18 Aug Stop the second tranche of PhilHealth fund transfers
(This column contains Dr. Antonio Dans’ statement during the July 30 hearing conducted by the Senate Committee on Health and Demography, an inquiry in aid of legislation on the implementation of the Universal Healthcare Act, including the utilization of PhilHealth funds for program benefits.)
This Wednesday, Aug. 21, the second tranche of “unused funds” from the Philippine Health Insurance Corp. (PhilHealth) worth P10 billion is scheduled to be transferred to the national treasury.
According to the schedule presented by the Department of Finance (DoF) in a Senate hearing, P20 billion was already transferred in May, P30 billion will be transferred in October, and the last tranche of P29.9 billion will be transferred in November. These tranches make up the P89.9 billion that the DoF ordered PhilHealth to return to the national treasury to fund projects like infrastructure and rural development.
Healthcare workers are urgently calling on the government to stop any further transfer of funds and to return the funds that have already been transferred. The Supreme Court has ordered the DoF, Congress, Senate, PhilHealth, and the Executive Secretary to comment on the petition questioning the constitutionality of the transfer.
Last July, our alliance of 90 healthcare professional organizations together with six former Health Secretaries signed a letter of appeal to President Ferdinand Marcos, Jr. that the P89.9 billion worth of reserve funds not be taken from PhilHealth. We argue that PhilHealth is a social health insurance fund, not a bank, and the people’s premiums cannot be withdrawn. “Savings” should be used, as defined by the Universal Healthcare Law, for benefits such as consultations, admissions, medicines, and laboratory tests — whether they are for the direct or indirect contributors.
In addition, we argue that PhilHealth should not call this unused fund “savings,” when Filipinos suffer daily from the inefficiency of our social health insurance system.
We would not feel so strongly about the PhilHealth fund diversion if we did not feel so much suffering from the patients we care for and stand with every single day. The suffering is difficult to quantify, but there are five indicators I will be discussing.
The first indicator is the percentage of out-of-pocket expenses. In the Philippines, 45.9% of health expenditures come from out-of-pocket expenses. We have the third-highest out-of-pocket health spending in Southeast Asia, only lower than Cambodia and Myanmar. When we spend out of pocket for health expenses, it displaces resources available for other necessities.
The high proportion of out-of-pocket expenses has profound consequences, including the second indicator: catastrophic health expenses, defined by the World Health Organization as spending more than 10% of household expenditures on health. The 2018 Family Income and Expenditure Survey shows that about 1.5 million households or about nine million Filipinos face catastrophic expenses every year because of out-of-pocket spending.
The third indicator is impoverishment, or the number of households whose health expenses were so enormous that they were pushed below the poverty line — a whopping 268,000 households or about 1.5 million Filipinos a year (Ulep, V., Analysis of Family Income and Expenditure Survey, 2018).
The fourth indicator is based on a 2022 study by Dr. Gideon Lasco, which highlighted the four domains of health financing in the Philippines that Filipinos face when personal funds are not enough, what he refers to as the “4Ps”: PhilHealth; pangungutang or incurring debt; pagmamakaawa or approaching politicians, government agencies, or other organizations for medical assistance. The 4th P is pagtitiis, or enduring their illness and not seeking treatment due to fear of huge costs.
An indirect measure of pagtitiis or “unmet need” can be done by comparing the utilization of inpatient hospital benefits among different income quintiles. PhilHealth and Universal Healthcare were formed so that all Filipinos have access to health services regardless of ability to pay. But based on the National Demographic and Health Survey 2022, 554,880 Filipinos from the richest quintile utilized inpatient benefits, compared to only 346,800 in the poorest quintile. Why is there such inequity? Surely, it’s not that the rich are more likely to get sick. But rather, this suggests that more than 200,000 Filipinos in that quintile may have decided to just ignore their illness. Nagtiis na lang sila, kaysa magpa-confine (They put up with their illness rather than be confined in a hospital). The only clear explanation for this is that they weren’t able to go to a hospital because of lack of funds to even seek treatment.
The unused P400 billion of PhilHealth funds is the fifth measure of unmet need. Our actuaries are tasked to estimate the number of Filipinos with heart illnesses and lung diseases, how often they occur, and how much they spend. They estimated these expenses, and yet the people were not able to use these benefits. This means the P400 billion of PhilHealth’s “reserve chest” is not savings — it’s a measure of suffering.
To put a face to the suffering, I’d like to pay tribute to Javier Idulza Ras, a 76-year-old former PLDT linesman. He suffered a stroke last May and was confined for two months. His daughter, a call center employee, had to help. The bill was mounting at a rate of P12,000 per day. The family could not afford it, so they resorted to the 4Ps.
The first P was PhilHealth, which gave a “whopping” benefit of P20,000. This was barely good enough for three days.
The second P was pangungutang. His daughter wrote to us and other friends and even organized biking events to raise money to pay for blood and medications that were not covered on a daily basis.
The third P was pagmamakaawa. After two months of confinement, their total bill was P700,000. After repeated visits to social services to beg for help, they got it. The bill was covered by a private entity, the PGH Foundation. They continued to spend P3,000 a month out of the daughter’s salary of P13,000. So every month, they face catastrophic expenses and impoverishment. Sadly, Mr. Idulza Ras passed away a few weeks ago, despite all the efforts of the family.
The Filipino population’s unmet healthcare need is immense. The government must not take money from PhilHealth because hundreds of thousands of patients experience pagtitiis and pagmamakaawa every day.
We are the ones they come to for help and we are with them in their suffering. It is clear that the help PhilHealth provides is not enough. Let us not call the unused PhilHealth funds “savings” — this is actually money that we owe to the Filipino people.
Dr. Antonio Dans is an internist, epidemiologist, president of the Asia Pacific Center for Evidence-based Healthcare, and an academician at the National Academy of Science and Technology. He is a health advocate who campaigned for tobacco tax reforms and convenes the Healthcare Professionals Alliance against COVID-19.