The Philippine Universal Health Care Law: A Differing View
Keywords:health financing, health insurance, equity, access to healthcare
AbstractThe World Health Organization espouses Universal Health Care (UHC) as a means to address health inequity and allow the poorest sections of the population to access health care. In the Philippines, government efforts to implement this have evolved over the last ten years, resulting in the passage of the Universal Health Care Act in 2019. The law relies heavily on health financing as the central driver of the healthcare system reforms. This article describes and analyzes key actors on the implementation of the UHC Act, particularly the insurance program it is anchored on, the agency that will be primarily tasked to implement it, and the overarching principle behind the law. These are burdened with problems and may be anathema to the outcomes sought. Rather than a health financing-based direction in health development, a rights-based approach is posited to be a better framework and roadmap to achieve health for all.
Philippine Statistics Authority (PSA) and ICF. Philippines National Demographic and Health Survey 2017. Quezon City, Philippines, and Rockville, Maryland, USA: PSA and ICF; 2018.
Dayrit MM, Lagrada LP, Picazo OF, Pons MC, Villaverde MC. The Philippines Health System Review. New Delhi, India: World Health Organization, Regional Office for SouthEast Asia; 2018.
Bredenkamp C, Buisman LR. Financial protection from health spending in the Philippines: policies and progress. Health Policy Plan. 2016 Sep;31(7):919-27. doi:10.1093/heapol/czw011. Epub 2016 Apr 11. PMID: 27072948.
Lambojon K, Chang J, Saeed A, Hayat K, Li P, Jiang M, Atif N, Desalegn GK, Khan FU, Fang Y. Prices, Availability and Affordability of Medicines with Value-Added Tax Exemption: A Cross-Sectional Survey in the Philippines. Int J Environ Res Public Health. 2020 Jul 21;17(14):5242. doi: 10.3390/ijerph17145242. PMID: 32708060; PMCID: PMC7400398.
Collado ZC. Challenges in public health facilities and services: evidence from a geographically isolated and disadvantaged area in the Philippines. Journal of Global Health Reports. 2019 Nov 21;3. doi: 10.29392/joghr.3.e2019059
Ulep VGT, Casas LDD. Regional health integration and cooperation in the Philippines. Quezon City, Philippines: Philippine Institute of Developmental Studies; 2021. Report No.: 2021–16.
Department of Health of the Philippines. Annual Report 1999: Setting the Agenda for Reform. Manila, Philippines; 1999.
Obermann K, Jowett M, Kwon S. The role of national health insurance for achieving UHC in the Philippines: a mixed methods analysis. Glob Health Action. 2018;11(1):1483638. doi: 10.1080/16549716.2018.1483638. PMID: 29914319; PMCID: PMC6008596.
Department of Health of the Philippines. Kalusugang Pangkalahatan 2010-2016: An Assessment Report. Manila, Philippines; 2016
Universal Health Care Act, Republic Act No. 11223, 17th Cong., 3rd Sess. (2019)
UHC Act in the Philippines: A new dawn for health care [Internet]. World Health Organization. 2019 Mar 14. [cited 2019 Dec 12]. Available from: https://www.who.int/philippines/news/feature-stories/detail/uhc-act-in-the-philippines-a-new-dawn-for-health-care
National Health Insurance Act of 1995, Republic Act No. 7875, (1995).
World Bank. World Development Report 1993: Investing in Health. Vol. 1. The World Bank; 1993.
Gotinga, JG. Duque’s Arroyo-era health cards bled PhilHealth billions of pesos, says official [Internet]. Rappler. 2020 Aug 14. [cited 2020 Jan 10]. Available from: https://www.rappler.com/nation/official-says-duque-arroyo-era-health-cards-bled-philhealth-billions-pesos
Villanueva M, Crisostomo S. Arroyo launches P3-B health care program [Internet]. Philstar Global. 2004 Feb 3. [cited 2020 Jan 10]. Available from: https://www.philstar.com/headlines/2004/02/03/237479/arroyo-launches-p3-b-health-care-program
PhilHealth 2003-2018 Annual Report [Internet]. Philippine Health Insurance Corporation (PhilHealth). 2018. [cited 2020 Jan 10]. Available from: [https://www.philhealth.gov.ph/about_us/annual_report/#gsc.tab=0]
Philippine National Health Accounts 2016-2018 [Internet]. Philippine Statistics Authority (PSA). 2019. [cited 2020 Jan 10]. Available from: [https://psa.gov.ph/pnha-press-release/node/144466]
Department of Health Philippines: Budget Portfolio FY 2018. Department of Health. 2018 [Internet]. [cited 2020 Jan 10]. Available from [https://www.aidsdatahub.org/sites/default/files/resource/doh-phl-budget-folio-2018.pdf]
de Claro V. Rapid Assessment of Strategic Purchasing in the Philippines: A Country Case Study. Kiel, Hamburg: ZBW - Leibniz Information Centre for Economics; 2018.
