• LANCET STUDY

    PH an ‘underachiever’ in health care

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    THE Philippines was described as an “underachiever” in Asia in terms of access to and quality of health care for the treatment of preventable diseases, ranking 120th out of 195 countries reviewed, a study published on Friday said.

    The Healthcare Access and Quality Index, based on death rates for 32 diseases that can be avoided or effectively treated with proper medical care, also tracked progress in each nation compared to the benchmark year of 1990.

    A consortium of several hundred doctors around the world conducted the study, which was an extension of the Global Burden of Disease Study 2015 published by the prestigious British medical journal The Lancet. The study results were published online on Friday, and made available to the public through a grant from the Bill and Melinda Gates Foundation.

    The 32 diseases for which death rates were tracked included tuberculosis and other respiratory infections; illnesses that can be prevented with vaccines (diphtheria, whooping cough, tetanus and measles); several forms of treatable cancer and heart disease; and maternal or neonatal disorders.

    Access to health care and quality of treatment for each disease in a country was scored on a scale of 0 to 100, with the average score determining the country’s ranking. The Philippines scored 52 out of 100.

    Diseases for which the Philippines received particularly low scores – i.e., for which there are higher than expected death rates – included chronic kidney disease (18 out of 100), leukemia (24 out of 100), and tuberculosis and peptic ulcer disease (32 out of 100 for both).

    By contrast, the Philippines was given good scores in the treatment of diphtheria (99 out of 100), whooping cough (97 out of 100), and epilepsy (82 out of 100).

    Underachiever

    The study concluded that healthcare improved in virtually all countries over the 25-year period, but many fell further behind others in providing basic care for their citizens.

    “Despite improvements in healthcare quality and access over 25 years, inequality between the best and worst performing countries has grown,” Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington and leader of the study consortium said in a statement.

    He added that the standard of primary care was lower in many nations than would be expected given their level of wealth and development, describing these nations as “underachievers.”

    Murray named the Philippines as one of the biggest underachievers in Asia, along with Indonesia, India, and Brunei.

    The “underachievement” was due to either low scores – i.e., higher than expected death rates for some diseases – despite an adequate amount of funding for health care, or as in the case of the Philippines, less funding than required for the size of the population and economy, or other administrative circumstances.

    Other countries or regions described as underachievers included Botswana, South Africa, and Lesotho in Africa, and Oceania, the Caribbean, and Central Asia.

    The study indicated the gap between the actual and expected ratings widened over the study period in 62 of the 195 nations examined, including the Philippines.

    “Overall, our results are a warning sign that heightened healthcare access and quality is not an inevitable product of increased development,” Murray said.

    DOH addressing issues

    In a statement reacting to the study’s findings sent to The Manila Times on Monday, the Department of Health said that it concurred with Murray’s conclusion that the “standard for primary care is lower than expected” in the Philippines.

    The DOH pointed out that health indicators had improved over the 25-year study period, as the study also concluded. For example, World Bank data showed that under-5 mortality per 1,000 live births had been reduced from 58.2 in 1990 to 28 in 2015.

    “But inequity and large performance disparities for primary care exists across many provinces and municipalities. For example, under-5 mortality per 1,000 live births in Region 4B (Mimaropa) is at 43, while in Region 4A (Calabarzon) it is at 23,” the DOH said.

    In the DOH’s view, “The reason for this may be the fragmentation of the health system due to a large and difficult to regulate private sector, multiplicity of accountable managers for service delivery in the government, and inefficiencies and overlaps in the existence of multiple funds financing health services,” such as through the DOH, PhilHealth, the Philippine Charity Sweepstakes Office (PCSO), the Department of Social Welfare and Development (DSWD), and others.

    “The Philippine Health Agenda aims to address these challenges through three guarantees,” the DOH said. “Providing a list of essential health services for Filipinos that will receive priority funding from health managers; establishing access to service delivery networks of health care providers that will group together to improve care coordination for identified catchment areas of people; and simplifying financing of health care and harmonization of funding sources,” are all measures the health department is pursuing to improve health care access and breadth of services.

    Except Australia, which ranked 6th, all of the top 10 nations in the ranking were in Western Europe, led by the tiny principality of Andorra. Japan at number 11 was the highest-ranked nation in Asia, while China, ranked 32nd, had one of the biggest improvements over the study period, and ranked ahead of the US, which finished a disappointing 35th.

    Somalia, Afghanistan, and the Central African Republic were the worst performing countries in the ranking.

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