Universal health care and the elections
By Alberto Romualdez, M.D.
24 March 2010
 SOME groups in the health community have identified inequity as the main problem of the health sector in the Philippines.
Gross inequalities in access to health services are deemed responsible for the Philippines lagging behind most of its neighbors in all the measures of population health status. Because the poorest segments of Philippine society have little or no access to health services at all levels of care, it is unlikely that the country will meet its commitments to the Millennium Development Goals unless significant changes are introduced into its health care system.
The impending change in government following elections in May can provide the opportunity for the introduction of reforms that will address the problem of health inequity. As early as the beginning of 2009, a variety of health sector meetings have been held to develop health reform packages that collectively comprise the concept of universal health care.
On May 12, 2009, a workshop organized by a multidisciplinary group of public health experts, economists, clinicians, and health academics defined Universal Health Care as "the provision of high quality healthcare that is efficient, accessible, equitably distributed, adequately funded, fairly financed, and directed in conjunction with an informed and empowered public. The overarching philosophy is that provision of service is based on needs and not based on the capability to pay".
The workshop recommended that the health community embark on a campaign to bring the concept of universal health care to the consciousness of politicians and political parties as a major issue of the national elections in May 2010.
For this purpose, a symposium on health was held at the University of the Philippines in Diliman in November 2009, just before candidates filed their certificates of candidacy. The forum aimed to deliver the universal health care message to the presidential aspirants. At that time only one declared aspirant attended – Bayani Fernando, now a vice-presidential candidate. Nevertheless, advocates persisted in their efforts.
Next, the student body of UP Manila, the health sciences center of the State University, planned a series of presidential forums with one presidentiable at a time to be questioned about their views on health and how to achieve universal health care.
The first forum was with Gilbert "Gibo" Teodoro, the candidate of the administration party. So far, the only other candidate to appear at this forum has been Richard Gordon.
Meanwhile, health questions began to be raised at other gatherings of presidentiables. The condom issue was raised during the Foreign Correspondents Association of the Philippines (FOCAP) forum. Similar questions mainly on reproductive health were raised in other non-health sector meetings.
Last month, the Philippine Academy of Family Physicians again invited presidentiables to give their reactions to a presentation on Universal Health Care at their annual convention. Noynoy Aquino and Richard Gordon shared their views on how health care would be accommodated in their platforms. Up to this point, it seemed that although they considered health as an important concern of the electorate, the candidates’ ideas on health were limited to the conventional "buy medicines and build hospitals" concepts favored by most politicians.
The most recent forum at The Medical City Hospital was sponsored by the Philippine College of Physicians (PCP). Only two candidates, Gordon and Teodoro, came but the event was televised and widely covered by media. The presence of the current Secretary of Health as well as two former secretaries also provided added significance to the discussions in which students, the medical profession at large, other health professions, as well as the internist-specialist members of PCP participated.
By this time, from their responses to the questions, it appeared that the candidates were giving serious thought to health care as an important national issue. The idea of equitable health care for all Filipinos or universal health care based on a constitutional mandate has now entered the lexicon of presidential electoral discourse.
Health advocates, many of them remnants of the old "health for all" days of primary health care promoted by then Director-General Hafdan Mahler of the World Health Organization, are encouraged by these developments. It is now incumbent on all the various health sector groups – from recipients of care to health providers to suppliers of pharmaceuticals and other health goods as well as the academe and public health professionals – to keep the pressure on all candidates at all levels to take clear positions on the various reforms required to make universal health care a reality.
This is easier said than done because the issues are complex and require careful explanations. Increasing government expenditures on health – coordinating bigger appropriations by national government agencies and local government units with improved benefits payments by the national health insurance program – may require actions that may not sit well with business groups. Raising revenues from higher taxes and diverting money from some infrastructure programs will require a firm conviction that financing health services is truly an investment on people rather than an expenditure of resources.
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One of the important features of a serious platform on universal health care has to be a strong commitment to provide appropriate reproductive health services to all Filipinos irrespective of socio-economic class. High fertility rates among the poorest Filipinos means that the overall health status of the country is held down by the poor health of its impoverished majority.
Support for reproductive health is therefore considered by health experts as a litmus test for a sincerely pro-poor health program. For this reason, health advocates are keeping a close watch on candidates’ pronouncements on the issues. The most recent assessments of presidentiables concerning reproductive health reveal the following:
"Gibo" Teodoro, on the basis of his statements at the PCP Forum, has improved his ratings considerably. His position that government funding should be used to support the reproductive health choices of poor Filipinos as well as his strong support for DOH Secretary Cabral on the issue of condoms for HIV/AIDS have moved him up from a negative rating to a plus 2. He may even move higher if he categorically expresses future support for RH legislation.
"Erap" Estrada remains at plus 2 mainly because of his past record. He should actually be higher but for the fact that religious conservatives are among his closest allies.
"Noynoy" Aquino stays at plus 1 because of his initial support for the RH bill. The presence of fundamentalists in his retinue prevents him from taking stronger positions.
"Dick" Gordon’s rating is now in negative territory (minus 1) because of his firm stand, expressed at the PCP forum, against using government funds to support contraceptive choices of the poor.
"Manny" Villar rated as minus 2 in previous assessments retains that rating. RH advocates have not heard any new positions that would merit an improved grade.
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