Healthcare aid payout via PhilHealth or hospitals? Lawmakers’ ideas clash

MANILA, Philippines — Where should healthcare subsidies be coursed – via the Philippine Health Insurance Corporation (PhilHealth) or directly to public hospitals?

Such was the question that members of the House of Representatives were threshing out as they discussed the proposed P5.268 trillion National Expenditure Program (NEP) for 2023 before the plenary.

For Alliance of Concerned Teachers (ACT) party-list Rep. France Castro, health care subsidies should be given directly to public hospitals citing the corruption issues and anomalies hurled against PhilHealth.

She also noted that data from the Philippine Statistics Authority shows the health expenditure of PhilHealth declined from P141.3 billion in 2019 to P133.2 billion in 2020 which goes against the objective of the Universal Healthcare Act to reduce the out-of-pocket health expenses of the Filipino people.

Marikina Rep. Stella Quimbo, senior vice-chair of the House committee on appropriations and sponsor of the proposed 2023 budget for the Department of Health (DOH) including PhilHealth being an attached agency, acknowledged Castro’s concerns that the state-run insurer is confronted with numerous issues.

But she nevertheless believed that health care subsidies should be channeled through PhilHealth.

“Napakaraming problema sa PhilHealth. May problema, halimbawa, sa disenyo ng programa. Gumagamit tayo ng case rates. Higit tatlong libo ata iyong ating mga case rate pero ang case rates na iyan, sa maraming illnesses, napakababa and therefore, hindi talaga niya kayang magbigay ng sapat na financial risk protection,” Quimbo said.

(There are a lot of problems in PhilHealth. One, for example, is the program designs. We use case rates, and we have more than 3,000 of these but for many illnesses, the case rates are notably low and therefore, it doesn’t provide sufficient financial risk protection.)

She then drew a raw example, saying that for every P100 a person would spend in the hospital, only P14 will come from PhilHealth, P30 from the government, and P44 from an individual’s own pocket.

“Kung sana tumaas iyong share na iyan, iyong P14 na iyan, kung pwede sana maging P40 rin iyan, ibig sabihin ay mapapababa na natin ang out-of-pocket share to total healthcare spending,” Quimbo argued.

(If only that P14 share increases to perhaps P40 then it would mean that we can already lower the out-of-pocket share to total healthcare spending.)

But Castro disagreed.

“Hindi ako sang-ayon na dapat pataasin pa iyong budget ng PhilHealth dahil nakita naman natin sa ilang panahon na stay natin dito sa Congress, batbat ng anomalya at korapsyon itong PhilHealth. Bakit nga ba ipinagkatiwala pa natin ang Universal Healthcare [Act] sa PhilHealth?” she argued.

(I do not agree that PhilHealth’s budget should be increased because we have seen over the years that we have been here in Congress, PhilHealth has always been riddled with anomalies and corruption issues. So why should be entrust the Universal Healthcare Act to PhilHealth?)

PhilHealth or no PhilHealth?

Castro, a member of the Makabayan bloc, then floated the idea of directly downloading funds for healthcare subsidies to healthcare facilities in the country.

Quimbo disapproved.

“Ang isang health insurance scheme is certainly more efficient than a direct subsidy. Kaya nga natin ine-effort na magkaroon ng social health insurance program ay dahil kada piso na nilalagay natin in the form of premium contributions, iyong piso na iyan ay kapag nagkasakit ka, ang makukuha mo is more than P1,” explained Quimbo, an economist.

(A health insurance scheme is certainly more efficient than a direct subsidy. The reason why we’re putting so much effort on having a social health insurance program is to ensure that for every peso we pay in the form of premium contributions, you’ll receive more than one peso when you get sick.)

This is the “beauty” of systems such as PhilHealth, Quimbo asserted..

“That’s why a health insurance scheme is always more efficient as a source of financing compared to direct subsidies,” she stressed.

Goods vs services

Castro, however, contested Quimbo’s assertions insisting that such is only true if shadows of corruption and irregularities were not in the picture.

“Katulad nga nito na parang goods ang health system natin instead na services. Nagiging goods na tuloy dahil sa ganyang kaisipan na neoliberal,” she said.

(This is an example that the health system is being taken as goods rather than services. It’s becoming goods because of that kind of neoliberal thinking.)

While PhilHealth is a government-owned corporation, Quimbo pointed out that this does not necessarily mean that its mandate is centered on business.

“In fact, merong indigent program ang ating PhilHealth. Ibig sabihin, sila po ay nagbibigay ng libreng insurance coverage sa ating indigent families. Ang mga miyembro ng Pantawid Pamilyang Pilipino Program ay libre pong nasasakop ng PhilHealth,” she noted.

(In fact, PhilHealth has a program for indigent families who are members of the Pantawid Pamilyang Pilipino Program, so they will be given free insurance coverage.)

Quimbo also mentioned that directly distributing healthcare subsidies to hospitals would limit its coverage to public hospitals only, as compared to a PhilHealth system that includes private health facilities as well.

“[At] alam naman po natin na very limited ang capacity ng ating public hospitals. Kailangan talaga natin ng private hospitals para dumagdag ang total number ng hospital beds ng ating bansa,” she added.

(And we know that public hospitals have a very limited capacity, so we really need private hospitals for more hospital beds in the country.)

Free healthcare for all

Later asked about how close the country is in achieving free healthcare services for all, Quimbo said she believes this may never happen.

“Hindi talaga mangyayari iyan. Hindi natin kakayanin. Kahit pumunta tayo sa pinakamayaman na bansa sa buong mundo, there’s no such thing as free healthcare for everyone. But sa ngayon, ang aspiration is to provide free healthcare for those in need,” the lawmaker explained.

(That won’t rally happen. We won’t be able to do it. Even if you go to the richest country in the world, there’s no such thing as free healthcare for everyone. But right now, our aspiration is to provide free healthcare for those in need.)

She added that the DOH will take “baby steps” to reduce the out-of-pocket payments from 44 percent to 30 percent by 2027.

But Castro said this vision for a free healthcare system should not be shot down believing that it remains possible just as it had been for tertiary education in the country.

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