Legal Research paper by: Meliza Hernandez

Healthcare: The Philippines and Other Countries, a Comparative Study

This is a research paper made to look into the Philippines’ current universal
medical healthcare system and make a comparative analysis and distinction with other
systems of medical care.

What is Universal Healthcare?

Before we discuss the current medical healthcare system of the Philippines, let us
first define what universal healthcare is. Universal healthcare, according to Wikipedia, is
a health care system that provides health care and financial protection to all residents
of a particular country or region. It is organized around providing a specified package of
benefits to all members of a society with the end goal of providing financial risk
protection, improved access to health services, and improved health outcomes. It is a
system that provides quality medical services to all citizens. The government offers it to
everyone regardless of their ability to pay.

Universal healthcare does not imply coverage for all people for everything, only
that all people have access to healthcare. Some universal healthcare systems are
government funded, while others are based on a requirement that all citizens purchase
private health insurance. Universal healthcare can be determined by three critical
dimensions: who is covered, what services are covered, and how much of the cost is
covered. It is described by the World Health Organization as a situation where citizens
can access health services without incurring financial hardship. The Director General of
WHO describes universal health coverage as the “single most powerful concept that
public health has to offer” since it unifies “services and delivers them in a
comprehensive and integrated way”. One of the goals with universal healthcare is to
create a system of protection which provides equality of opportunity for people to enjoy
the highest possible level of health.

UHC Constitutional Roots

The right to health of the people is a Constitutional right. Healthcare originates

from Constitutional policies like Art II Sec 9 that states that The State shall promote a
just and dynamic social order that will ensure the prosperity and independence of the
nation and free the people from poverty through policies that provide adequate social
services, promote full employment, a rising standard of living, and an improved quality
of life for all; Art II Sec 10 also states that The State shall promote social justice in all
Legal Research paper by: Meliza Hernandez

phases of national development. Other Constitutional provision which talks about the
right to health of the people are:

Art II Section 11: The State values the dignity of every human person and
guarantees full respect for human rights.

Art II Section 13: The State recognizes the sanctity of family life and shall protect
and strengthen the family as a basic autonomous social institution. It shall equally
protect the life of the mother and the life of the unborn from conception. The natural
and primary right and duty of parents in the rearing of the youth for civic efficiency and
the development of moral character shall receive the support of the Government.

Art II Section 14: The State recognizes the vital role of the youth in nation-building
and shall promote and protect their physical, moral, spiritual, intellectual, and social
well-being. It shall inculcate in the youth patriotism and nationalism, and encourage
their involvement in public and civic affairs.

Art II Section 15: The State shall protect and promote the right to health of the
people and instill health consciousness among them.

Art III Section 1: No person shall be deprived of life, liberty, or property without due
process of law, nor shall any person be denied the equal protection of the laws.

Art XIII Section 1: The Congress shall give highest priority to the enactment of
measures that protect and enhance the right of all the people to human dignity, reduce
social, economic, and political inequalities, and remove cultural inequities by equitably
diffusing wealth and political power for the common good.

Art XIII Section 2: The promotion of social justice shall include the commitment to
create economic opportunities based on freedom of initiative and self-reliance.

Art XIII Section 11: The State shall adopt an integrated and comprehensive
approach to health development which shall endeavor to make essential goods, health
and other social services available to all the people at affordable cost. There shall be
priority for the needs of the under-privileged, sick, elderly, disabled, women, and
children. The State shall endeavor to provide free medical care to paupers.
Legal Research paper by: Meliza Hernandez

Philippines’ Universal Healthcare

President Rodrigo Duterte of the Philippines signed into law on Feb. 20, 2019
Republic Act 11223 entitled “An Act Instituting Universal Health Care for all Filipinos,
Prescribing Reforms in the Health Care System, and Appropriating Funds Therefor”, or
the Universal Healthcare act. Its policies are mirrored with Art II Sec 15 of the 1987
Constitution. Other policies of this act are:

An integrated and comprehensive approach to ensure that all Filipinos are health
literate, provided with healthy living conditions, and protected from hazards and risks
that could affect their health;

A health care model that provides all Filipinos access to a comprehensive set of
quality and cost-effective, promotive, preventive, curative, rehabilitative, and palliative
health services without causing financial hardship, and prioritizes the needs of the
population who cannot afford such services;

A framework that fosters a whole-of-system, whole-of-government, and whole-

of-society approach in the development, implementation, monitoring, and evaluation of
health policies, programs and plans; and

A people-oriented approach for the delivery of health services that is centered on

people’s needs and well-being, and cognizant of the differences in culture, values, and
beliefs.

