“Health is about people, not profits. The provision of health services should never be contingent on the patient’s ability to pay or the public hospital’s capacity to generate its own income. The provision of health services should be guaranteed by government to its people.” –- Health Alliance for Democracy
By MARYA SALAMAT
MANILA –- If Filipinos had dreamed that public health care may improve under the new Aquino government, which packaged itself as an agent of change with a “health for all” agenda during the election campaign, its 2010 performance would come as a nasty shock. The recently signed national budget and the cuts it inflicted on public health spending for 2011 signify the opposite of change.
“We are hoping for change that will move forward, not backward, in terms of providing health for all,” Dr. Geneve Rivera, secretary-general of Health Alliance for Democracy (HEAD), earlier said in a statement.
Rather, the Aquino administration is pushing for austerity measures for the sake of bigger debt servicing and military spending. According to Ibon Foundation, an independent economic think tank, the PhP1.645-billion national government budget for 2011 is a PhP104.4-billion or 6.8 percent increase from the proposed budget for 2010. But most of this increase is accounted for by the large PhP80.9 billion increase in interest payments on debt to PhP357.1 billion. This is the largest absolute increase in interest payments in the country’s history and, at a 29.2 percent increase from the year before, is the second largest percentage increase after the 32.6 percent growth in 2000. To pay for this, the government is “retreating from its responsibilities in key areas,” said Ibon.
The biggest retreat seemed to have been on government health services. To appease the striking students who opposed budget cuts on state universities, the Aquino government realigned funds that had been allocated for family health including family planning, rather than touch the highly discretionary, “vague, huge lump-sum funds.” Activists contend that there should never be a clash between equally important services of the government.
Abdicating Responsibility on Health
Health advocates in 2010 repeatedly brought the peoples’ “health agenda” to President Benigno Aquino III before and after he was sworn into office. They also held a dialogue with the new health secretary, Dr. Enrique Ona, who promised them that he would ask for a P60-billion ($1.4b) budget at least. It was P30 billion ($684m) short of the P90-billion ($2.1b) “required budget” for the health sector being demanded by progressive health groups, but the actual health department proposal and what was subsequently approved were just a third of this P90 billion ($2.1b) “realistically” needed and feasible budget.
The progressive health groups were disappointed when the national government, proclaiming change and reforms, merely continued the trend of slashing the allotment for health. The Department of Health’s (DOH) budget for 2011 is “an abdication of its constitutional duty to endeavor to make health services available to ALL the people at affordable cost,” Gabriela Women’s Party Rep. Emmi de Jesus said.
“May I remind the DOH that it is the government, and not the private sector, that has the primordial constitutional mandate to deliver health services, to move toward social justice and equity. Our health system should be managed as a social service, and not as a business that focuses on the extraction of profit! The Aquino administration should show that it has the capacity to provide as much budget for the 12 public DOH hospitals by a sum comparable to the P1-billion ($23m) budget being provided to the AFP Medical Center, and an average of P500M ($ 11.4m) for each of the 55 regional hospitals,” de Jesus added.
But the reminders of progressive partylist groups in Congress and the rallies and dialogues held by various health advocates to prod the government to fulfill its obligations to peoples’ health were in vain. President Aquino signed this week the country’s budget for 2011, with the proposed paltry allotment for health largely unchanged.
This meant that in 2011, the government will be “guilty of causing the deaths of many ill Filipinos just because they are poor, just because there is no health facility nearby, and just because our health system is progressively weakened by devolution and the declining quality of the primary health care system,” de Jesus said.
More than half of the Philippine population do not have health insurance while a quarter do not see a doctor when sick, a nationwide survey released last September revealed. Most of those without health insurance belonged to the lower classes of society, said the Social Weather Stations.
The survey ,which was conducted between Jan. 29 and Feb. 1 this year, also revealed that nearly nine in 10 adult Filipinos expect the government to provide health care for all, including those who cannot afford to pay for it.
When Filipinos get sick, it often results in a family crisis as they have to raise and spend money to be treated. Studies show that out-of-pocket expenses account for nearly 60 percent of health care spending in the country, private health care providers account for 20 percent, while government-run PhilHealth accounts for 12 percent to 15 percent of the country’s total health-care expenditure.
When the Aquino government came to power, its promise of “health for all” was downgraded to “PhilHealth for all” or “universal health care coverage,” or beefing up the membership and benefits of PhilHealth, in hopes that families will not “fall into the cracks of poverty” if a member got ill. The trouble is, majority of Filipinos (67 percent, according to an Ibon survey) are already deeply stuck in the quagmire of poverty and not just in its cracks.
The “chronic unevenness of economic resources and opportunities for social mobility” worsen the lack of health care available to Filipinos, so that many Filipino children (32 per 1,000 live births) die before the age of five due to diseases that are preventable and treatable in nature, said Bayan Muna Rep. Neri Colmenares early this year, when he urged the House Committee on Health to grant children of low-earners 50-percent discount on medical services.
The Philippine health care system consists of a public sector and a private sector. Public health care is mainly financed through taxes, and supposedly provide free services to citizens; the private sector is largely market-oriented and financed based on the patients’ paying capacity. Poorer Filipinos obtain health services from health facilities operated by the government while the wealthier section of Filipino society has the option to choose health services from private facilities.