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Home Op-Ed Columns Opinion on Page One Public health: Death by a thousand cuts

Public health: Death by a thousand cuts



In 2012, the World Health Organization (WHO) did a detailed analysis of the country’s health financing system. Even with the effort to frame the findings in the most diplomatic of terms, the
WHO’s findings failed to paper over the harsh realities of that financing system. The main findings were:

– The financing system is fragmented, with insufficient government investments.

– Incentives to providers have been inappropriate.

– The system has a weak social protection and high inequity.

The health financing system, because of its fragmented and inadequate nature, failed to meet the WHO’s requirement for a well-functioning healthcare system, which is one that provides “access to quality healthcare regardless of paying capacity.”  A condition where both the rich and the poor have access to quality healthcare. The findings had this tacit admission: the poor suffered from this condition of weak social protection and high inequity.

The findings touched on these familiar issues. Many Filipinos faced tuberculosis, dengue, measles and HIV/AIDS. Maternal and newborn mortality rates were both high. Malnutrition was widespread. Put simply, the marks and scourges of poverty.

It is now 2019, and Congress is now deliberating on the more than P4-trillion national budget proposed for next year.  State propagandists say we are on the cusp of a “Golden Age” and the government is pursuing the most ambitious infrastructure development program in Philippine history. The supposition is this. The health sector, because it is as vital as education in the development of the human capital, is also rising in this historic age of development and growth. The Build, Build, Build initiative is in theory an across-the-board thing, sweeping up, lifting up, every public sector that needs propping up.  Modern public hospitals, the latest and state-of-the-art acquisitions for these modern public hospitals, the best and the brightest doctors serving in these modern public hospitals. The works.

So, what has changed in the health sector’s financing system from that 2012 findings of fragmentation and inadequacy? In this supposed “Golden Age,” that has Congress deliberating on a P4-trillion plus budget, the answer is a depressing one. Nothing much has changed, except perhaps more fragmentation and inadequacies.

In just a span of one week, Sen. Ralph Recto made two depressing revelations about the public financing of the health sector.

The first one was about the failure of the Department of Health (DoH) and the Philippine Health Insurance Corp. (PhilHealth) to get their due share from the sin tax collections. The law provides that 50 percent of such collections should go to the two agencies to shore up the fight against diseases and fund the basic medical expenses especially for poor Filipinos under the mandate of PhilHealth. Recto said the two agencies had been shortchanged of P28.3 billion of their just share under the sin tax collections under the proposed 2020 national budget.

The higher taxes on the so-called “sin” products were specifically predicated on the need to prop up the healthcare budget.
Where did the P28.3 billion go? Lump sums? “Pork” for congressmen? Foreign travel? Some sleight-of-the-hand accounting trickery to fund some frivolous items? That, we do not know.

The next item was the P10-billion cut proposed by the Department of Budget and Management (DBM) on the allocation for the DoH’s important Health Facilities Enhancement Program next year.

The current budget is P15.9 billion and next year, under the DBM proposal, that critical spending item in the DoH budget, would be given an allocation of just P5.9 billion. The lame excuse of the DBM for the budget cut? The usual excuse of “absorptive capacity,” the usual invocation of the DBM whenever it gets the itch to slash an important, life-saving item of the DoH.

The assault on the budget for public health came at the most tragic of context.  The health situation in the country is under siege, comparable to the sad state of a comatose patient in an intensive care unit.

The country is currently faced with a dengue epidemic, and a declaration of that grievous state was made in coordination with the National Disaster Risk Reduction and Management Council early August.  The DoH has recorded more than 1,000 deaths, mostly poor children from ages 5 to 9. The total dengue cases reported from January to September this year was 98 percent up from the dengue cases last year.

The dengue cases and deaths were mostly from the poor regions, with sizable populations of vulnerable, malnourished children.

A measles outbreak declaration from the DoH now covers the following regions: National Capital Region, Central Luzon, Bicol Region and Western Visayas.

But if these tragedies were not enough, here comes another depressing piece of health-related news. The University of the Philippines-managed Philippine General Hospital (PGH) now faces a budgetary cut of P450 million next year. Remember, this is the best public hospital in the country. Medical students on their last year of medical school render round-the-clock service to attend to thousands of patients, mostly indigents. Those treated for motorcycle-related injuries alone on a monthly basis are probably more than the entire yearly patient population of the famous Mayo Clinic.

Will that P450 million go to the “pork barrel” of one or two House leaders? Or hidden somewhere in the budget labyrinths so it can be used to buy chocolates and flowers for the “gelprens” of some high powers in government?

The latest version of the House budget sent to the Senate reportedly restored the health budget cuts and the PGH budget reduction. Nothing is final yet. So, let us see.


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