of smokers in the country by one million. Data from the GATS-Philippines 2015 show that close to 16 million Filipino adults used or smoked tobacco products. The poorest population is the most susceptible to the hazards of tobacco use. At least 300,000 deaths in Philippines recorded (lifestyle disease) due to smoking related disease based on the study of Frame Convention Alliance, Philippines (FCAP). As early as 1970, it was projected that the major problem will be lifestyle diseases or non-communicable diseases while infectious diseases decline in time. Sarmiento hopes that the consumption of tobacco products will significantly fall down if President Rodrigo Duterte will impose the smoking ban in all public places in the country to save the Filipino people from smoking related illnesses resulting to deaths. (Rhaydz B. Barcia) NOTE: This featured article was produced under the “Mga Nagbabagang Kuwento: Reporting on Tobacco and Sin Tax Media Training and Fellowship Program” by Probe Media Foundation with support of the Campaign for Tobacco Free Kids.