Treating the sick healthcare system: Aanhin pa ang damo kung patay na ang kabayo?

President Rodrigo Duterte signed Universal Health Care (UHC) Bill into law (Republic Act No. 11223) in February 2022 that automatically makes all Filipinos members in the National Health Insurance Program or PhilHealth, giving the citizens access to free health care services.

Five women met me on separate occasions this year to talk about their harrowing experiences in gaining access to the country’s available free health care system. Their plight --shared by millions of others living in poverty-stricken barangays across regions- signals an urgent need to seek a solution to a dying industry: public health care.

I know these women as strong and active leaders of their community organizations that the Tabang Bikol Movement constantly engaged with at the height of the Pandemic crisis from 2020 to 2021. Esperanza or Espe of a far-flung mountain barangay in Ocampo agonized over the death of her 65-year-old father farmer to Covid-19 because no hospital could take him in. Her 12-year-old daughter almost died of meningitis a few months later when the tricycle they rode got stuck in the mud along the unpaved road, delaying emergency aid the health center could not provide. Rosario or Roseng, to her neighbors in Bonbon, decried the utter insensitivity of a health worker who told her to look for another doctor in Naga City because the doctor assigned at their locality was still with another patient. Rosalyn of Canaman was frantic in her incessant messages to her Ilaw ng Kababaihan chat group for help bring home her husband from Nueva Ecija after waiting in line in a cramped ward of the provincial hospital for more than a week after an accident. Josefa from barangay Sogod, Bacacay, Albay, spent more than P2,000 going back and forth to the Bicol Regional Training and Teaching Hospital (BRTTH) and Ago General Hospital in Legazpi City, hoping for a much-needed cure to her still unknown disease. Finally, disappointed and cash trapped, she decided to stay home and leave her fate to the albularyo.

A 2013 National Demographic and Health Survey Report revealed two main obstacles people “fail to enjoy the health care benefits,” namely a lack of financial resources and the remoteness of facilities. The same problems have prevailed for almost a decade since the UHC law was enforced. The case of 65-year-old Laida, who suffers from life-threatening kidney disease and heart enlargement that need regular check-ups and lab tests, is a classic example of receiving services “na mabagal pa sa pagong.” Last week, she spent P2,500 pesos on borrowed and donated money, most of the time walking under the scorching sun and up and down the stairs of the Bicol Medical Center before she could secure the health amenities of P3,000 for X-ray and a series of lab tests. The frail but feisty lady took all five days from the Municipal Health Center to the Malasakit Center and Bicol Medical Center as an outpatient before she ended up at the provincial governor’s health office beside the hospital to get the cash assistance. She was almost down and exhausted.

Fragmented and deplorable

Espe, Roseng, Rosalyn, Josefa, and Laida tried but failed to access the UHC Law’s so-called benefits fully. The scheme is government-controlled, deeply politicized, and funded by local and national government subsidies. One can avail of the free medical consultation, but it is useless if the sick has no money to buy the medicines.

The World Health Organization (WHO) calls the country’s healthcare system fragmented and not yet fully functional to serve all. Some lawmakers and ordinary citizens consider the health care situation deplorable, politicized, and ailing. There are only six doctors for every 10,000 Filipinos. Nurses and health workers get paid dismally low. The country ranks 124 out of 198 countries due to the country’s poor hospital facilities and lack of health care personnel. Many still face “third-world diseases” such as TB, dengue, malaria, malnutrition, and modern-day ones such as obesity, HIV/AIDs, and Covid-19. A politician’s name still matters to gain easier access. At an emergency webinar on the resurgence of Covid-19 last year, the TBM joined doctors from the Bicol chapter of the Philippine Medical Association (PMA), the Philippine College of Physicians, Bicol Medical Center, and the Bicol University to call the national government’s attention to take the lead and shape up in times of crisis.

PhilHealth mess

The PhilHealth or the Philippine Health Insurance Corporation was created in 1995 to implement the country’s universal health coverage. It serves as a protection and a safety net against the prohibitive cost of health care. The health benefits package includes inpatient and outpatient care, with inpatient benefits of room and board, professional healthcare services, diagnostics, other medical examination services, maternity care, prescription drugs, etc. But issues of corruption and inefficiency have continually plagued the agency. If it were an SME, it would have gone bankrupt. Yearly, it receives funds from the national government to pay premiums for indigents, senior citizens, and the like and administrative needs. Yet complaints abound from private hospitals that the PhilHealth cannot pay their share and from the health workers about their unpaid benefits since the Pandemic began.

Socialize and digitalize

The DOH said, “The money is there, but we are still trying to facilitate the payment process.” It’s about time, the government should take the UHC law seriously after its enactment and three years of implementation. What use is a good law if it fails to benefit the majority of sick and vulnerable Filipinos? “Aanhin pa ang damo kung patay na ang kabayo?” about help or relief that comes too late or not at all.

The UHC was a product of more than 50 years of hard struggle from the parliamentarians of the streets and Congress. The country’s health care system is weak and sick. But the WHO cites the lessons of some European countries and that of neighboring China, where government took a significant role in ensuring 100% coverage, subsidies, and the process of digitalization to help eliminate health disparity, inefficiency, and corruption. The Philippines should act no less.