Health care beyond reach of poor, say critics

(11th of a series)

For any Filipino family, especially among the poor, an illness striking any of its members is viewed as a catastrophe.

Six of 10 Filipinos who succumb to sickness die without ever seeing a doctor, according to the University of the Philippines’ National Health Institute.

Health care is one of the most important items that should be on the agenda of whoever gets elected president in the May election, according to a group of former senior government officials who have drawn up a list of urgent concerns for the next administration to address in its first year.

Unlike in the United States, where health care occupied center stage in the past presidential election and continues to be a major program of the Obama administration, very little attention is focused on the current debates on this major problem that impacts heavily on improving education and easing poverty in this country.

Ailing parents can’t support their families. Sickly and malnourished children can’t attend schools, setting back their education, the main vehicle for social mobility especially among the poor who have no access to wealth or capital.

Even among those with a regular income, like Jeremy Macalalag, 39, surviving a major ailment is nothing short of a miracle.

Macalalag was diagnosed with severe kidney problem requiring dialysis, an expensive treatment that cost P3,500 a session. He had to undergo this process or would die unless he had a P1.2 million transplant operation, doctors said.

“I didn’t know from which pocket and from what kind of hand I would get the money to save my husband’s life,” says Macalalag’s wife, Joanne, 38, an ultrasound technician in a hospital who earned P30,000 a month on which her family of four depended to survive.

With her social network, however, she secured help from humanitarian organizations, such as the Lifeline Foundation and the Philippine Charity Sweepstakes Office, to defray the cost of the transplant.

Not many in this nation of 90 million are that fortunate, especially among the more than 27 million who survive on a dollar a day, the poverty threshold defined by the World Bank.

Infant mortality rates

The poorest Filipinos have an infant mortality rate of 42 per 1,000 births, compared with 19 per 1,000 births among the rich, according to a concept paper presented at a UP forum on universal health care last year.

“The same can be observed in maternal mortality rates. The lowest income groups are also 1.4 times more likely to be positive for tuberculosis based on X-ray exam compared to the highest income groups,” it says.

Urban areas, such as the National Capital Region, have the highest number of health facilities, while the poorer regions such as the Autonomous Region in Muslim Mindanao have predominantly private facilities—far from the reach of the poor.

“Despite 76 percent coverage of PhilHealth insurance, 49 percent of health spending is still out-of-pocket. Due to increasing cost of services and the lack of appropriate social protection, illness now tends to be viewed as a catastrophic event, especially for the poorest Filipino families,” the paper says.

Universal health care

Dr. Ramon Paterno of the UP National Health Institute says the country needs a universal health care system where “every Filipino has access to needed health care, with minimal or no co-payment.”

He stresses that this isn’t about charity. “It is prepaid by taxes and social premiums.”

Paterno laments that health care financing has almost always been troublesome.

“Government’s budget for health care only amounts to less than 3 percent of the country’s GDP (gross domestic product). This is 2 percent lower than the standard health care allocation, 5 percent, recommended by the World Health Organization,” Paterno says.

“As a nation, we spend P200 billion for health care but 60 percent of this are out-of-the-pocket expenditures.”

Philippine Health Insurance Corp. (PhilHealth) is a state agency attached to the Department of Health, which strives to deliver universal health care to its clients.

The agency “ensures sustainable, affordable and progressive social health insurance, which endeavors to influence the delivery of accessible quality health care for all Filipinos.”

Public hospitals

Workers pay P100 to P750 a month for PhilHealth, but 50 percent of the monthly premium is covered by their employers.

Critics say that PhilHealth is one of the better-run state corporations, accumulating assets of up to P70 billion.

But they say that little of PhilHealth’s assets are being used to finance the improvement of provincial hospitals so that they can be accredited into the system and thereby ease the shortage of medical services in the rural areas.

Little tertiary health care—services provided for major ailments by such hospitals as Makati Medical Center and Medical City—is available in the provinces.

Valid concern

Health Secretary Esperanza Cabral acknowledges this is a valid concern.

“We need to improve our activities as far as accrediting hospitals and clinics so that patients with PhilHealth cards can access them and they can be reimbursed for the services they provide so that they can have money that they can pour into other health services,” Cabral says.

