Health Issues | Universal Health Care

[Music] health is one of the most important if not the most important topic for every population or individual in 2019 our legislators passed the universal health care act or Republic Act one one two two three the landmark law expands access to health services by automatically enrolling all Filipinos in fill health national health insurance program it seeks to ensure that all Filipino citizens have access to a comprehensive set of health services without financial hardship according to our social economic planning secretary arnesto Pena our medium-term plan recognizes human development not just as a means of 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 and president the third day on signing the law said by automatically enrolling our citizens into the national health insurance program and expanding fill health coverage to include free medical consultations and laboratory tests the UHC law will guarantee equitable access to quality and affordable health care services to all Filipinos after almost a year the implementing rules and regulations were finally written and signed by the secretary of health dr. francisco de duque in this episode of health issues we will explain what universal health care law really means this is dr. Terry her Bossa and we will be talking to dr. Emily Topher all about the salient features of the UHC law and the issues and concerns regarding the progressive attainment of universal health care for all filipinos our guest today is dr. Emory tohe save for our own MD MBA is an assistant professor of the College of Public Health former assistant to the Dean for academic affairs and former chair of the department of health policy and administration in the College of Public Health of the university of the philippines manila he teaches courses in hospital administration public health administration health economics and research methods in health informatics Emmer welcome back to health issues and good afternoon dr. Tanner basta it is an honor again to be here I guess we have a very exciting afternoon yes let's start with the basic question what is universal health coverage or universal health care as we call it in the Philippines in the Philippines actually there is still a debate on the care part in the coverage point it's a fully universal healthcare for us but I think there was a long debate on the care in the coverage because the World Health Organization sees it as coverage so the for the Philippines it's universal meaning all Filipinos are covered they will not suffer for financial catastrophe and these services are all accessible affordable and up quality very good definition how so what is the universal health care law Philippines the universal health care law ensures and ensures that everyone from the barangay to the national level will be following a certain framework on how it is going to be delivered so it was passed it was discussed a long time for a long time it was just an advocacy and now after years I think even before it was just a journal article so propagated by the universal health care Study Group and it I think spend at least two administrations two presidents before it was finally signed into law by this administration and I think it was it is described by the website of the Department of Health a progressively policy that progressive attainment of universal it's not an endpoint yet yeah so so it's a progressive work in progress it's work in progress so when you say universal health care or you without coverage who are we trying to cover all Filipinos so basically all Filipinos I'm a foreigner I'm not covered I don't think so it is the resources our resources for Filipinos because before you still have to show your card you have to be a member but now I think just as long as you are Filipino Filipino citizen and that is what the universal there means as far as the country is concerned so that our constitution actually provides that health care is a right and that right is supposed to be provided by government but this kind of right is a progressive right it's not like right to life telegin you're alive you're actually alive but the right to health care or access to equitable affordable healthcare is a progressive one correct because it's an imperfect way of delivering it there's a it's dependent on how the government will give it to you and government this is of two types local and national and that there is a complexity in the local because we have a different way of interpreting the law much like the Bible everybody interprets it differently so let's talk about that I mean it seems that universal health care law is actually about tweaking or reforming the health system yes can you describe the health system prior to the law and where we plan to bring this health system in the future with the presence of the law I think before well depends when you where you start before it was fully before the Pimentel law which was the devolution law was centralized so all services stem from our lead health system which is the Department of Health like Deb at DEP at the centralized yes all schools are under their hands and are run by and employed by teachers from their ped but what happened during the payment alone payment a lawyer referring to the local government code local government code 1992 in 92 for yes what happened there so now it's just like the parent having children the children can already fend for themselves so you part so these are the mayors these are the local government units so they decided to give parts of the health system to the local government decision making resource a lot man employment yes all of those things so after that what happened Department of Health took care of like 70 hospitals right yes and regional centers yes and then the local government the governor's took care of of the local primary health care so does the provincial hospitals and then the mayor's took care of the health centers the health centers and the health district so very interesting