The objectives of this act are:

To progressively realize universal health care in the country through a systemic

approach and clear delineation of roles of key agencies and stakeholders towards better
performance in the health system; and

To ensure that all Filipinos are guaranteed equitable access to quality and
affordable health care goods and services, and protected against financial risk.

According to an article from ABS-CBN News, in more than 100 countries that
faced the same problem in health as the Philippines, the one common remedy is the
institution of a UHC as the dominant health care system. In our part of the world, the
Philippines is among the last, if not the last, to adopt UHC.
Legal Research paper by: Meliza Hernandez

Universal Health Care is meant to provide every Filipino the highest possible quality of
health care that is accessible, efficient, equitably distributed, adequately funded, fairly
financed, and appropriately used by an informed and empowered public. The
overarching philosophy is that health is a right and provision of health services is based
on needs and not on an individual capacity to pay.

The National Economic and Development Authority (NEDA) said that the signing
of the law is a big leap towards reforming the country’s health care system. “Our
medium-term plan recognizes human development not just as a means to economic
development but as an end in itself. That is why the signing of the UHC law is a victory
scored for the health sector. We are glad that we have reached this milestone halfway
into the term of the Duterte administration,” Socioeconomic Planning Secretary Ernesto
M. Pernia said. Health Secretary Francisco Duque III signed the implementing rules and
regulations of the UHC last October 10, 2019. Duque said that the issuance of the IRR
would pave the way for the implementation of a holistic health care system for every
Filipino. But how does universal health care work? A Rappler article by Sofia Tomacruz
made quick breakdown of how the law works:

ALL Filipinos are covered: Every single Filipino citizen is automatically enrolled
into the newly-created National Health Insurance Program (NHIP). The program
classified membership into two types:

 Direct contributors – those who pay PhilHealth premiums, are employed and
bound by an "employer-employee relationship," self-earning, professional
practitioners, and migrant workers. Members’ qualified dependents and lifetime
members are also included.
 Indirect contributors – those not considered as direct contributors, along with
their qualified dependents, whose health premiums are subsidized by the
government

All Filipinos will be granted “immediate eligibility” and access to the full spectrum of
health care which includes preventive, promotive, curative, rehabilitative, and palliative
care. This can be expected for medical, dental, mental, and emergency health services.

Filipinos will also be enrolled with a primary health care provider of their choice. The
primary care provider is the health worker they can go and seek treatment from for
health concerns. They will also serve as the person in charge of referring and
coordinating with other health centers if patients need further treatment.
Legal Research paper by: Meliza Hernandez

Citizens will not need to present any PhilHealth ID to avail of these benefits. Meanwhile,
poor Filipinos or those who are located in geographically isolated areas will also be
given priority when ensuring access to health services.

It is not completely free: Contrary to what some people may think, UHC does
not mean every single health expense will be made free. The law outlines that basic
services accommodations will be covered by PhilHealth. As a patient, that means that if
you’re admitted in a hospital you can expect regular meals, a bed in a shared room with
fan ventilation, and a shared toilet and bath to be covered. All are also entitled to an
“essential health benefit package,” which includes primary care, medicines, diagnostic,
and laboratory tests. It also includes preventive, curative, and rehabilitative services. It
will no longer be free when one wants to stay in a hospital room offering private
accommodation, air conditioning, telephone, television, and meal choices, among
others.

