11th National Forum on Health Research for Action “New Directions and Challenges towards Ensuring Financial Risk Protection”

July 29, 2010


11th National Forum on Health Research for Action


  “New Directions and Challenges towards Ensuring Financial Risk Protection”
Century Park, Malate, Manila 

Thank you Asec Gako for your very kind introduction …. My dear colleagues in the Department of Health, our friends from the academe and the research community, other distinguished guests, ladies and gentlemen, magandang umaga po sa inyong lahat.  It is my pleasure to join you today in this Health Research Forum especially since the focus of our discussion this year takes center stage in the reform agenda of the New Administration and that is to deliver Universal Health Care for all Filipinos!

True to his promise during his campaign, the President ---- President Benigno Noynoy Aquino III --- has taken on among his highest political commitments to seek an integrated reform of our healthcare system primarily through comprehensive transformation of Philhealth.   his singular marching order on health during his inaugural speech and the recent State of the Nation Address:   Pursue rapid and massive enrollment of Filipinos to Philhealth toward universal coverage in three years.  Make quality health care available to our countrymen, including the poor and underserved.

I therefore wish to thank everyone for joining us this morning and agreeing to participate in this strategic forum as we define “New Directions and Challenges towards better Ensuring Financial Risk Protection” for Filipinos.  This indeed is the first step in the path toward universal health care.  This Forum has tremendous implications on how we shall proceed to mobilize funds for health in the coming years to achieve our mandate of universal healthcare coverage in the background of rising expectations and needs and competing and complex health challenges.

More than just a strategic discussion, however, I would like this forum to be an opportunity for all of us to face the drawing boards and map out a clear plan that will enable us to get the job done in the next three years.  As you all know, there has been much rhetoric on the universal healthcare agenda over the past few years.  Ambitious goals have been proposed and major policy and legislative changes have been planned with the end goal of providing comprehensive healthcare for our citizens.  Unhappily, there has been more talk than necessary action taken.   Today, based on the latest figures from the National Demographic Health Survey, we are nowhere near our set target of universal Philhealth coverage by 2010.  Some 15 M of our indigents and approximately 20 M of our non-poor citizens are said to be still without health insurance if we are to believe this latest survey (NDHS 2008).

This situation is truly deplorable and I can speak on behalf of the thousands of Filipino patients I’ve witnessed in my practice as a clinician.  Increasingly, for example, we are seeing more and more of our patients being hit by the chronic disease epidemic.  End-stage kidney disease, cancers, disabilities following major strokes and heart attacks --- these are powerful drivers of human suffering and significant sources of catastrophic health spending.  In fact, many of our patients go without health care and are forced to forego medical procedures and prescription drugs …afraid that their families will be driven permanently into poverty.   Based on the limited data that I got this week from Philhealth, there is so little protection --- at most 30% of all hospital charges--- afforded to our patients given the current depth of PHIC coverage in shielding against these catastrophic causes which comprise about 15% of all Philhealth claims.  Thus, given the scenario where out-of pocket costs soar faster than benefits get improved and wages are increased, our people are highly vulnerable to financial shocks.  It is not a surprise how a single catastrophic event can wipe out a lifetime of family savings.

Ladies and gentlemen, I believe that any meaningful discourse on health financing must answer genuinely the needs of our patients who are not receiving any treatment or care… or those who fall into the cracks of financial ruin… and the millions more of our people who do not have security or stability because they are not covered adequately by health insurance.

The time for answers is now. The moment for change and action is today.  The last two decades of healthcare reform in the country have not been able to reduce the burden of out-of pocket spending and have in fact deepened healthcare inequalities based on worsening health outcomes among the poor and the wide gaps in health service delivery across our regions.  Reform has miserably failed to provide sufficient protection to our families against the rising costs of healthcare with an effective organization of health service delivery that could provide quality and affordable health care to every Filipino.