Tobe M, Stickley A, del Rosario RB Jr, Shibuya K. Out-of-pocket medical expenses for inpatient care among beneficiaries of the National Health Insurance Program in the Philippines. Health Policy Plan. 2013 Aug;28(5):536-48. doi: 10.1093/heapol/czs092. Epub 2012 Oct 9. PMID: 23048125.
Crisostomo S. PhilHealth implements 'no balance billing' scheme [Internet]. Philstar Global. 2012 Jan 19. [cited 2020 Jan 14]. Available from: https://www.philstar.com/business/science-and-environment/2012/01/19/768702/philhealth-implements-no-balance-billing-scheme
New Phil Health Case Rates for Selected Medical Cases and Surgical Procedures and the No Balance Billing Policy, Circular No. 011-2011 [Internet]. Philippine Health Insurance Corporation. 2011. [cited 2020 Jan 14] Accessed from [https://www.philhealth.gov.ph/circulars/2011/circ11_2011.pdf]
Lam HY, Adovich SR. Independent Assessments towards Validating the 2013-2014 Performance of PhilHealth for the NHTS population. Manila and Quezon City Philippines: National Institute of Health, Institute of Health Policy and Development Studies; 2017.
Faraon EJA, Estrada JAG, Farillas ELF, Mabera FRD, Paras AMP, Pastrana MKR, Yap AML. Significant Predictors of Underutilization of Inpatient Benefits among PhilHealth Members in Selected Barangays in Manila. Acta Medica Philippina. 2013;47(3):69-73. doi: 10.47895/amp.v47i3.1324
Alipio M. A Path Analysis Examining the Relationship Between Access Barriers to Health Services and Healthcare Utilization Among the Publicly Insured: Insights from a Multiprovince Survey in the Philippines. Public Health. 2020; d6vbm. doi: 10.31219/osf.io/d6vbm
Quimbo S, Florentino J, Peabody JW, Shimkhada R, Panelo C, Solon O. Underutilization of social insurance among the poor: evidence from the Philippines. PLoS One. 2008;3(10):e3379. doi: 10.1371/journal.pone.0003379. Epub 2008 Oct 13. PMID: 18852881; PMCID: PMC2557126.
Rivera LJD. Why poor mothers fail to enjoy Philhealth benefits? Barriers to Philhealth Benefit Utilization and Full Financial Support. Quezon City, Philippines: National Anti-Poverty Comission; 2016.
Ellao JAK. Philhealth militarization, ‘ghost’ claims reflect problems in health services [Internet]. Bulatlat Journalism for the People. 2019 Jun 27. [cited 2020 Feb 24] Available from: https://www.bulatlat.com/2019/06/27/philhealth-militarization-ghost-claims-reflect-problems-in-health-services/
COA to PhilHealth: Return P164-M illegal perks [Internet]. Rappler. 2018 Aug 3. [cited 2020 Mar 27] Available from: https://www.rappler.com/nation/208734-coa-decision-philhealth-officials-allowances-bonuses
Gamboa R.. Corruption and inefficiency in PhilHealth [Internet]. PhilStar Global. 2019 June 20. [cited 2020 Mar 27] Available from: https://www.philstar.com/business/2019/06/20/1927841/corruption-and-inefficiency-philhealth.
Nazario D, Damicog JG, Panaligan RG. ‘Ghost dialysis’ blamed on corruption at Philhealth [Internet]. Manila Bulletin. 2019 June 6. [cited 2020 Mar 27]. Available from: https://mb.com.ph/2019/06/06/ghost-dialysis-blamed-on-corruption-at-philhealth/
Ramos CM. Morales: PhilHealth investigating 20,000 fraud cases [Internet]. Inquirer. 2020 Aug 4. [cited 2021 Oct 14]. Available from: https://newsinfo.inquirer.net/1316738/philhealth-investigating-20k-fraud-cases-chief-tells-senate
Magsambol B. PhilHealth execs misspent, stole P15 billion, says resigned anti-fraud official [Internet]. Rappler. 2020 Aug 4. [cited 2021 Oct 14]. Available from: https://www.rappler.com/nation/ex-official-says-billions-stolen-by-philhealth-fraud-schemes
Kabiling G, Damicog JG. Top PhilHealth officials face charges [Internet]. Manila Bulletin. 2020 Sept 15. [cited Oct 14]. Available from https://mb.com.ph/2020/09/15/top-philhealth-officials-face-charges/]
Romero A. Morales resigns as PhilHealth CEO after Duterte gives hint to quit [Internet]. Philstar. 2020 Aug 26. [cited 2021 Oct 14]. Available from: https://www.philstar.com/headlines/2020/08/26/2038045/morales-resigns-philhealth-ceo-after-duterte-gives-hint-quit
World Health Organization. Declaration of Alma-Ata. World Health Organization; 1978.
