Speech of the Health Secretary on the Aquino Health Agenda for universal health care, March 28, 2011

Speech of the Secretary of Health, Dr. Enrique T. Ona:

On the Aquino Health Agenda for universal health care

[Delivered during the 4th National Directorate Meeting and Health Summit of the League of Municipalities of the Philippines, Boracay Island, Aklan on March 28 2011]

The theme of this health summit, “Mayor Health Advocate: Sama-sama, Kayang-kaya,” is an affirmation of the celebrated Filipino tradition of bayanihan, which is concerted action of everyone for a desired common good. Bayanihan captures the sense of shared responsibility and the commitment of all stakeholders in health, namely, the department of health, our local government units, the private sector, development partners and other national government agencies, in ensuring better health outcomes for all Filipinos.

I am genuinely delighted to be part of this event, because this is a propitious time for me to thank all of your for your contributions to the substantial gains our country has achieved in implementing health reforms.

This is also an opportunity for me, as your Secretary of Health, to share to all of you the Aquino Health Agenda for achieving universal health care for all Filipinos. As the frontliners in providing primary health care services to our people, your support to the Aquino Health Agenda is crucial and valuable.

Universal health care is the Aquino administration’s answer to the sad observation of our president, Benigno S. Aquino III that 30 percent of our countrymen die without seeing a health professional.

Universal health care means that all Filipinos, especially the poor, have access to affordable and quality health care when they need it, with ample protection from financial ruin.

The Aquino Health Agenda spells out our thrusts in achieving universal health care for all Filipinos.

The cornerstone of universal health care is ensuring that all Filipinos are protected from the financial burden illnesses bring through a reformed PhilHealth.

Sixteen years after the PhilHealth law was passed, our estimated coverage in 2010 is a scant 54 percent of the population, a far cry from the mandated 85 percent required to achieve universal coverage. Of the 54 percent covered, only 42 percent can access the benefits of PhilHealth. And only 34 percent of the total health care costs are covered by PhilHealth. The resulting PhilHealth support value translates to a meager 8 percent.

Our reforms in PhilHealth focus on the poorest 40 percent of our population, amounting to about 9 million families. The poorest 20 percent of our population, consisting of about 4.7 million families, earn about P3,500 or less every month. Meanwhile, the next poorest 20 percent is made up of another 4 million families, with monthly incomes between P 3,500 to P 6,000.

Let us work hand in hand to ensure that the poorest 40 percent of our population will be enrolled to PhilHealth by 2013. The national government will shoulder the Philhealth premiums of the poorest 20 percent as identified by the National Household Targeting System or the NHTS. DSWD Secretary Soliman has agreed to use part of the cash grant for the Pantawid Pamilyang Pilipino Program [4Ps] to pay for the PhilHealth premiums of the 4Ps beneficiaries.

Through the years, recognizing the need for financial risk protection, you have enrolled your poor to PhilHealth using local government funds. Today, I ask of you to continue enrolling your constituents who may not belong to the NHTS but are also poor, mostly belonging to the second poorest 20 percent of the population. In this way, together, we can achieve our target of PhilHealth coverage for the poorest 40 percent.

Even as we expand PhilHealth coverage to the very poor and not so poor, I also ask your help in compelling your constituents who can pay the minimal premium of P100 per month to enroll in PhilHealth, for their own protection as well as to increase the pooled fund for paying out benefits. For instance, PhilHealth membership can be made a prerequisite for certain municipal permits. This is in keeping with the PhilHealth law’s mandate for mandatory coverage for all Filipinos.

In my dialogues with various local chief executives, horror stories of the difficulties in accessing PhilHealth benefits abound. Some even question the wisdom of enrolling their constituents to PhilHealth when its benefits are scant in often out of reach. Do not worry, as we are now instituting measures to improve PhilHealth benefit availment and its support value.

We are modernizing the information system of PhilHealth to facilitate claims processing and reduce the disincentives associated with PhilHealth benefits, such as delays in payment.

The support value of PhilHealth, estimated to be at 20 percent of the total health bill, is being increased. Our target is for PhilHealth to have 70-percent support value and drastically lower out of pocket spending. There shall be no balance billing for the identified poorest of the poor identified by the NHTS in government hospitals. Both inpatient and outpatient benefits are now being improved. Case payment, wherein each medical and surgical case has a predetermined cost to be paid out by PhilHealth, is being introduced. There are an initial 11 medical and 11 surgical cases approved for case payment. Case payment holds the promise of lowering health care costs by encouraging efficiency among health care providers.