so we fragmented our health system in a way or we decentralized there some people say fragmented some people say it's centralized centralized and closer to the people it depends on the perspective so I think it has its advantages it also has its disadvantages if you are very efficient with your managerial administrative progress in the local setting then it will work so we have to define a term that comes out often in universal health coverage it's called equity this law this local government code created in equity for the poor yes because this resources not all municipalities not all local government units are rich or first first class are you know municipalities first class second class up to 56 plus 56 plus the the fixed with six plus or the poorest first class so the income resources are not the same and with income because that's the primary thing comes human resources equipment even the skills needed and there's always the tendency of course to go to the more populous areas so when I when I say you go for universal health care or universal health coverage yes I agree with you in principle yes I do want that if I am the mayor but my capacity my skills my resources I can't I don't think I can do it the way you envisioned it so I think there is that so big divide the divide in the back so equity while equity will will will be there in equity that the drive for equity is there the principle of the law but in equity will exist because much as I if I were the mayor would like to deliver the services she envisioned it I cannot because I'm limited by what I have so but that also came in the time where in the government we didn't have enough funds for health the health budget wasn't high so the private sector continued to develop you can get access to health care but you will have to pay a private hospital for all the modern care medicines anti-cancer but the poor were left with minimal the government the government passing was minimal and the meager budget had to be divided to in their larger population and there's also the question of quality because of that the quality will so they say that there's this study I haven't found it yet but it sounds logical so word association between government hospitals in a private hospital they say that the people go to the private hospitals for quality but it is expensive then they go to the government hospitals not so expensive affordable but it's affordable or probably free or comes with a disco so can you define that so what is affordable healthcare so we've defined inequity as the divide between the economics of the health services delivered so what is affordable affordable is something that will not drive you into financial catastrophe affordable is something that after getting sick I will not be very poor afterwards I will not I will still be able to pay the tuition fee of my children I'll be able to pay the rent of my whatever I maybe we can discuss to the viewers like some of the health systems in other countries like the Scandinavian countries or even the UK where there is a national health service as long as you're a citizen you will get healthier cover you are covered but from the time you're born to the time you are in the tomb you are covered by the government and if you need open-heart surgery the government will take yes so I think in in those countries they're very I mean they were ahead of us in interpreting it and we are not as you said fragmented as we are so they might be also subdivided but there is that centralized notion of if they give money you said single-payer or a pool of money a good percentage of that really goes to health such that if it's curative preventive everything all those sets of services will be delivered to the person's concerned so this passage of the universal health care law is like stamp of approval that the government does value health and life of its human of its people its population the fact that now they are creating a framework of a health system that is affordable and equitable to the Filipinos yes but it is a progressive okay so let's talk about progressive what services can be delivered as of now right like like now when I ask people about fill help fill health will cover only like 30 percent of your expenses when you're hospitalized and it doesn't cover your outpatient diagnostic and your outpatient care what changes with the law what change with the law is that I think the primary focus now I mean it's like educating the people at the same time deviate from the curative deviate from the massive treatment which as you know entails more cost for the government and for the people that's why out-of-pocket is also increasing so more on the primary health care services preventive science so this is part of the you know there's McD's we have the triple burden already of the disease so that's LCDs and non communicable diseases infectious diseases and of course the diseases of it we'll hope I hope it will also concentrate not only on primary health care but also on health promotion and prevention yes so maybe we can define that to the people so what is primary care what is health promotion what is primary prevention okay well we start first with primary health care I think that's the basis I think this was there long before this Alma help for all 1974 yes and so 2000 came and there was no help no help in equity in the whole world and if you get at the serous probably you would see that help for all universe out correct so that's still universal health care so it's I think just a rolling progressive thing but that primary health care never happened but for so many reasons of course it could be said that it creates jobs because if it's business driven you earn more money so it gives these corporations more money more jobs you create more jobs but the notion of universal health care is preventive so that you do not end up with a terminal illness and you get to catch the symptoms first so that's the primary that's why it's primary so secondary and tertiary you probably end