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PhilHealth benefits rich, not poor Filipinos – DOH official
A 67-year-old coffee farmer from Tagaytay who had been having difficulty swallowing since December found out he had tuberculosis and cancer after a series of medical examinations. His doctor prescribed antibiotics and several therapies, but the farmer decided to simply go home, worried about his P43,000 pesos debt for hospital fees and the future of his nine children. "This is what it means to live in a fragmented health care system," said Dr. Jose Acuin, an expert in clinical research and the director for Medical Quality Improvement of the Medical City. He did not reveal the identity of his patient in line with the profession’s confidentiality requirement. By fragmented health system, former Health Secretary Alberto Romualdez explained that only those with money who often have adequate health insurance can fully pay medical bills. “The near-poor and the lower middle classes can become impoverished to meet out-of-pocket payments for health care," Romualdez said. “The very poor don’t even have pockets," he added. Worse, one of the reasons for the inequality in health services is the failure of Philhealth, the government’s health insurance program, to properly target poor households and provide correct information to beneficiaries, according to Liezel Lagrada of the Department of Health (DOH). “The enrollment coverage of Philhealth favors the rich due to [its] weak poverty targeting policy," said Lagrada, officer-in-charge of the Health Policy Development and Planning Bureau of the DOH. The three health specialists were among the pool of medical experts invited by the Zuellig Family Foundation to address the first Health Outlook Forum last January at the AIM center in Makati City, which tackled health inequalities in the Philippines. Lagrada presented a 2006 study that showed more Philhealth funds going to well-to-do families instead of the less privileged. According to the study, P5.2 billion in Philhealth reimbursements in 2003 went to the richest 20 per cent of beneficiaries, while only P1.4 billion went to the poorest income quintile. Free medical services Moreover, Philhealth’s efforts to develop benefit packages for the poorer segment of the population often become useless because they are not aware of the sponsored programs that allow people who have insufficient income to avail of free medical services. “It’s [the Philhealth benefits] there but nobody is using it," said Lagrada. “Since members do not know that they can actually get them for free, especially in the sponsored programs, they don’t access these services." Among these free services are chest x-ray, sputum microscopy, fecalysis, urinalysis, complete blood count, breast examination, annual digital rectal exam, blood pressure measurement, and visual screening. Consultations on “lifestyle modification" such as cessation of smoking are also covered. Lagrada added that poor people often seek medical services from rural health units (RHU), but only half of these centers are accredited by the Philhealth. Established through the National Health Insurance Act of 1995, Philhealth aims to reduce out-of-pocket spending as well as the inequities in health financing. In 1999, the DOH Health department came up with a health sector reform agenda to resolve Philhealth’s “inadequate benefit support with bias towards in-patient care and limited population coverage" arising from problems with program implementation. More than a decade later, however, nearly half of all Filipino families still rely on their own pockets, Lagrada said.