World Health Organization. The World Health Report 2008: Primary Health Care Now More Than Ever. World Health Organization; 2008.
World Health Organization. Closing the gap in a generation: Health equity through action on the social determinants of health. World Health Organization; 2008.
Etienne C, Asamoa-Baah A, Evans DB.. Health systems financing: the path to universal coverage. World Health Organization; 2010.
World Heatlh Organization. Arguing for Universal Health Coverage. World Health Organization; 2013.
World Health Organization. Declaration of Astana. World Health Organization; 2018.
Sanders D, Nandi S, Labonté R, Vance C, Van Damme W. From primary health care to universal health coverage-one step forward and two steps back. Lancet. 2019 Aug 24;394(10199):619-621. doi: 10.1016/S0140-6736(19)31831-8. PMID: 31448726.
People’s Health Movement. A civil society assessment of the political declaration of the UN High Level Meeting on Universal Health Coverage (Internet). Health for All Now: People's Health Movement. 2019 Sep 23. [cited 2021 Oct 26] [https://phmovement.org/wp-content/uploads/2019/09/Civil-Society-Assessment-of-UHC-HLM-declaration_16-Sept.docx.pdf]
Kieny MP, Bekedam H, Dovlo D, Fitzgerald J, Habicht J, Harrison G, Kluge H, Lin V, Menabde N, Mirza Z, Siddiqi S, Travis P. Strengthening health systems for universal health coverage and sustainable development. Bull World Health Organ. 2017 Jul 1;95(7):537-539. doi: 10.2471/BLT.16.187476. Epub 2017 Apr 7. Erratum in: Bull World Health Organ. 2017 Aug 1;95(8):608. PMID: 28670019; PMCID: PMC5487973.
Sanogo NA, Fantaye AW, Yaya S. Universal Health Coverage and Facilitation of Equitable Access to Care in Africa. Front Public Health. 2019 Apr 26;7:102. doi: 10.3389/fpubh.2019.00102. PMID: 31080792; PMCID: PMC6497736.
Rodney AM, Hill PS. Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. Int J Equity Health. 2014 Oct 10;13:72. doi: 10.1186/s12939-014-0072-8. PMID: 25928840; PMCID: PMC4192297.
Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev. 2017 Jun 6;6(1):110. doi: 10.1186/s13643-017-0503-x. PMID: 28587676; PMCID: PMC5461715.
Bedford J, Singh A, Ponferrada M, Eldred L. Access to Health Services: Analysing Non-Financial Barriers in Ghana, Bangladesh, Vietnam and Rwanda Using Qualitative Methods A Review of the Literature. New York, NY: United Nations Children’s Fund; 2013. Available from: https://www.unicef.org/health/files/Access_to_Health_Services-Ghana-Bangladesh-Vietnam-Rwanda__2013.pdf
Averill C, Marriott A. Universal health coverage: why health insurance schemes are leaving the poor behind. Oxfam International; 2013.
Gwatkin DR, Ergo A. Universal health coverage: friend or foe of health equity? Lancet. 2011 Jun 25;377(9784):2160-1. doi: 10.1016/S0140-6736(10)62058-2. PMID: 21084113.
Caballes AB, Söllner W, Nañagas J. Financial protection mechanisms for inpatients at selected Philippine hospitals. Soc Sci Med. 2012 Nov;75(10):1820-7. doi: 10.1016/j.socscimed.2012.07.027. Epub 2012 Aug 6. PMID: 22901795.
Picazo OF, Pantig IM, Ortiz, DA, Aldeon M, Dela Cruz NA, Tanghal JA. The impact of improving capital stock on the utilization of local health services: Preliminary findings on the evaluation of the Health Facilities Enhancement Program. Quezon City: Philippine Institute of Developmental Studies; 2016. Report No.: 2016-14
Acuin CS, Lim BA, Lasco PG. Universal Health Care in the Philippines: An Introduction. Acta Medica Philippina. 2010;44(4):14-21.
Romualdez AG.. Universal Health Care in the Philippines: Governance. Acta Medica Philippina. 2010;44(4):22-24.
Ranada P. Duterte Signs Universal Health Care Law [Internet]. Rappler. 2019 Feb 20. Available from: https://www.rappler.com/nation/duterte-signs-universal-health-care-law
Melgar JD. Organizing Health Services Towards Universal Health Care. Acta Medica Philippina. 2010;44(4):36-42.
Paterno RP, Herrera CE. Health Financing. Acta Medica Philippina. 2010;44(4): 58-70.