The Universal Health Care (UHC) Act promised Filipinos broader access to healthcare services, but many continue to shoulder significant out-of-pocket expenses for medical treatment, a sign that major gaps remain in the country’s healthcare system, according to health systems researcher Dr. Vencient Pepito.
Speaking at a forum on the country’s healthcare system, Pepito said the law, signed in 2019, has yet to be fully felt by many Filipinos.
‘The reality of our healthcare system in the country is that despite the law, patients continue to shoulder significant out-of-pocket expenses for medical treatment,’ he said.
Pepito and his research team conducted key informant interviews and focus group discussions with officials from the Department of Health (DOH) and Philippine Health Insurance Corp. (PhilHealth), local government implementers, healthcare facility administrators and providers, as well as patients.
Using the World Health Organization’s six health-system building blocks-governance and leadership, health information systems, health financing, service delivery, the health workforce, and medicines and technologies-the research identified several barriers to implementing UHC.
A system divided
One of the biggest challenges is the devolution of health services to local government units (LGUs), which has contributed to a fragmented health system.
Pepito said UHC cannot be implemented consistently across the country when national and local governments, as well as public and private healthcare providers, operate without sufficient technical, managerial and financial integration.
Local political dynamics can further complicate implementation, particularly when provincial governors and municipal mayors do not see eye to eye.
Pepito also said health can receive less political attention than highly visible infrastructure projects because the benefits of health programs are often less immediately apparent to voters.
‘Health is not a priority,’ he said, noting that roads, infrastructure and other projects tend to be more visible.
The research also identified procurement problems that can contribute to shortages of medicines, equipment and other supplies.
Meanwhile, some private-sector providers remain reluctant to participate in UHC because of concerns over profitability, compliance requirements and possible penalties.
Too few hands, too many roles
The shortage and maldistribution of healthcare professionals represent another major obstacle.
Pepito said many doctors, nurses and other healthcare professionals are concentrated in Metro Manila, leaving provinces and geographically isolated areas underserved.
Healthcare professionals are also not always adequately prepared for the administrative, procurement and management responsibilities required under a devolved UHC system, he said.
LGUs face constraints in hiring additional health workers, while existing personnel are often required to perform multiple functions without additional compensation.
‘These caps prevent them from hiring additional human resources for health,’ Pepito said, describing situations in which nurses are assigned additional administrative or records-related duties.
When the money doesn’t follow the patient
Financing remains another challenge, with health often receiving a limited share of local government budgets.
Pepito also cited concerns over PhilHealth reimbursement rates, claims processing and delays, as well as the difficulty of keeping reimbursement packages aligned with rising medical costs.
For some private providers, the cost of training personnel and complying with accreditation requirements can exceed the revenues generated from primary care services.
These financial pressures can discourage private-sector participation in UHC, despite the sector’s significant role in delivering healthcare services in the Philippines.
Making information move with patients
Fragmented health information systems are another major problem.
Government health information platforms are not always interoperable, meaning patient information does not necessarily follow a patient when he or she moves from primary care to a hospital or from one locality to another.
As a result, patients may have to repeatedly provide their medical history and undergo the same information-gathering process.
‘What we want is the data flows with the patient,’ Pepito said.
Improving interoperability could bring significant benefits, he said, although concerns involving data privacy, cybersecurity, technology and the readiness of health workers must also be addressed.
Self-care, but not self-treatment
While systemic reforms are essential, Pepito also emphasized that individuals have a role to play in easing the burden on an already stretched healthcare system.
For him, responsible self-care is not about managing illnesses without professional help. Rather, it involves practices that promote well-being, prevent avoidable illness and do not interfere with appropriate medical treatment.
This becomes particularly relevant when people use traditional, complementary or alternative health practices. While some may be beneficial, others can potentially interact with conventional medicines or treatments.
The goal, Pepito said, is not to replace professional medical care but to encourage people to take greater responsibility for their health and make informed choices about when and how to seek care.
‘Taking care of ourselves’ is particularly important because ‘it’s still so expensive to get sick here in the Philippines,’ he said.
He urged Filipinos to pay closer attention to their diet, lifestyle and everyday health practices.
UHC as a shared responsibility
Pepito stressed, however, that responsible self-care cannot substitute for reforms in the healthcare system.
Several initiatives could help strengthen UHC, including reforms introduced during the Covid-19 pandemic, changes in health-professions education, improvements in health financing and procurement, and efforts to strengthen local health governance.
The Commission on Higher Education, for instance, has moved to reorient health-professions education toward UHC, while reforms in procurement and the Special Health Fund are intended to improve the financing and delivery of health services.
PhilHealth has also evolved its primary-care benefit program from Consulta to the current YAKAP (Yamang Kalusugan) program, which Pepito described as a potentially positive step toward encouraging Filipinos to undergo regular checkups and avail themselves of primary-care services.
Ultimately, UHC requires the participation of government, healthcare providers, communities and individual Filipinos.
Pepito said Filipinos should not view UHC simply as free healthcare. Rather, it is a system based on shared responsibility-including paying health insurance premiums, using health services appropriately, advocating for accountability and protecting public health resources from misuse.
For individuals, that responsibility also means taking steps to stay healthy and seeking appropriate medical care when needed.
‘UHC-we all have a role to play,’ Pepito said. ‘Universal health coverage in the end is based on shared responsibility.’