Critique on Ubial-DOH's 2017 Budget Proposal: Designed Far from the Cuban Health System

All for Health, Health for All: New Name, Old Game
A critique on the Department of Health 2017 budget proposal

September 14, 2016

“All for Health towards Health for All” is the new tagline of the Department of Health (DOH) under the Duterte administration. The Duterte Health Agenda intends of providing accessible healthcare to Filipinos.But instead of implementing much-needed changes that point to a more pro-people direction, the 2017 health budget proposal reveals a profit-centered system that neglects the immediate and important health needs of the Filipino people.

The “over-all strategic thrust” according the Health Secretary Ubial is to bring key stakeholders together to improve “access to health services” and reduce “out-of-pocket costs.” PhilHealth and partnerships with private institutions has been failing to achieve this goal during the past decade. The Philippines instead saw increased healthcare costs and diminishing services for the poor and indigent. “Health for all” shall remain a fantasy as the policies remain profit centered and income oriented.

The hospital budget cuts and the strong endorsement of PhilHealth reflect the previous administration’s policies geared towards turning public healthcare into a private enterprise, while pretending to increase the budget for the poor and indigent through PhilHealth.

This position paper exposes DOH Secretary Ubial’s deception through comparisons with previous administrations and their failure to achieve “Universal Health Care” by implementing the same strategies.The paper also shows how public healthcare system will worsen through implementation of same policiesand decreasing public funds. President Duterte has also expressed interest in adopting the Cuban healthcare system. Thus, this paper explores how the 2017 proposal, reflective of the supposedly “new” health agenda, is not aligned with Cuba's revolutionary healthcare system.

Same programs, less funds

The budget for Maintenance and Other Operating Expenses (MOOE) for the 72 DOH hospitals decreased by more than half (51%: P74.4 billion in 2016 to P38 billion in 2017). MOOE is used for medical supplies, medicine, laboratory supplies, utilities and other needs. In addition, budget for Capital Outlay and Health Facilities Enhancement Program (HFEP) also decreased in the 12 DOH specialty hospitals and the 54 regional hospitals.

The decreased budget for MOOE in specific DOH hospitals show a clearer picture on what happens at service levels. Southern Philippines Medical Center, located in Davao region and home to President Rodrigo Duterte, will also suffer budget cuts of around P225 million (2016 MOOE GAA of P357 million to 2017 MOOE NEP of P132 million). Davao is known for their thrust in providing free and direct health services to its citizens. The huge decrease in their budget would greatly affect Davao’s success in providing free and direct health services to its people.

One of the biggest allocations on the 2017 health budget goes to HFEP (15.5%, P21 billion), which is reserved for the maintenance of facilities and infrastructure. It started at around P1 billion under the Arroyo administration and ballooned to more than P26.8 billion under the Aquino administration. Yet after more than P80 billion total spending on HFEP, neither the Arroyo nor the Aquino regimes has shown that the program has succeeded.

Meanwhile, budget for Barangay Health Stations (BHS) for 2017 is zero. DOH has failed to recognize the importance of providing basic healthcare services at the grassroots level.

This trend of decreased hospital budgets in the 72 DOH hospitals, comprised of 12 specialty hospitals and 60 regional hospitals and GOCCs, has led to increased prices of hospital services, medicine, hospital stays, laboratory fees, etc. Some hospitals even have comforts rooms for a fee.

The decreased funds also affect human resource programs. Doctors to the Barrios (DTTB), the main health resource program of DOH, has been in existence for 24 years, yet the budget was decreased in the 2017 NEP. Under DTTB, doctors are hired as contractuals instead of filling plantilla positions. For 2 years, doctors are sent to rural health units that lack medicine, utilities, and laboratory equipment.

Nurses also suffer the same fate under the Nurse Deployment Program. They work full time as community health nurses but are not recognized as employed but as nurses undergoing “training and development.”They have no benefits, and salaries subjected to tax are often delayed from 2 to 3 months. Contracts must be renewed every 6 months.

PhilHealth as a business enterprise

Increased PhilHealth budget and coverage does not translate to actual services rendered. Based on the 2013 data by the Philippine Statistics Authority, PhilHealth accounts for only 11.5% of the total health expenditure based on a patient’s source of funds. Meanwhile, health expenditure from private sources including out-of-pocket, private insurance, and health maintenance organizations is at 68.2%. Despite the increased PhilHealth budget over the years, the bulk of healthcare expenditure still comes from patients.

In addition, 65% of PhilHealth accredited hospitals are private institutions. With their more expensive rates than public hospitals, private institutions would benefit more from the P50.1 billion PhilHealth budget for 2017. The budget should instead be transferred on MOOE and other direct and point-of-care services and in the development and improvement of government hospitals and facilities. 

Health Secretary Ubial’s strong endorsement of PhilHealth as an answer to the health needs of the Filipinos will fail miserably as it continued to do so during the previous administrations. The concept of social health insurance as a solution to our health problems is absurd, as though much of the problems are only about health financing. Such flawed concept has resulted in the persistent dependence on PhilHealth as a silver bullet, a cure-for-all.
In reality, PhilHealth as an insurance system is a business enterprise. It serves the interest of businessmen, other private entities, and for-profit organizations instead of the majority of the Filipinos who lack access to quality healthcare. PhilHealth is not suited to the social conditions of the country; the increased PhilHealth budget is useless when there is lack of available health facilities, medicine, equipment and more importantly, healthcare providers.