We are now studying the real cost of services by physicians. The results of this study will guide PhilHealth in establishing benchmarks in professional fees of doctors to arrest the ballooning cost of health care.

All our reforms in PhilHealth have been incorporated in a health care financing bill that seeks to amend the PhilHealth Law. The President has certified this bill as urgent and is now being heard in both Houses of Congress.

The national leadership is now taking steps to ensure PhilHealth operates for what it is intended for: as a genuine social health insurance that will confer protection from financial ruin for our citizens once they get sick.

However, our efforts can only go so far without your cooperation. Let this be an invitation from the Department of Health for us to work together toward making PhilHealth more meaningful for our people.

I urge all of you to coordinate and work with your DOH Centers for Health Development and the PhilHealth Regional Offices in your areas to increase PhilHealth enrollment. Let us ensure that your rural health units and local government hospitals are accredited to PhilHealth, for improved health services among PhilHealth members and increased revenues for your health facilities. I ask you, our mayors, to ensure that the PhilHealth Capitation Fund paid to you for enrolling your indigents, is used to improve the outpatient services of your RHUs, increase the supply of medicines and other essential medical supplies, and augment the benefits of your health workers.

The state of our government health facilities is a reflection of our health care system. For so long, the public has associated government hospitals and health centers with filth, decay, and neglect. We are determined to turn this sad state of affairs around and give our poor countrymen, who primarily depend on these facilities, the same quality of health care services their richer counterparts enjoy.

Our 2011 budget has allocated P7 billion for improvement of health facilities: government regional, provincial and district hospitals, rural health units and barangay health stations. We are uplifting these facilities to have emergency obstetric and neonatal care capabilities to address maternal and infant deaths. Womens’ health teams have been trained to track expectant mothers during pregnancy and life-saving services are ensured in these health facilities with skilled professional care. But we shall not stop here. Cognizant of the important role of the private sector, we are exploring viable public private partnerships to bring our regional medical centers to the 21st century.

Given the scarcity of financial resources for health facilities enhancement, counter-parting of both national and local government can increase the number of rural health stations, barangay health stations and local hospitals we can upgrade. The Department of Health, through the Province-wide Investment Plan for Health, provides funding assistance to LGUs for local health systems strengthening.

Our commitments to reach our MDG Targets require that we take particular attention to improving the health of our mothers and children. Statistics show that 10 to 11 mothers are dying daily from pregnancy and child birth-related causes, which are largely preventable. Although there have been reductions in maternal and child mortality over the years, we are lagging behind our Asian neighbors in reducing infant and maternal mortality. There are wide differences in outcomes and performance across varied geographic areas and income groups in our country. Maternal mortality ratio (MMR) is at 162/100,000 live births as of 2006, while Infant Mortality Rate (IMR) is 25/1000 live births in 2008. We intend to reach MMR and IMR targets of 52deaths /100,000 live births and 19 deaths/1,000 live births in 2015 or earlier.

It is unfortunate that side by side with lacking health services for the poor is a huge pool of nurses idled due to lack of opportunities for employment. As of June 2010, there were about 187,000 to 200,000 unemployed nurses according to the Board of Nursing.

A month ago, we launched the Registered Nurses for Health Enhancement and Local Service (RN Heals). RN Heals is our immediate answer to improve access to health services of our poor, especially our mothers and children. Through RN Heals, our nurses are provided with opportunities to learn and serve in both hospital and community settings for a period of one year. They are stationed in rural health units with basic emergency obstetric and neonatal care capabilities to help address maternal and child morbidity and mortality.

Ten thousand nurses are now serving in identified 4P communities nationwide. Our nurses are provided with P8,000.00 monthly allowance from the national government, PhilHealth, and GSIS insurance. At the end of the yearlong deployment, our nurses shall be given a certificate of competency and employment. I urge you to augment the allowance of our RN Heals nurses by at least P 2,000.00.

There are other areas where the DOH and the local governments can collaborate for improving health outcomes of our people. I am happy to hear from you ideas on how best we can go about this collaboration.

Let us harness our combined efforts and maximize our resources in the spirit of solidarity for the attainment of universal health care for all Filipinos.

Kayang-kaya kung sama-sama! Maraming salamat po at magandang umaga sa inyong lahat!