BACKBURNER
Not-So-Primary Healthcare
by Joanna Pauline Honasan
We are all one health emergency away from drowning into the pits of debt and financial loss.
Such realizations come to mind as I pass by the Philippine General Hospital (PGH) day and night. Only the wealthy ones afford the privilege of being healthy — of being able to consult physicians or being able to afford medications personalized to their conditions.
Health is really wealth, especially for Filipinos who depend on the public healthcare system. This saying is mirrored in the worn out carton boxes made into makeshift beds by patients queuing at the Outpatient Department. It is seen in the cramped waiting sheds at Phi Walk, where patients’ relatives sleep in uncomfortable spaces, beside sewers and pests that scurry through the night.
Seeing the state of PGH on a daily basis, realization hit me when I took my internship in a private hospital earlier this year: that it is possible for people to achieve such quality of healthcare, where no one has to fall in line during the wee hours of the night just to get a consultation slot.
This is the sad reality for most patients years after the passage of the Universal Health Care (UHC) Law of 2019 (RA 11223). Public hospitals are clad in dilapidated walls and overcrowded halls, and all the more do barangay healthcare centers, despite the existence of health devolution as a concept.
Health devolution liberalized and allowed local governments to orchestrate how they would spend their National Tax Allotment (NTA), which is a portion of taxes allocated for their services. Upon devolving services such as health facilities enhancement programs, epidemiology and surveillance, human resources for health deployment, and public health commodities to LGUs, these projects are then withdrawn from the responsibilities of the national government.
Ideally, this is preferable, since LGUs should know exactly which aspects of their health services need more funding — emphasis on the word should. Yet, reality begs to differ. Since there are no existing guidelines ensuring that most of the NTA funds should be used for health services, LGUs spend it on projects unrelated to health. This explains the lack of efficient services in barangay healthcare centers — or the lack of these especially in geographically isolated and disadvantaged areas (GIDA).
Despite the existence of primary care facilities and the few tertiary hospitals in provinces, most patients, especially those needing specialized care, are forced to travel to Metro Manila as they get referred here. Such circumstances reflect the lack of health equipment and facilities in areas outside NCR, exacerbating health inequity. Upon reaching public hospitals in Manila, being treated is not guaranteed, as there is a cut off for patients due to understaffing of healthcare personnel. Furthermore, being diagnosed with a disease weighs heavy on people’s pockets, as they need to pay for laboratory services outside public hospitals. Further draining their finances, there comes the long list of medications of polypharmacy patients, who could only afford a week’s worth of a month-long prescription.
There are different sources of health funding in the Philippines — wherein majority of these come from the Philippines’ budget allotted to health via the GAA and NTA, and the PhilHealth social insurance contributions of Filipinos. Yet, out-of-pocket expenditures remain to be the main source of health expenditures in the Philippines, with medicines being the largest cost-driver.
This suggests two things regarding health inequity: one, is that there is inefficient use of funds at the government level; two, is that the current PhilHealth benefit packages only cover limited services needed by patients.
For instance, PhilHealth’s Konsulta+ Package only caters accredited primary care provider facilities, however, far-flung communities lack such facilities. Moreover, patients with the PhilHealth Guaranteed and Accessible Medications for Outpatient Treatment (GAMOT) Package would only have P9,000.00 worth of their medications covered per year, which include preventive medicines and maintenance drugs for diabetes, hypertension, dyslipidemia, and asthma. For patients who need to take maintenance medications everyday, this amount only covers a few months’ worth of medication.
This becomes more concerning as currently, P89.9 billion ‘excess funds’ from PhilHealth is being transferred to the national treasury — meaning these could be used for purposes other than health, such as for public works and transportation. Depleting health resources are further depleted, and despite being one of the fundamental rights of Filipinos, health remains at the backburner of the long list of mispriorities of the government.
“Tiis-tiis na lang. Mahal magpatingin, may reading glasses naman riyan,” I remember my grandmother saying when I attempted to get her to see an ophthalmologist. As I have grown through the years, I have witnessed the progression of cloudiness in her eyes — a foretelling sign of cataract.
Much as I want her to get treatment, we could not handle its catastrophic impact on our already diminishing finances. Perhaps the financial burden of surgery and hospitalization weighs more than the gradual loss of her vision. Indeed, health is only for those who have enough wealth.
