Primary care physicians (PCPs) will definitely play a major role in the implementation of universal health care (UHC) in the country. As the lead specialty in Family and Community Medicine, the Philippine Academy of Family Physicians gears up to provide comprehensive and holistic care in our current fragmented health system
By Gelyka Ruth R. Dumaraos
Everyone eagerly awaits the implementation of the Universal Health Care (UHC), which has just been signed into a law by President Duterte earlier this year. The law promises easier access to effective health care by expanding the coverage of Philhealth to all Filipinos both here and abroad, whether as indirect or direct contributors.
The UHC law enables all Filipinos to be covered in the full spectrum of health care—both as out- or in-patient, for preventive, curative, rehabilitative and palliative purposes. While this new law is considered a landmark legislation, various concerns still need to be addressed in order for Filipinos to finally enjoy its benefits.
Under the new law, healthcare professionals are expected to “give back,” particularly government scholars who have completed their health-related courses from government universities. These healthcare professionals, especially doctors and nurses, are required to work in the public health sector for at least three full years. This addresses the lack of health workers in the country, most especially in remote areas that do not have immediate access to medical facilities.
The Department of Health (DOH) will supervise the salaries of the health workers, with incentive opportunities for professionals who extend their services for another two years.
Other graduates of health courses in state universities and colleges, and even graduates in private schools are encouraged to work in the public sector.
Heightened primary care development
The Philippine Academy of Family Physicians (PAFP), in its 58th founding anniversary, welcomed the passage of the UHC law or Republic Act No 11223. The law mandates that every Filipino citizen is automatically enrolled as PhilHealh members. The law grants automatic eligibility to healthcare for preventive, promotive, curative, rehabilitative, and palliative care; and also for medical, dental, mental, and emergency health services.
PAFP, the leading organization for family physicians, sees the health reform as an opportunity for primary health care providers to grow with “heightened professional development.”
“We shall not yield from our continuous collaborative efforts with health leaders to urge them to invest in the training of skilled family doctors, from basic medical education to postgraduate training until continuing professional development,” PAFP said in a statement.
The organization believes that with a patient-centered, family focused, community-oriented care model, family medicine can provide integrated care in the current fragmented health system. The new law needs primary care providers who are trained in providing accessible first contact care that is comprehensive, continuous, compassionate and coordinated care.
PAFP commits to continue to collaborate with DOH for its support for the training of frontline health workers and capacity building of primary care teams and to develop good working conditions, just compensations and venues for professional growth and advancement in order to make primary care an attractive career option.
Shifting paradigm to keep people well
Putting up more facilities for prevention and health promotion is another step towards engaging more people to foil diseases that poses financial burden.
In his keynote address at PAFP’s convention last March, DOH Secretary Francisco Duque III said that the goal is to shift the paradigm from just taking care of the sick to one that keeps people healthy. He puts more importance in making more hospital centric management of patients towards health promotion, disease prevention and of course, wellness preservation.
The problem, according to Sec. Duque is that the system is too hospital-centric. This is the reason why hospitals are overly congested with patients because there are no intermediate delivery units to respond to their health problems that don’t really require hospitalization. On the other hand, those who are financially challenged choose to ignore their illnesses until such extreme circumstances when they have no choice but to be rushed to the hospital. In some instances, it might be too late already for treatment.
“Our problem, in many forms, is hospital,” said Sec. Duque. He shared stories of patients lying on stretchers in the corridors in congested health facilities and hospitals. “This is really sad, this is really pathetic. So, we need to change the way health delivery is provided in this country,” he stressed.
It’s also well known the lack of doctors and hospitals in rural villages especially in the mountainous provinces. In many areas, there are even no ambulances to transport severely ill patients to the nearest facility where they could be adequately managed. In many instances, family members and friends become the ‘means of transportation’ by carrying the patient on foot for hours to bring the patient to the nearest hospital. Some patients die on the road because of the long distance, lamented Sec. Duque.
Therefore, Sec. Duque emphasized the importance of the lower level basic delivery units to be more active and more responsive to the health care needs of the people. He explained the need to strengthen these lower units since they are the major providers and conveyors of primary care.
About PhP 257 billon is needed to implement health reforms during the first year of implementing the UHC law. However, Sec. Duque said there is still a funding gap of PhP 164 billion which can be addressed if higher tobacco taxes are imposed.
DOH is pushing to increase excise tax on cigarettes to PhP 90 per pack from the current P32.50. This will generate about PhP 45 to PhP 47 billion of additional revenues.
The World Health Organization (WHO) agrees on raising tobacco taxes to fund UHC. In a statement, WHO said, “the new UHC Act must be adequately funded for its promises to be carried out. The evidence is clear and incontrovertible: Further increases in tobacco excise taxes is a win-win solution that will save lives by supporting UHC and reducing the number of Filipino smokers at the same time.”
Dr. Anthony Leachon, health care advocate of the Sin Tax Coalition agrees too that funding from casino and lotto income is not sufficient. For him, appropriately increasing sin taxes is hitting two birds with one stone, noting that higher taxes on tobacco curbs tobacco use while getting a sustainable source of UHC funding. “UHC without sustainable funding will not work. It’s the most important issue that should be tackled before its final approval,” he said.
Sec. Duque acknowledged that in UHC, implementation is a crucial point and he sees this as an opportunity for public and private health movers to form partnerships.
“That is why I like you to come together and really march according to the dictates and mandates of the Universal Health Care,” he urged the PAFP doctors in his keynote address.