Realizing the Promise of the Philippines' Universal Health Coverage Act

Introduction

The Universal Health Care (UHC) Act, officially known as Republic Act No. 11223, was enacted in 2019 to reform the Philippines’ health system with the aim of providing equitable access to quality and affordable health services for all Filipinos. The landmark legislation mandated the automatic enrollment of all citizens in the National Health Insurance Program to be administered by PhilHealth. The UHC Act made PhilHealth coverage universal, with the goal of ensuring no one suffers undue financial hardship from accessing medical treatment and health services.

Some of the key provisions outlined in the law include expanded health insurance coverage for inpatient and outpatient services, the institution of organizational and health financing reforms, improved benefits for healthcare workers, strengthened health regulation, and the introduction of a health technology assessment process. The ambitious initiative has been described as the “game changer” for the Philippines’ healthcare landscape. This essay seeks to comprehensively analyze the UHC policy using the policy analysis framework outlined by Kraft and Furlong.

First, the public health problem that UHC aims to address will be defined and examined. Next, potential alternative policy solutions will be discussed. Evaluative criteria will then be established to assess the UHC law and its implementation. The analysis will consider costs, benefits, and consequences and highlight key challenges. Finally, conclusions will be drawn on the current state of UHC in the Philippines, along with recommendations to strengthen and improve this pivotal healthcare policy. The analysis aims to provide insights into the complex, multi-faceted nature of policymaking and the continuous process of evaluation needed to achieve intended policy goals.

I. Analyzing the Problem

The introduction of the UHC Act in 2019 aimed to address systemic problems within the Philippine healthcare system that created barriers to universal and equitable access to medical services for all citizens. One major issue was the lack of financial access and protection that left many Filipinos unable to afford quality healthcare. A study by Antonio (2022) found evidence of catastrophic health expenditures, particularly among low-income households and individuals dealing with chronic illnesses or disasters. Out-of-pocket spending accounted for a large part of the total health expenditures of the country’s people.

Ulep (2015) reveals that out-of-pocket expenses are the major source of financing for medical care in the Philippines, and this reliance contributes to the impoverishment of Filipino households. The high costs were exacerbated by limited health insurance coverage. Prior to UHC, national insurance through PhilHealth was not yet compulsory or automatic for the entire population. The poor, informal workers and vulnerable groups often had the least access to PhilHealth benefits. For those covered, insurance only accounted for approximately 40% of the total medical bill for inpatient services.

Consequently, stark inequities and disparities existed in access to healthcare and health outcomes. Rural populations, indigenous groups, the unemployed, women, and children were disproportionately affected by lack of access. Public hospital utilization was highest among the poorest Filipinos, while wealthier groups dominated private facility usage. These inequalities contributed to uneven health outcomes and mortality rates across different demographics.

The UHC Act hence sought to introduce reforms to make healthcare more affordable, accessible, and fairer for all Filipinos. Automatic universal coverage under PhilHealth was intended to increase financial risk protection. Removing barriers to access was a key step towards creating a more equitable health system that leaves no one behind. However, the law’s implementation would reveal lingering challenges in translating policy into positive outcomes on the ground.

II. Constructing Policy Alternatives

The introduction of the UHC Act in 2019 represented a definitive policy decision to adopt universal health coverage as a solution to the health access issues in the Philippines. UHC was determined to be the most effective approach to systematically expanding access to medical services for all Filipinos. The concept of achieving universal health coverage (UHC) by 2030, as outlined in the Sustainable Development Goals (SDGs) established by the United Nations in 2015, has garnered support from various UN General Assembly resolutions and the World Health Organization (WHO).

These international entities advocate for the gradual realization of UHC by all member states as a means to advance health-related SDGs (Pannarunothai, 2019). The UHC Act made enrollment in the national insurance program compulsory. This immediately increased coverage from around 75% of the population to theoretically 100%. Removing financial and non-financial barriers to access through entitlements and benefits packages was expected to protect all citizens from unaffordable out-of-pocket costs. However, alternative policy options were available prior to the all-encompassing UHC agenda.

More incremental changes could have expanded public health insurance and services gradually. For example, the Pantawid Pamilyang Pilipino Program provided targeted conditional cash transfers to poor households for health and education (Acupido, et al., 2020). This could have been expanded to wider groups. Premium subsidies could also have made PhilHealth insurance more affordable for identified vulnerable sectors. A step-by-step approach to building the health system’s capacity over time aligned with the World Health Organization’s recommendation of phasing UHC in by 2030. However, legislators pushed for the immediate adoption of sweeping reforms through the UHC law despite some reservations about the adequacy of implementation preparations.