up in a hospital getting control of course there are those cases as well but nipping it in the bud I think it's there so let me when the fil health law was created or the National Health Insurance Act of 1994 when it was created the fill help was designed so that it would take care of the people's hospitalization needs and that continued on but its support value or money was only a small proportion so the people still had to pay a lot for hospitalization what changes now because I think in the UHC law they're saying that Phil help will pay for consultation in the primary healthcare clinic and laboratory tests in the in the healthcare clinic what changes now and how will this be implemented as I said as long as you are Filipino you are covered and so patients when they come and they consult they have different illnesses so it could be terminal it could be chronic so it could be a primary element so Phil health as the financial arm of the universal health care would be able to deliver both kinds of services so the whole spectrum will primarily be its secondary and be it tertiary so the but the emphasis again it's in italicized words is primary so I'm also winning away the patients from thinking chronic because part of it is also a education and health promotion but in a subtle way delivering it through the financing part so I will not so they've now decided to focus on primary prevention and even secondary prevention yes if you have non communicable disease they prevent you have hypertension and make sure they control your hypertension so that you don't get a stroke or a heart attack and another key for that is the referral system so so it's like hospitals level three hospitals those are tertiary hospitals are for those with chronic illnesses so your barangay health station your rural health unit probably anything that is in the municipal area would be towards preventive and primary you describe to me how that will happen so I am thinking about a headache or a stomachache so you come to the house the first notion of a Pilipino is go to my doctor and yes very sure doctor and of the hospital in the hospital so that will be kind of remedy or tweak it will you will be referred back to where you are so something like that that you will be in that service delivery network that's how they term it where you belong and if you have gone there already you have this certification that you have been seen and of course if the Diagnostics show that you really indeed need tertiary care then that is the time that you will go so I think that that referral system that financing part is really tailored to go into preventive and you go if your chronic or terminal you go to the right mechanic shop if you're a car how does that work I have I have let's say diabetes I cannot go to my endocrinologist I have to go to a primary oh yes you have to go before a Marine Network referred to the endocrinology and the usual notion of course is where you live so what is near to you so where is your place of residence so everyone will have a service delivery network so that's very different from the way people access healthcare today because the way people access healthcare today's dr. Botha do you know anyone who is a good endocrinologist and then I referred them to the endocrinologist and they go straight to them so you mean that cannot happen anymore it can still happen if you can pay yes but fill help on that page I visited endocrinologist no no there is this slow education through that kind of setup that you will that doctor probably or that expense whatever consultation that was will not get the correct reimbursement or will not be reimbursed totally unless they will jump the queue the the referral system okay now I'll ask you we have a lack of doctors most of our doctors are specialists because I was in med school everybody wanted to become a specialist I'm a surgeon so it took me years of training to be governor but who will take care who where will we get the primary physicians or we call that Family and Community Medicine right so where are we going to get all this family physicians that will take care of a hundred million Filipinos it just not exists right now correct at this point so I as I said before it's a work in progress so the Department of Health I think is making talking to a primary care physicians building that network primary health care strengthening that so our schools produce the doctors I think there have been changes in the curriculum now to orient our medical not like the ones we did before wherein you enter school and of course after medical school enter into a residency program where you are expected to become a specialist correct now so our country our Filipinos are have a certain discrimination toward the generalist and primary care they prefer to feed the special if it is early because the thinking is especially it is good because they had more years of training and that is a mindset that needs to be changed because my friends from the UK they cannot access a specialist without going to their assigned GP they call it in the UK GP GP actually is a general general practitioner but they can diagnose and without this referral without is gatekeeping you cannot access an orthopedic surgeon and endocrinology is a surgeon like me and we don't have that yet now yeah so how do we build that that's the big question so it's a work in progress as I've told you the Department of Health right now is trying to beef up its primary health care approach starting with cos the universities the universities who produce the health professionals and orient them into more family community approaches primary health care how of course by changing the curriculum of course in the University of the Philippines we have talks already of changing the curriculum and you know that and in the College of Medicine where I teach yes the goal is community oriented medical education yes so this is not the curriculum where we were oriented to before so but it as I said it will not happen overnight