“The support value is only about 30 percent. At the moment, we actually say that is the only amount that we can afford. I have to take a serious look as to whether that is true and whether, if that’s the only thing we can afford, we are putting it in the right places.”

Paterno shows documentaries of the rural poor who are unable to avail themselves of medical services.

“There’s nothing I can do,” says an ailing woman profiled in the documentary. “I am just waiting to die if no one lends help,” she says, tears welling in her wrinkled eyes.

Health on P1.10 a day?

How does the average Filipino cope?

“I do everything. I sell perfumes and I work during my days off. We also collect bottles, newspapers, boxes and the like, and sell them,” Joanne Macalalag says.

“We are in a hand-to-mouth condition. My kids are used to eating corned beef almost always. We cannot afford other extra expenses.”

Based on the allocation of government’s budget, a tax-paying Filipino spends only P1.10 a day for health care compared to P21.75 spent on debt-servicing, authorities say.

Apparently, P1.10 a day isn’t giving the Jeremy Macalalags in this country too much hope.

While every Filipino is entitled to health care in the Constitution, it is regarded more as a privilege, as poverty incidence widens.

“Health care in the Philippines is costly as it is mostly given for profit. Most Filipinos are poor and health care becomes least in their priorities next to food, shelter and education,” says Dr. Geneve Rivera, secretary general of Health Alliance for Democracy.

She says the profit-driven nature of health care is characterized by privatization of services, including those dispensed by government facilities, as well as the western orientation of health education designed for the needs of other countries.

Ill-equipped gov’t hospitals

“Government hospitals are ill-equipped that a PhilHealth member will have minimal use of the membership,” Rivera says.

For example, she says, few public hospitals have an ultrasound facility. Which means, you have to go to a private hospital to avail yourself of this service and pay for it.

“PhilHealth also has various limitations in its coverage,” Rivera says. “But the whole concept of it does not answer the bigger problems. In these times when most Filipinos can barely afford to buy food, how can one pay for the contributions?” she says.

“Government policies on health care provision have made the health care services more and more inaccessible to the people especially the underprivileged. The continued privatization of government hospitals, the low priority in allocating budget for health, and the continuing program of sending our health professionals abroad are all contributing to the worsening of the health care delivery in the country,” she says.

And unfortunately, health professionals who choose to stay in the country and do community work are being targeted as enemies of the government and are being harassed, like the 43 health workers allegedly illegally arrested and detained in Camp Capinpin. The case has reached the Commission on Human Rights.

Rivera says that the government should promote community health work and ensure that volunteers are safe from harassment.

“The government should work on making health and other social services equitable, those who have less should receive more,” says Rivera, one of the few doctors who immerse themselves in depressed communities and serve the poor.

Alternative medicine

Because of the high cost of health care, many Filipinos resort to alternative medicine.

Norberto Cervales, a 32-year-old jobless father, usually brings his 16-month-old daughter to a mangtatawas, a sort of an exorcist, whenever she gets sick.

Tawas is a ritual to find out supernatural causes of physical illnesses.

The practitioner chants a prayer. A candle is lit and as the melted wax drops in a basin of water, an image is formed, said to be the creature responsible for the ailment. The sick then sleeps on the wax image and, voila, the ailment disappears.

Cervales says he had tried to raise P300 for a doctor’s consultation fee, but decided he couldn’t afford it, much less the prescribed medicine.

“We are asked to return again and again,” he says. “We don’t have the money for it.”

Lita Panganiban, 64, a mangtatawas, says that her patients are growing. “Even in the middle of the night, they come to my house,” she says.

Faith healing

Panganiban says she learned the ritual from her mother back in her Masbate hometown.

“If you’re smart, you can easily learn the prayer,” she says.

Panganiban’s services are also very much affordable. She accepts any donation the patient hands over.

“I am not totally against health care alternatives, but it depends on the method,” says Dr. Imelda Ferrer. “As long as it is sanitary and does not let patients take drugs prior to doctor’s prescription.”

Ferrer also says it can get dangerous. “The illness can get worse,” she says. “With spiritual healing, I must say that it is important for a patient’s recovery.”

It’s all about faith, when all else fails. –Kirsten Bernabe, Philippine Daily Inquirer