While UHC represented a bold policy shift, execution issues would arise by moving too far too fast beyond the health system’s capabilities. The merits and trade-offs of the policy alternatives could have benefited from deeper analysis and consideration.

III. Developing an Evaluative Criteria

To conduct an effective analysis of the UHC Act, appropriate evaluative criteria must be established. The law and its implementation can be assessed based on a set of four key indicators:

● Effectiveness - Measuring how well UHC expanded equitable access and financial risk protection based on insurance coverage, service utilization, and out-of-pocket costs.

● Efficiency - Evaluating optimal utilization of financial and human resources based on metrics like administrative costs, waste, duplication, and resource allocation.

● Equity - Assessing the impact on equitable access and financial risk protection across income, gender, ethnic, and geographic groups.

● Feasibility - Analyzing the practicability of implementation given absorptive capacity, infrastructure, workforce, and economic constraints.

These evaluative criteria cover the technical, allocative, and social dimensions required to examine if UHC achieved its objectives to expand affordable, equitable healthcare access, given systemic capacities and limitations.

IV. Assessing Alternatives

The UHC Act sought to guarantee equitable and affordable access to healthcare services for all Filipinos. However, assessment based on the evaluative criteria reveals mixed outcomes. On effectiveness, while insurance enrollment increased, utilization and affordability barriers persist due to infrastructure and workforce constraints (Flaminiano, et al.,2022).

Out-of-pocket costs continue to be high for many poor and vulnerable groups. Regarding efficiency, one key concern is the potential challenges in resource allocation and financial management. In a study conducted by Padilla et al. (2020) on the roles of government agencies and financing mechanisms in the Philippines' healthcare system, it is highlighted that the Universal Health Care Act has introduced significant changes in how healthcare services are funded and managed.

The study emphasizes the importance of a clear delineation of roles among key actors, such as the Department of Health (DOH) and PhilHealth, in funding and managing healthcare services. However, it also indirectly raises questions about the potential inefficiencies that might arise due to the complexities in resource allocation and funding mechanisms. Equity has improved with wider insurance coverage. However, access and quality gaps remain between urban and rural facilities. Poorer groups still rely largely on lower-quality public facilities.

On Feasibility, health system absorptive deficiencies, particularly in rural areas, have dampened UHC rollout. Infrastructure, staffing, and drug supply shortages continue to hinder equitable access. While expanding coverage, the hasty UHC introduction without adequately addressing health system barriers has undermined effectiveness, efficiency, and equitable access. A phased approach could have facilitated smoother implementation.

V. Drawing Conclusions

In conclusion, the analysis has identified ongoing challenges in the implementation of UHC in the Philippines. While insurance coverage expanded, issues of effectiveness, efficiency, equity and feasibility have emerged.

Key problems include continued high out-of-pocket costs, infrastructure and workforce deficiencies, improper resource allocation, and regional disparities in quality and access. These undermine the policy's aims of equitable financial risk protection and healthcare access.

Recommendations to strengthen UHC include phased enhancements to health system capacity, especially in rural areas; improved health workforce planning and funding allocations; increased health infrastructure and drug supply; and continued monitoring of access and affordability metrics across demographics.

The UHC Act represents a major shift towards universal coverage. However, realizing its goals requires continuous evaluation and evidence-based improvements in implementation. Its success relies on an iterative process of strengthening health systems, finest-tuning resource management, closing care disparities, and making quality healthcare truly accessible and affordable for all Filipinos. Ongoing reforms and policy analysis are imperative.

REFERENCES

Antonio, C. A. T. (2022). Catastrophic expenditure for health in the Philippines. Acta Medica Philippina, 56(11).

Ulep, V. G. T. (2015). Analysis of out-of-pocket expenditures in the Philippines (No. PJD 2015 Vol. 40 Nos. 1-2d). Philippine Institute for Development Studies.

Pannarunothai, S. (2019). Primary Health Care: the building block of Universal Health Coverage. F1000Research, 8(835), 835.

ACUPIDO, R. J., CABILANGAN, R., & TABAMO, H. (2020). Analysis on the Implementation of the Pantawid Pamilyang Pilipino Program: A Research Review. The ASTR Research Journal, 4(1), 1-1.

Flaminiano, C., Puyat, V., Antonio, V., Uy, J., & Ulep, V. (2022). Spatiotemporal analysis of health service coverage in the Philippines.

Estacio Jr, L. R., Avila, C. M. S., Zarsuelo, M. A. M., Silva, M. E. C., Mendoza, M. A. F., & Padilla, C. D. (2020). Policy Analysis on Financing Roles for Population-and Individual-based Health Services in Light of the Universal Health Care Act. Acta Medica Philippina, 54(6).