PhilHealth will become the “national purchaser” of health goods and

services: This means that PhilHealth will be in charge of paying health care providers
like hospitals and clinics for services given to Filipinos. This is already a job PhilHealth
carries out but the universal health care law wants to pool more funds so it can cover
all Filipinos and eventually, more services.

Funds for PhilHealth will be sourced from the following:

 Philippine Amusement and Gaming Corporation – 50% of national government’s

share
 Philippine Charity Sweepstakes Office (PCSO) – 40% of its charity fund, net of
document stamp tax payments, and mandatory PCSO contributions
 Premium contributions of direct contributory members
 PhilHealth annual budget

With multiple fund sources for PhilHealth, Filipinos will no longer need to troop to
various government offices to secure funds to pay for health expenses. It will also make
them less dependent on politicians to help pay for health services. By giving PhilHealth
more funds, a goal of the UHC is to make PhilHealth the national purchaser of
medicines. This can lower the cost of medicines as these will be bought in bulk.
Legal Research paper by: Meliza Hernandez

Those are some of the key guidelines for the law. Now, let us take a look at some of
the countries who also employ Universal Health Care but with modifications. An article
from thebalance.com made a summary of some Countries’ universal health plans:

Other Countries’ Universal Health Care Systems

Australia: Australia adopted a two-tier system. The government pays two-thirds, and
the private sector pays one-third. The public universal system is called Medicare.
Everyone receives coverage. That includes visiting students, people seeking asylum,
and those with temporary visas. People must pay deductibles before government
payments kick in. Half of the residents have paid for private health insurance to receive
a higher quality of care. Those who buy private insurance before they reach 30 receive
a lifetime discount. Government regulations protect seniors, the poor, children,
and rural residents.

In 2016, health care cost 9.6% of Australia's gross domestic product. The per capita
cost was US$4,798 or 239,900 Php. The Organization for Economic Cooperation and
Development disclosed that 22.4% of patients reported a wait time of more than four
weeks to see a specialist. On the other hand, only 7.8% of patients skipped medications
because the cost was too high. In 2015, the Australian life expectancy was 84.5 years.

Canada: Canada has a single-payer system. The government pays for services
provided by a private delivery system. The government pays for 70% of care. Private
supplemental insurance pays for vision, dental care, and prescription drugs. Hospitals
are publicly funded. They provide free care to all residents regardless of the ability to
pay. The government keeps hospitals on a fixed budget to control costs. It reimburses
doctors at a fee-for-service rate. It negotiates bulk prices for prescription medicine.

In 2016, health care cost 10.6% of Canada’s GDP. The cost per person was US$4,752
or 237,600 Php, and 10.5% of patients skipped prescriptions because of cost. A
whopping 56.3% of patients waited more than four weeks to see a specialist. As a
result, many patients who can afford it go to the United States for care. In 2015, the
life expectancy was 82.2 years. Canada has high survival rates for cancer and low
hospital admission rates for asthma and diabetes.

France: France has an excellent two-tier system. Its mandatory health insurance
system covers 75% of health care spending. That includes hospitals, doctors, drugs,
and mental health. Doctors are paid less than in other countries, but their education
and insurance is free. The French government also pays for homeopathy, house calls,
Legal Research paper by: Meliza Hernandez

and child care. Of that, payroll taxes fund 40%, income taxes cover 30%, and the rest
is from tobacco and alcohol taxes. For-profit corporations own one-third of
hospitals. Patients give care consistent high ratings.

In 2016, health care cost 11% of GDP. That was US$4,600 or 230,000 Php per person.
In 2013, 49.3% of patients reported a wait time of more than four weeks to see a
specialist. But only 7.8% of patients skipped prescriptions because of cost. In 2015, the
life expectancy was 85.5 years.