correct and so the education would begin with the educators who are the doctors facing the so the University and the other medical schools have a big role to play yes in shifting the focus of the young doctors the medical students to understand universal health care systems and primary care systems because they are the first ones to have contact with the patients so I think they also play a role in being educators to the patient on how to shift that mindset that if I have a stomachache or a headache I should go to my specialist doctor in the hospital but but you know I'll tell you that that was very hard because as a medical student when the person that came in to lecture in our class was a surgeon he was driving a mercedes-benz he was wearing a nice signature tie and signature belt and shoes so I said I want to be like him you know he has lots of money then the person from family and community medicine would enter and he was wore wearing jeans and t-shirt his hair was scruffy so he didn't epitomize a model that I wanted to be as a doctor how can we shift that role modeling for our young people I guess we have to go back to the basics our model doctor is a believer see result was a result I think didn't care for Mercedes Benz didn't care for but he trained in Germany but there was no nothing at that point during that time so I think the model would be service business yes you can still get into residency yes you can still be a specialist but sir and and observe the countryside first serve this community where primary health care is supposed to be delivered so actually I'll second your motion because I became a surgeon and I started operating in remote villages and the gratification is actually great in fact I'm flying off to Mindanao again in a couple of days to do free surgical mission to offer it to the people who have no access to specialists so I think there's a gratification as well to being what you're describing and it is just not communicated to the medicals that that offering of service to the poor and because the mindset is just like an internship you get to rotate all to all disciplines now you get to rotate to the countryside yes and then choose your residence if you still would like to go into family medicine or a specialist like a cardiologist so but that is I'm stating it very fast but actually it's a yearly it's a slow progress so from the University to the doctors out there practice out their practice to the patient patient now knows the referral system I think it will come in phases before you will really know the notion that's right it's very simple when we pass the law and there is more money in the health system our government hospitals became more overcrowded because every Filipino with or without fill health can now go to the hospital and access health services because before they will not go I would see patients in the ER and I would ask them why didn't you go um to the ER last week when you were feeling but I didn't have money but now money is no longer an issue because there is provided for that they cannot be denied health care and strengthening the local health system before you go to the hospital okay so now you've described the word the word is health system we've talked about manpower and professionalizing creating more GPS and family physicians and community doctors so that's going to be a struggle the university has a role in that so let's talk about the health system what will be the role of the Department of Health the role of the local government hospitals the low role of medical centers or what I call Apex hospitals how will the whole architecture look like because it's a fragmented system they will now create near-perfect networks to deliver this because it's so many fragments a word move near perfect I can say it's perfect its near perfect so it's still a work in progress as we go on so under the universal health care law there will be served delivery being made effective in the local health system a local health system as they defined it in the implementation sites would be composed of of course the barangay health stations the municipal health office the provincial health office with a tie-up with either the district hospital the provincial health hospital acting as the part answering for the therapeutic treatment part while that local where you will begin your navigation should be the primary health care so you cannot go directly to the hospital without being cleared first by your either your municipal health officer your rural head position your public health associates there it's a team that is really focused on primary health care before going there so you could have a terminal illness but still you would probably be seen first in that primary health care setting before being ever I see that as implementable and doable in the public health system in the government but our health care system is also composed of the private sector and the private sector attracts paying people that will jump the gun we they pride themselves off specialist expensive tests that you you know they have they advertised their new CT scan the new PET scan the latest ultrasound so how do we that is the line changes device that is the mindset that we're trying to break and educate the people we so you said that in the Constitution health is a human right and the universal health care law tries to guarantee that but with that comes also the education that they should be involved in the decision-making of their own health so it should begin again in the primary setting so how do you how do you say that the marketing of the first class CT scan it doesn't necessarily translate into getting well so so I think it should be the doctor underneath it's advertising it's marketing it's basically saying we have the best and most modern machine so it doesn't translate to better healthcare for in trying to win that perspective the Department of Health I think will try or is already trying to shake hands with the private sector so they're trying now