Universal healthcare minus the spin

If physicians don’t appear as angry or noisy as other groups of people who love our country, it is not because we are indifferent. Many of us are also among the walking wounded.  And given the nature of our work, we feel the pain of betrayal, not just from flood control projects but from our healthcare system as well. We are the ground troops. We know the truth.  But we need to rise above our pain for the sake of our patients who are ailing and come to us for healing.

One source of dismay is when we hear unsubstantiated claims that paint a deceptively rosy picture of the state of our healthcare system.

I was recently asked to be a resource person at a roundtable discussion organized by a prestigious school of government. The reason for the gathering was the President’s statement that “our country has achieved 80% of universal healthcare (UHC).” Those in the know were generally agape upon hearing this because we are in touch with reality.  None of those in the group knew what this statement meant.

Did it refer to the percentage of Filipinos enrolled in PhilHealth? Did it refer to the zero balance billing system being practiced in Department of Health (DoH)-retained and select government hospitals?  Certainly it could not refer to the overall goals of UHC, where out-of-pocket expenses of private patients admitted to healthcare Institutions would be reduced to 20-30% as a general rule, and where all Filipinos would have access to out-patient primary healthcare clinics of their choice for free annual check-ups, tests and free basic maintenance medication.

The statement could not possibly mean that 80% of Filipinos already have access to a primary healthcare provider who helps each Filipino navigate the healthcare system, refers patients to integrated hospitals if necessary and then resumes care of the patient after the hospital treatment. It also cannot mean that 80% of Filipinos have access to community-based palliative care.

And surely it cannot mean that the government has allocated at least 80% of the funds that should be given to PhilHealth and the DoH in accordance with law. Nothing could be further from the truth.

To be fair, almost all DoH hospitals, including its four specialty hospitals, practice zero balance billing for patients admitted to basic or ward accommodation. The Philippine General Hospital (PGH) also does the same. But DoH hospitals make up only 6.2% of the total number of hospitals.  All other government hospitals combined make up only 24% of all hospitals, while private hospitals make up 69.8% of the 1,498 hospitals, based on PhilHealth data. And while the law states that government hospitals should have no less than 90% of beds for zero balance billing patients and private hospitals should have no less than 10% of their beds dedicated to these patients, this does not really happen. Then there are the 9,025 nonhospital health facilities, most of which are private. The math alone will show that zero balance billing in DoH hospitals does not translate to 80% of UHC.

Among private hospitals, co-pay can range from 50% to 70% of the total bill. Sometimes it is even more, depending on the illness. Why is co-pay so high? While most large private hospitals are for profit, most of the small hospitals have to charge considerable co-pay for survival. While contentious, the Private Hospital Association of the Philippines, Inc. reported that as of January 2025, PhilHealth had owed private hospitals P4 billion to P6 billion. Without charging co-pay, many of these hospitals would close. As things stand, it is difficult for some hospitals to pay salaries and maintain equipment. And while PhilHealth has expanded benefits despite the defunding by the government, there are still a lot of vital ancillary procedures and tests that they don’t cover.

Our DoH hospitals were forced to do good, so to speak. They have to offer zero balance billing. But even the most stable of them are worried about sustainability.

Because PhilHealth does not pay for many ancillary procedures, the hospitals have to depend on PCSO (Philippine Charity Sweepstakes Office), Malasakit Centers and the MAIFIP (Medical Assistance for Indigent and Financially Incapacitated Patients) from politicians to make ends meet. MAIFIP is dependent on patronage, and thus can be removed at a whim.

This pervasive use of healthcare for patronage is something the UHC Act had hoped to eliminate. We should not have to beg for or be held hostage by politics for healthcare. But this is what is happening, especially in many provincial and local government unit hospitals where true zero balance billing might be possible for a kaalyado but not for hindi kaalyado. Among the saddest sights are sick people and relatives lining up for financial help from the MAIFIP of politicians, when true UHC means access to healthcare regardless of political affiliation. 

Then there is primary healthcare. We are happy that thousands of YAKAP clinics have sprouted up around the country.  But while there are many good YAKAP clinics, we are alarmed that the system is being abused by unscrupulous players and some politicians who have found a way to monetize the program through ghost patients and fee splitting, leaving our people with substandard or no services at all.  Just like flood control scams, these can run to tens of billions of pesos a year. PhilHealth is addressing this now, and we hope they can nip the scams in the bud.

Have we achieved 80% of UHC? Certainly not. But we can get there. Let’s fund PhilHealth fully in accordance with law. Transfer most of the billions in MAIFIP to PhilHealth so that services can be expanded minus the patronage. Hold people accountable for PhilHealth scams and anomalous infrastructure and procurement projects in the DoH. Imagine the legitimate health needs these stolen or wasted billions could provide! Improve communication so that our people understand their health rights and what red flags to look for.

Spin doctors will not deliver UHC. Integrity, transparency, accountability and hard work will.

Ma. Dominga “Minguita” Padilla is an ophthalmologist, a long-time health reform advocate and social media personality. She is the founding president of the Eye Bank Foundation of the Philippines and served as head executive staff of PhilHealth from 2015 to 2016. She is a recipient of multiple awards for her work in prevention of blindness, community service and curbing health insurance fraud.