Singapore: Singapore's two-tier system is one of the best in the world. Two-thirds is
private and one-third public spending. It provides five classes of hospital care. The
government manages hospitals that provide low-cost or free care. It sets regulations
that control the cost of the entire health care system. People can buy higher levels of
deluxe care for a fee. Workers pay 20% of their salary to three mandated savings
accounts. The employer pays another 16% into the account. One account is for
housing, insurance, or education investment. The second account is for retirement
savings. The third is for health care. The Medisave account collects 7% to 9.5% of
income, earns interest, and is capped at the $43,500 income. More than 90% of the
population enrolls in Medishield, a catastrophic insurance program. The Medifund pays
for health costs after the Medisave and Medishield accounts are exhausted. Eldershield
pays for nursing home care. Once an employee turns 40, a portion of income is
automatically deposited into the account.

In 2009, Singapore spent 4.9% of its GDP on health care. That's US$2,000 or 100,000
Php per person. In 2015, life expectancy was 83.1 years.

Switzerland: The country has mandatory health insurance that covers all
residents. Quality of care is one of the best in the world. Coverage is provided by
competing private insurance companies. People can buy voluntary insurance to access
better hospitals, doctors, and amenities. The government pays for 60% of the country's
health care. Dental care is not covered. Vision is only covered for children. The
government subsidizes premiums for low-income families, about 30% of the
total. There is a 10% coinsurance cost for services and 20% for drugs. These out-of-
pocket costs are waived for maternity care, preventive care, and child hospitalization.
The government sets prices.

In 2016, health care spending was 12.4% of GDP. It was USD$7,919 or 395,590 Php
per person. There were 11.6% of patients who skipped prescriptions because of
Legal Research paper by: Meliza Hernandez

cost. Also, 20.2% of patients reported a wait time of more than four weeks to see a
specialist. In 2015, life expectancy was 83.4 years.

United States: The United States has a mixture of government-run and private
insurance. The government pays most of the cost, but also subsidizes private health
insurance through Obamacare. Health care service providers are private. Sixty percent
of citizens get private insurance from their employers. Fifteen percent receive Medicare
for those 65 and older. The federal government also funds Medicaid for low-income
families and the Children's Health Insurance Program for children. It pays for veterans,
Congress, and federal employees. Despite all these, there are 28 million Americans who
have no coverage. They either are exempt from the Obamacare mandate or can't afford
insurance.

In 2016, health care cost 18% of GDP. That was a staggering US$9,892 or 494,600 Php
per person. Exactly 18% of patients skipped prescriptions because of cost. But
only 4.9% of patients reported a wait time of more than four weeks to see a
specialist. In 2015, life expectancy was 79.3 years. The third leading cause of death
was a medical error. The quality of care is low. It ranks 28th according to the United
Nations.

Summary

RA 11223 has been a big step in the right direction for the current
administration. This act would be a game-changer for our fellow Filipinos who do not
have a medical insurance or cannot afford one. This move, albeit kind of late is what we
need to be able to move forward in this society. Since the government is just starting to
implement UHC, we should look into other countries to see how they have implemented
their medical systems, and see this as a guideline for the continued success of our
medical care system and for the betterment of the country and society.
Legal Research paper by: Meliza Hernandez

References:

https://en.wikipedia.org/wiki/Universal_health_care

https://www.doh.gov.ph/universal-health-care

https://www.youtube.com/watch?v=PuqYC-1abVM

https://www.thebalance.com/universal-health-care-4156211

https://www.who.int/philippines/news/feature-stories/detail/uhc-act-in-the-philippines-a-new-
dawn-for-health-care

https://www.rappler.com/newsbreak/iq/226810-explanation-what-filipinos-can-expect-universal-
health-care-law

https://www.philstar.com/headlines/2019/10/11/1959315/doh-chief-signs-irr-universal-health-
care

http://www.neda.gov.ph/explainer-universal-health-care-law-and-what-it-means-to-ph-
development/

https://news.abs-cbn.com/blogs/opinions/10/05/19/why-the-philippines-needs-universal-health-
care

https://opinion.inquirer.net/120618/universal-health-care-phs-best-investment

https://www.gmanetwork.com/news/news/nation/711172/duque-signs-irr-of-universal-health-
care-law/story/

https://twitter.com/makipulido/status/1182125079771009024/photo/1

https://www.philstar.com/headlines/2019/10/11/1959315/doh-chief-signs-irr-universal-health-
care