But despite our challenges and past failings, our conviction must be strong and our path must be bold and imaginative.  The path toward reform is not easy but we must push forward relentlessly, cognizant of the cost, to achieve a massive expansion of healthcare coverage within the next two to three years.   The alternative of doing nothing is not a choice because fifteen years ago,  we already made a pledge to the Filipino people that there will be equitable access to quality health care for everyone, rich or poor, with the establishment of Philhealth as the key driver of financing, reform and development in the health sector.  We do not want to be speaking about another healthcare crisis after 15 years by failing to respond,  govern and address what apparently ails our healthcare system when the solutions are already clear and obvious.

Ladies and gentlemen, I have committed myself and the Department of Health to the President’s agenda to implement and achieve Universal Health Care in two to three years.  We now have the Healthcare Financing Strategy 2010-2020 --- which shall be our blue print for health financing reform in the next decade toward achieving a better and more efficient health system that truly has the values of equity, solidarity, fairness and quality at its heart. 

The Health Care Financing Strategy is a Plan that spells for us radical changes.  It asks everyone to take responsibility for meeting the universal health care challenge -- not just the DOH, or Philhealth or the government, but everybody, including local governments, our health providers and individual citizens as users of healthcare.  It is a Plan that aims to achieve five health care imperatives during this Administration: 

     1)  First, we will aim to increase overall health spending with government’s budget for health projected to reach  7% of total public spending

     2)  Second, we will also endeavor to achieve Universal Coverage within two to 3 years by increasing and sustaining Philhealth membership.  This is our most important commitment to the President and the Filipino people.  Towards this end, I am asking Philhealth and DOH to jointly organize a National Philhealth Registration Day --- which we shall call P-NOY Philhealth day --- within the first 100 days of the Administration.

I shall seek support coming from all our partners like our Local Governments, the Private Sector and the Civil Society in organizing this event as we prepare for this grand challenge to enroll as many Filipinos in all provinces and regions of the country. I also call on my professional colleagues from the medical and surgical societies to help us organize medical and surgical missions that shall provide services to our indigents using Philhealth rates with no co-payments. 

      3)  Third, we shall make strategies on how we can enroll those who can afford to pay and make sure that we spend our money right for the right things and employ the most appropriate financing strategy.

This strategy includes transforming Philhealth as the main purchaser of health services within the next five years and improving its benefit packages and support value to our members.  The goal is to increase the Philhealth share of total health spending to 35% by 2020 up from the current level at 11%.  This means Philhealth must spend big but it must also spend more wisely for the most cost-effective services.  For example, by starting to invest in preventive primary outpatient care and contracting the services of GPs and RHUs in establishing a gatekeeping system.  This way we achieve true value and efficiency in healthcare.    This cannot happen unless Philhealth becomes a major player in the health financing field.

The fourth and fifth strategies are challenging because they will entail organizational transformation, modernizing our operations, reforming payment mechanisms and reinventing the dealings and relationships of our health care facilities and providers.  To adopt a higher level of efficiency, we shall explore new provider payment mechanisms such as case-mix based payments and define essential health packages in different levels of health care as well as guidelines on professional fees. Lastly, we will transform our healthcare facilities by making them autonomous and more responsive to the incentives that will be put in place in the system to recognize good performance and high quality health care.

In closing, let me say that we face exciting times in health financing and health reform.  There is greater hope for change as the health sector now has enjoyed a steady and unprecedented windfall of new resources both from the government and development partners.

While the DOH’s role will be vital in ensuring that the imperatives of the Health Care Financing Strategy will happen in the next two to three years, it is really Philhealth that must lead and embrace the challenge of truly LEAPING forward.   This is the time to be bold.  This is the time to act decisively and mightily on behalf of 90 million of our citizens.  Once and for all, Philhealth must be the front wheel that will move everyone in the system toward a single national healthcare strategy that is centered on one goal:  Universal healthcare that is fair, equitable and just and in the spirit of solidarity, succeeds in protecting and healing our people.

Good morning!