to involve even those physicians with private practices so you're probably a rich physician coming from a rich family so you have this family-owned clinic you will also be accorded that offer to join that network because that is the network that is composed both of the public and the private so the network will be a geographic network and people will will be both the public hospitals and private sector hospitals should be inclusive yes and they know and they know the navigation system and they know the network so if you are the one with all the superb technology you will say hey did you go with the rural help unit first for the baronial station because you'd probably do not need this tests so that is the AVL notion of how the navigation and the network should work so that's a local health system a local health apex hospital with different spokes of hub and spokes model yes so yeah but the periphery primary health care and then they refer to an apex or the either the private or the medical center public medical center to provide tertiary care but you have to help them also learn that tertiary is different from primary so that the not because there is this CT scan that a CT scan will not heal the headache so yes but it will entail more experience and in that it does not necessarily translate that if you shall out big money you get cured correct so we're trying to to improve on that mindset and tell these people that have health literacy health literacy another and I think we need to discuss not an overnight thing grass that color will happen because we have to make our people literate about what is vital in healthcare and what is just an icing on the cake yes but I see me probably 20 years from now it is really a very very good system functioning and this universal health care law which we started now as a as a happy ending I have a few minutes left and I'd like to ask you about issues and concerns about this nice picture that you're painting going to this attainment of universal health care I think we will have many bumps because the way you describe it is we have human capital development - do we have health systems and buy improvement - do we have education and we need primary care and we need health promotion and it's a lot of work and as an asymmetry and what I call an asymmetry of information of what it really is what universal health care law so what is asymmetry of information and not not there is an imbalance of what the patient knows and what the doctor knows so there is also an imbalance of what the Department of Health tries to say and what the patient knows it is always the patient because that is our client who should know what it is really so and the second part is the governance part the the ones in the law first we need to put the patient in the center of the system yes so he is he is the one being served by the system yes we must be able to address his needs and must be able to make him satisfied yes and the second one is the the leadership and governance part of the health system so these are in the local government heads so they are very very vital partners they are not doctors or some probably are doctors and that makes it easier for them to implement UHC I call that leadership and governance leadership and units next part is really making sure that these systems they don't work by themselves yes they must be led and they must have a governance system that is not corrupt that is not that is efficient that is efficient very ideal yes and another I think missed point is health information so health information I did not see it in the highlights in yeah even in the law I did not see it being highlighted like service liberty leadership I'm talking about health information digital health or are you talking about a centralized system even knowledge management knowledge mouth is probably the better term so a knowledge management in that local health system such that the mayor who probably is not health oriented it's not a doctor would probably be able to allocate his resources or her resources more efficiently towards the end goal I know what you're talking about because I've seen this with my classmate who studied in Canada because Canada has this Ottawa rules on me play brave head injury rules so who goes to the next excellent of care is decided by evidence-based guidelines and helps the primary care physician and we need to develop those because we cannot get the Canadian and apply it in the Philippine health system but if you don't have an information infrastructure it will you know when you you mean you decide when you make a decision especially this Authority you need good information you cannot decide just on a whim so you cannot decide just because that person voted for me it's not a good decision so you need updated reliable information and that is electronic probably so that it would be better so that is the part that will also help health promotion health education navigating the system making it work from primary health care to the tertiary level of care very interesting any final words to our viewers out there about universal health care we will hold your hand but bear with us I am from a khadeem so bear with us in the education part this will be made perfect soon well with that I'd like to thank you all for covering health issues and concerns regarding the universal health care law it seems this is work in progress we continue to strive for and achieve universal health care for all Filipinos and we do hope that this law will succeed and will benefit each and every Filipino out there maraming salamat goodbye and thank you very much [Music]

Channel: TVUP

Views: 6,939

Rating: 4.8425198 out of 5

Keywords: tvup, university of the philippines, health, health issues, health policies, teddy herbosa, herbosa, teodoro herbosa, up manila, college of medicine, up college of medicine, universal health care, health care system, faraon, emerito jose faraon, uhc

Id: T5T9vAG16JA

Length: 37min 8sec (2228 seconds)

Published: Mon Mar 02 2020