Cuban healthcare system

The Cuban healthcare system is a product of their socialist revolution. Cuba has seen the need for accessible and quality healthcare and used this as motivation to achieve their efficient, strong public healthcare system that is free, people-centered, innovative and technologically advanced. Their citizens are greatly involved and understand the importance of a healthy populace, which mainly fuels their economy under US embargo and despite their economic disadvantage compared with their South American neighbors. 

In Cuba, healthcare coverage is at 99%. There is no national insurance system like PhilHealth, and health services go direct into their public healthcare facilities, which comprises 99% of their whole healthcare delivery system. Preventive medicine is given higher priority in Cuba, whereas PhilHealth focuses on hospital treatments and intervention. Doctor to patient ratio in Cuba is at 1:1,057; in the Philippines, this ratio is at 1:33,000.

Secretary Ubial recently stated that to copy Cuba’s healthcare system, we need only additional doctors and a 400% increase in health budget. This analysis is shallow and short sighted. To attain a healthcare system similar to that of Cuba, the public healthcare system must be strengthened. Access and quality of health services must be close to ideal standards even at the grass roots level. Budget must be poured on poorer communities and rural health units, providing more access to direct, point-of-care services to every Filipino. Filipinos must be entitled to free healthcare regardless of PhilHealth coverage.

We cannot achieve this type of healthcare under a capitalist system where profits are given priority instead of the overall health and well-being of the country. We cannot achieve universal healthcare if the policies being implemented are directed to the privatization and corporatization of health.

Clearly, the DOH’s recent visit to Cuba has no effect on the policies being implemented. To achieve a healthcare system such as in Cuba, the Duterte Health Agenda needs to abandon the neoliberal policies of privatization, corporatization and contractualization that only guarantee income to private institutions. The Duterte Health Agenda instead needs to guarantee the development of a strong public healthcare system that understands and addresses fully the needs of the Filipino people.

Alternatives

Priority should be given to the public healthcare system. Additional budget, equivalent to 5% of Gross Domestic Product as recommended by WHO, must be allocated to establish a free, comprehensive and progressive healthcare.

Free: Health is a fundamental human right; therefore, quality healthcare must be accessible to all Filipinos with no payment at point of service. As a social service, health must be provided free to all working class and indigents, no questions asked whether you have a PhilHealth card or health insurance. Budget must be allocated directly in hospitals and barangay health stations to ensure adequate medical equipment, medicine, maintenance of facilities, etc. Health professionals must be compensated well and they should understand well the importance of their work as part of working towards a comprehensive healthcare system.

Comprehensive: It should be comprehensive as to foster the complete physical, mental and social well-being of Filipinos; budget must be allocated to prioritize and ensure preventive care and primary healthcare. Health education is an important part in achieving a comprehensive healthcare system, which would provide every Filipino access to necessary health information.

Lastly, it should be progressive: the people should be at the core of government policies on health and should be based on the needs of the people. Sustained development and research must be pursued; the health budget must support the development of our own drug industry that will provide cheap and quality essential medicine. Health policies and programs designed to promote the highest level of health of the people must be adopted and given attention.

Conclusion

Health Secretary Ubial claims that there will be no privatization, but the budget cuts show otherwise. Public hospitals are forced to tie up with private healthcare institutions to increase revenues for maintenance of utilities and equipment. Moreover, Health Secretary Ubial pushes for corporatization of hospitals. This will double healthcare costs, result in lesser accessibility of health services to the poor, deterioration of health facilities and equipment, and neglect for indigent patients.

The Duterte administration promised change to come, but under present circumstances, we see that the policies being implemented by DOH is the same as the previous administrations. Worse, the 2017 budget cuts allow the smooth transition of the Philippine healthcare system from public healthcare into a for-profit private enterprise.

The 2017 health budget cuts are in line with neoliberal policies of privatization and corporatization of health services. These in turn are part of the larger scheme by international monopoly capitalists to turn healthcare into a commodity where international markets can profit. Through various trade agreements and institutions such as the IMF-WB (International Monetary Fund–World Bank), it aims to serve foreign private interests as well as local private institutions instead of the majority of Filipinos.

With the “Universal Healthcare System” at its helm in the form of health insurance, these policies have taken the Philippine healthcare system nowhere. Maternal mortality remained high. Highly preventable and curable communicable diseases are still major causes of death. Access of Filipinos to healthcare remainslow.

Meanwhile, the prevalence of contractualization in health practice and the DOH’s failure to fill plantilla positions in hospitals and rural health units result in poor working conditions and exploitation of health professionals and workers.

The outright abuse of health worker’s rights does not help address the health needs of the Filipino people. Overworked and underpaid doctors, nurses and other healthcare practitioners strive to make ends meet, and these conditions push them to go abroad for better opportunities. The Philippines is in dire need of health workers, yet the government has no effort to ensure their well-being.

The neoliberal policies of privatization, corporatization and contractualization must stop. We cannot achieve a strong public healthcare system under a capitalist framework. The Duterte Health Agenda must let go of neoliberal policies and adopt a more pro-people public healthcare delivery system. Additional budget must be allocated to ensure a free, comprehensive and progressive healthcare system.

No to neoliberal impositions on health!

No to budget cuts!

Increase health budget for direct services!
No to privatization and corporatization!
No to contractualization of health workers!